Editor's Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety

The past two decades have witnessed an exponential rise in the number of Xray guided minimally invasive procedures in vascular surgery. With time, many of these endovascular procedures have been validated and have established themselves as the preferred treatment modality based on lower morbidity, mortality, and reduced length of hospital stay, compared with the open surgical alternatives. A large proportion of all vascular interventions are now performed using Xray guided endovascular techniques. Advances in technical expertise, evolving materials technology, and improved imaging capabilities have led to increasingly complex endovascular solutions which are associated with prolonged fluoroscopy times and consequently a rise in radiation exposure to both the patient and the endovascular operating team. There is growing concern regarding the increasing radiation exposure to the patient, and to the whole endovascular team. Endovascular operators are key personnel for promoting radiation safety and should work with other key stakeholders in a team approach to protect the patient and all healthcare staff in the endovascular operating room. The risks of radiation exposure are not universally recognised by all, however, because of a poor understanding of key concepts and paucity of educational material directly relevant to vascular surgery. The present guidelines on the subject of radiation safety are the first to be written under the auspices of a vascular surgical society. Their explicit aim is to inform the reader about radiation physics and radiation dosimetry, raising awareness of the risks of ionising radiation and describing the methods available to protect against radiation exposure. Key issues of relevance to radiation protection for endovascular operators and all allied personnel have been outlined, and recommendations provided for best practice. This will no doubt also result in better radiation protection for the patient but a focus on patient radiation protection has been reserved, including during diagnostic procedures that require radiation exposure, for future iterations of the guideline.

The guideline was written and approved by 14 members who, as well as vascular surgeons and interventional radiologists, included a radiation protection scientist and a medical physicist. The collated work is based on the best available evidence but also relies on the expert opinion of the aforementioned individuals who, as part of the process of gathering the evidence, identified several areas where future studies would better guide opinion. The reader should note that this document offers guidance and does not aim to dictate standards of care.