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O'Rourke M, Moore N, Young R, Svetlic S, Bucknall H, McEntee MF, Alzyoud KS, England A. An investigation into the knowledge, attitudes, and practice of radiation protection in interventional radiology and cardiac catheter-laboratories. J Med Imaging Radiat Sci 2024; 55:101440. [PMID: 38908031 DOI: 10.1016/j.jmir.2024.101440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND According to current literature, there is a lack of information regarding the radiation protection (RP) practices of interventional radiology (IR) and cardiology catheter laboratory (CCL) staff. This study aims to determine the RP practices of staff within IR and CCLs internationally and to suggest areas for improvement. METHODS A cross-sectional study in the form of an online questionnaire was developed. Participation was advertised via online platforms and through email. Participants were included if they were healthcare professionals currently working in IR and CCLs internationally. Questionnaire design included Section 1 demographic data, Section 2 assessed RP training and protocols, Section 3 surveyed the use of different types of RP lead shields, both personal and co-worker use and Section 4 assessed other methods of minimising radiation dose within practice. Questions were a mix of open and closed ended, descriptive statistics were used for closed questions and thematic analysis was employed for open ended responses. RESULTS A total of 178 responses to the questionnaire were recorded with 130 (73 %) suitable for analysis. Most respondents were female (n = 94, 72 %) and were radiographers (n = 97, 75 %). Only 68 (53 %) had received training, the majority receiving this in-house (n = 54, 79 %). 118 (98 %) of respondents had departmental protocols in place for RP. Radiology managers (n = 106, 82 %) were most likely to contribute to such protocols. Multiple methods of dose minimisation exist, these include low-dose fluoroscopy, staff rotation, radiation dose audits and minimal time in the controlled areas. Respondents reported that lead apron shields were wore personally by 99 % of respondents and by co-workers in 95 % of cases. CONCLUSION The practices of RP by IR and CCL staff in this survey was variable and can be improved. The unavailability of basic radiation protection tools and RP specific training courses/modules were some of the reasons for sub-optimal self-protection against ionising radiation reported by respondents.
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Affiliation(s)
- Megan O'Rourke
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - Niamh Moore
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - Rena Young
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - Silvia Svetlic
- Department of Radiology, San Raffaelle Hospital, Milan, Italy
| | - Helen Bucknall
- Department of Radiology, St. George's Hospital, London, UK
| | - Mark F McEntee
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland; Faculty of Medicine, University of Sydney, Sydney, Australia; School of Health Sciences, University of Southern Denmark, Denmark
| | - Kholoud S Alzyoud
- The Hashemite University, Faculty of Allied Health Sciences, Zarqa, Jordan
| | - Andrew England
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland.
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2
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Ohno S, Konta S, Shindo R, Yamamoto K, Isobe R, Inaba Y, Suzuki M, Zuguchi M, Chida K. Effect of backscatter radiation on the occupational eye-lens dose. JOURNAL OF RADIATION RESEARCH 2024; 65:450-458. [PMID: 38818635 PMCID: PMC11262866 DOI: 10.1093/jrr/rrae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/21/2024] [Indexed: 06/01/2024]
Abstract
We quantified the level of backscatter radiation generated from physicians' heads using a phantom. We also evaluated the shielding rate of the protective eyewear and optimal placement of the eye-dedicated dosimeter (skin surface or behind the Pb-eyewear). We performed diagnostic X-rays of two head phantoms: Styrofoam (negligible backscatter radiation) and anthropomorphic (included backscatter radiation). Radiophotoluminescence glass dosimeters were used to measure the eye-lens dose, with or without 0.07-mm Pb-equivalent protective eyewear. We used tube voltages of 50, 65 and 80 kV because the scattered radiation has a lower mean energy than the primary X-ray beam. The backscatter radiation accounted for 17.3-22.3% of the eye-lens dose, with the percentage increasing with increasing tube voltage. Furthermore, the shielding rate of the protective eyewear was overestimated, and the eye-lens dose was underestimated when the eye-dedicated dosimeter was placed behind the protective eyewear. We quantified the backscatter radiation generated from physicians' heads. To account for the effect of backscatter radiation, an anthropomorphic, rather than Styrofoam, phantom should be used. Close contact of the dosimeter with the skin surface is essential for accurate evaluation of backscatter radiation from physician's own heads. To assess the eye-lens dose accurately, the dosimeter should be placed near the eye. If the dosimeter is placed behind the lens of the protective eyewear, we recommend using a backscatter radiation calibration factor of 1.2-1.3.
