Occupational Radiation Exposure During Robotic-Assisted Navigational Bronchoscopy

BACKGROUND: Robotic-assisted bronchoscopy (RAB) uses fluoroscopy and cone-beam CT (CBCT), which can expose procedural staff to ionizing radiation. Real-time, role-specific occupational dosimetry data from live RAB procedures remain limited. METHODS: We prospectively collected continuous personal dosimetry from attending physicians, anesthesia providers, and scrub nurses during 51 consecutive RAB procedures at a single academic center using a standardized low-dose imaging protocol and shielding. Collar-badge readings were converted to estimated effective dose using a conservative upper-bound conversion factor. Role-specific dose distributions were compared, and scenario-based annual estimates were generated by bootstrap resampling. RESULTS: Median per-procedure estimated dose was 1.27 µSv for attending physicians, 0.58 µSv for anesthesia providers, and 0.55 µSv for scrub nurses. Exposure differed by role, with the primary operator receiving the highest dose. CBCT cases were associated with higher staff and patient radiation measures but also involved smaller lesions and longer fluoroscopy times, indicating confounding by procedural complexity. Patient BMI was independently associated with physician exposure. Projected annual exposures remained well below the ICRP 20 mSv occupational limit across all roles. CONCLUSION: Occupational radiation exposure during RAB was low across all staff roles under an optimized imaging workflow. Role-specific dosimetry captures exposure differences across the procedural team and supports standardized low-dose imaging and shielding as core safety practices.