As the topic of radiation safety across various interventional specialties continues to garner increased interest, Melissa Kirkwood (Dallas, USA) homes in on the under-recognised issue of clinician hand exposure during these procedures.
For neurointerventionists, fluoroscopy is essential to guiding complex procedures. Yet, the imaging that supports patient care also exposes operators to significant scatter radiation. Protecting clinicians from this occupational exposure is therefore an important part of practice in the interventional suite.
Radiation can cause two types of harm: deterministic effects, typically cataract development in operators, and stochastic effects, including cancer. Both forms of injury are two-to-three times more likely in interventionists than in the general population because of occupational exposure. These risks underline the importance of reducing exposure throughout every procedure.
Standard practice follows ‘as low as reasonably achievable’ (ALARA). This means applying the principles of time, distance and shielding to limit radiation exposure. A 0.5mm lead apron and thyroid collar are recommended for interventionists, but additional protection should also be considered—particularly during complex procedures.
Our published research has shown that adding lead arm sleeves and leg wraps can significantly decrease exposure and operator risk.1,2 Additionally, a recent multi-society consensus document published in the Journal of the Society for Cardiovascular Angiography & Interventions raises the standard of care by recommending enhanced radiation protection devices for all interventional rooms.3
Even with these measures, the operator’s hands remain unprotected. For clinicians manipulating wires, catheters and other devices close to the imaging field, hand protection deserves particular attention. Placing hands directly in the X-ray beam during fluoroscopically guided interventions is contraindicated. However, this is sometimes unavoidable and may happen more often than operators realise.
The role of protective gloves remains debated. The 2023 European clinical practice guidelines on radiation safety recommend against radiation protection gloves—a class III recommendation supported by level C evidence—because of concerns about increased scatter radiation.4 We therefore sought to answer a practical question: can tungsten protective gloves reduce hand radiation dose without increasing scatter dose to the operator?
We conducted a prospective clinical trial involving 50 fluoroscopically guided interventions: 25 using tungsten protective gloves and 25 using regular surgical gloves. Optically stimulated luminescence detectors were placed at matching locations on both hands, with control detectors positioned over the sternum.
We found that hand radiation dose was significantly lower with protective gloves than with regular gloves, with no increase in scatter dose measured at the operator’s sternum. These findings were corroborated by a phantom study, in which protective gloves reduced hand dose by 58%—again, without increasing scatter dose to the operator.5
Best practice remains to keep the interventionist’s hands out of, and away from, the X-ray beam. However, certain cases cannot be completed without hands entering or approaching it. In these circumstances, wearing protective gloves protects the hands without increasing radiation dose to the body.
These findings bring hand protection into the wider discussion about occupational radiation safety. Gloves should sit alongside the established principles of time, distance and shielding within procedural planning. Given the increased risk of certain cancers associated with occupational exposure, it seems prudent to use all available forms of protection to limit exposure and protect the clinicians delivering these procedures throughout their careers.
References:
- Ramanan B, Pizano A, Solano A et al. The addition of a leaded arm sleeve to leaded aprons further decreases operator upper outer quadrant chest wall radiation dose during fluoroscopically guided interventions. J Vasc Surg. 2024; 79(4): 948–53.
- Ramanan B, Pizano A, Timaran C H et al. Operator Lower Leg Radiation Dose during Fluoroscopically Guided Interventions is Effectively Reduced by Wearing Lead-Equivalent Leg Wraps. Ann Vasc Surg. 2023; 89: 161–5.
- Rizik D G, Sutton N R, Lansky A J et al. SCAI/ASE/HRS/SIR/SVS Expert Consensus Statement on Enhanced Radiation Protection: Time for Mandatory and Urgent Action. JSCAI. 2026; 5(8): 105455.
- Modarai B, Haulon S, Ainsbury E et al. Editor’s choice – European Society for Vascular Surgery (ESVS) 2023 clinical practice guidelines on radiation safety. Eur J Vasc Endovasc Surg. 2023; 65(2): 171–222.
- Salono A, Klein A, Siah M C et al. The use of radiation protective surgical gloves reduces hand radiation exposure without increasing operator radiation dose during fluoroscopically guided interventions. J Vasc Surg. 2025; 82(3): 875–81.
Melissa Kirkwood is a professor and chief of the Department of Surgery’s Division of Vascular Surgery at the University of Texas (UT) Southwestern Medical Center in Dallas, USA.
The author disclosed that they are a consultant and scientific advisory board member for W L Gore, consultant and scientific advisory board for Mölnlycke Health Care, and founder and consultant for BOLD shield.
