We would like to thank Dr Patelis for his relevant comments regarding the worrying issue of long term occupational exposure.
1We definitely agree that it is the real question lying behind all the recent literature regarding radiation. By law in France, staff are supposed to be trained, monitored, and adequately equipped against radiation. This is the institution's responsibility. On an individual basis, every operator has the moral responsibility of justification and optimisation. Justification questions the indication. Optimisation requires awareness, experience, and caring for the team. It seems paramount that the operator should be in charge of the radioprotection approach, as the ethics acceptance of staff radiation exposure requires the daily application of all these rules.
- Patelis N.
Re “The elephant in the operating room”.
Eur J Vasc Endovasc Surg. 2021; 61: 165
As we are trying to answer the question of “ethics in occupational exposure”, it seems mandatory to define dose reference levels to discriminate the reasonable from the non-reasonable. Large and multicentre registries are needed to define such levels. One could imagine that in the near future, radiation dose would be a criterion of quality of care as part of a textbook outcome.
Meanwhile, there is a tremendous gap between theory and real life. This gap is even larger in non-elective procedures, where junior surgeons are the most exposed. It raises the question of the right balance between risk and training. Obviously, simulation in endovascular procedures is still not sufficiently integrated into vascular training programmes.
However, the youngest generation of vascular surgeons has been raised with the “shields up” spirit. In many teams, the youngest are the most aware of the danger of radiation and therefore more respectful for the rules. In a way, the young community has taken the lead on this issue involving their own future, as they did for climate change. The reduction of occupational exposure will come with their innovative ideas and technologies.
- Re “The elephant in the operating room”.Eur J Vasc Endovasc Surg. 2021; 61: 165
Published online: December 08, 2020
Accepted: October 20, 2020
Received: September 22, 2020
© 2020 European Society for Vascular Surgery. Published by Elsevier B.V.
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- Response to “Re The Elephant in the Operating Room”European Journal of Vascular and Endovascular SurgeryVol. 61Issue 1
- PreviewWe thank Dr Patelis for his thought provoking letter. The risk of working with radiation is evident but still largely uncertain. There is no “radiation free” option for most specialists, certainly not for residents who are young and require great exposure in a short period of time, but also for nurses and anaesthetists. In short, we are compelled to put ourselves in harm's way to do our job. With the endovascular revolution, our practice now takes place in a dangerous environment, a fact that must be acknowledged.
- Re “The Elephant in the Operating Room”European Journal of Vascular and Endovascular SurgeryVol. 61Issue 1
- PreviewI read the work by Massiot et al.1 and the commentary by Gonçalves and Chakfé2 with great interest. Technology has provided us with high resolution imaging equipment allowing us to perform demanding procedures at a fraction of the exposure of older devices. In most centres, low dose protocols and radiation safety training are already in place. However, daily exposure to radiation should not be underestimated as its cumulative effects could take decades to be evaluated. Because of the poly-aetiological nature of some pathologies (e.g.
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