Prevalence of the use of dosimeters for ionizing radiation from fluoroscopy − a systematic literature review and meta-analysis

This study aims to assess the prevalence of individual dosimeter use among workers exposed to ionizing radiation during fluoroscopy-guided procedures. Additionally, factors contributing to its use were identified.

Studies were identified through searches in five databases on 13 April 2024. Additionally, snowballing techniques were employed. The review followed PRISMA guidelines and the CoCoPop model. A narrative synthesis, bibliometric analysis, and meta-analysis were performed. Study quality was assessed using the Joanna Briggs Institute checklist for prevalence studies.

Fifty studies involving 11,067 individuals were included. Orthopedics/traumatology was the most studied specialty (46 %). Median use rates were: 24 %(IQR = 44 %) for eye lens dosimeters, 15 %(IQR = 13 %) for electronic real-time dosimeters, 27 %(IQR = 42 %) for wrist/finger dosimeters, 25 %(IQR = 23 %) for collar/thyroid dosimeters and 5 % for ankle dosimeter; 15 %(IQR = 78 %) reported no monitoring device. In 15 studies (30 %) with 4,188 individuals (38 %), the overall prevalence of “always” using whole-body dosimeters was 43 %[95 %CI:24–62]. By continent, the highest prevalence was found in Africa (75 %[95 % CI: 46–95]), while the lowest was in the “Americas” (33 %[95 % CI: 16–52]). Significant moderator effects were found: higher prevalence in “Africa” (p = 0.04), “gastroenterology” (p = 0.04), and “involving radiology” (p = 0.01); lower in “orthopedics” (p = 0.01) and “physicians” (p = 0.03). No significant moderator effects were found: “very high Human Development Index” (p = 0.72) and “high Human Development Index” (p = 0.69). Studies showed moderate risk of bias (6/9), with little evidence of publication bias.

Exposure doses may be underestimated due to the low prevalence of dosimeter use. Interventions targeting individual and organizational factors are needed to promote consistent use and improve safety.