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Affiliation(s)
- Saya Ohno
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Satoe Konta
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Ryota Shindo
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Keisuke Yamamoto
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Rio Isobe
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Yohei Inaba
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4, Aoba, Sendai 980-8579, Japan
| | - Masatoshi Suzuki
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4, Aoba, Sendai 980-8579, Japan
| | - Masayuki Zuguchi
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Radiological Disasters and Medical Science, Department of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 6-6-4, Aoba, Sendai 980-8579, Japan
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Wijma IN, Casal RF, Cheng GZ, Einsiedel PF, Fantin A, Hall DJ, Herth FJF, Ng CSH, Pritchett MA, Shah PL, Steinfort DP, Trisolini R, Verhoeven RLJ, van der Heijden EHFM. Radiation Principles, Protection, and Reporting for Interventional Pulmonology: A World Association of Bronchology and Interventional Pulmonology White Paper. Respiration 2024:1-15. [PMID: 39033746 DOI: 10.1159/000540102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
The use and availability of diverse advanced X-ray based imaging and guidance systems in the field of interventional pulmonology are rapidly growing. This popularity links inextricably to an increase in ionizing radiation use. Knowing ionizing radiation is hazardous, knowledge and competent use of X-ray imaging and guidance systems are important. The globally implemented As Low As Reasonably Achievable (ALARA) principle demands careful attention to minimize radiation exposure while achieving the precise goals of the intervention and imaging therein. To allow careful and targeted weighing of risk against reward while using X-ray based equipment, proper background knowledge of physics as well as imaging system aspects are needed. This white paper summarizes the principles of ionizing radiation which are crucial to enhance awareness and interpretation of dosimetric quantities. Consecutively, a consensus on standards for reporting radiation exposure in interventional pulmonology procedures is indicated to facilitate comparisons between different systems, approaches and results. Last but not least, it provides a list of practical measures, considerations and tips to optimize procedural imaging as well as reduce radiation dose to patients and staff.
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Affiliation(s)
- Inge N Wijma
- Department of Pulmonary Diseases, Interventional Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands,
| | - Roberto F Casal
- Department of Medicine, Advanced Bronchoscopy Program, Clinical Research Unit, Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - George Z Cheng
- Department of Interventional Pulmonology, Bronchoscopy, and Pleural Disease, Interventional Pulmonology Fellowship, University of California San Diego, La Jolla, California, USA
| | - Paul F Einsiedel
- Department of Medical Imaging, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Alberto Fantin
- Department of Pulmonology, University Hospital of Udine (ASUFC), Udine, Italy
| | - David J Hall
- Department of Radiology, Diagnostic Medical Physics, University of California, San Diego, California, USA
- UCSD Moores Cancer Center, La Jolla, California, USA
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Calvin S H Ng
- Department of Thoracic Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
| | - Michael A Pritchett
- Chest Center of the Carolinas, FirstHealth of the Carolinas and Pinehurst Medical Clinic, Pinehurst, North Carolina, USA
| | - Pallav L Shah
- Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Daniel P Steinfort
- Department Respiratory Medicine, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Rocco Trisolini
- Department of Pulmonary Medicine and Interventional Pulmonolonology, Catholic University of the Sacred Hearth, Fondazione Polilcinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roel L J Verhoeven
- Department of Pulmonary Diseases, Interventional Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik H F M van der Heijden
- Department of Pulmonary Diseases, Interventional Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands
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Engström A, Isaksson M, Larsson PA, Lundh C, Båth M. Lead aprons and thyroid collars: to be, or not to be? JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:031516. [PMID: 37678246 DOI: 10.1088/1361-6498/acf76f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/07/2023] [Indexed: 09/09/2023]
Abstract
Wearing lead aprons and thyroid collars for long periods of time has a subjective component: to balance the effective dose reduction with the effort of carrying a heavy load. Occupational radiation exposure has decreased dramatically in the last century within the health care system. During the same period the use of lead aprons and thyroid collars has also gone up. Therefore, a question that may be raised is: how safe is safe enough? In order to promote stakeholder involvement, the aim of the present study was to investigate staff's experience of discomforts associated with wearing lead aprons and thyroid collars for long periods of time, and also to investigate staff's willingness to tolerate personal dose equivalent (expressed as radiation dose) and the corresponding increase in future cancer risk to avoid wearing these protective tools. A questionnaire was developed and given to staff working in operating or angiography rooms at Skaraborg Hospital in Sweden. The results from the 245 respondents showed that 51% experienced bothersome warmth, 36% experienced fatigue and 26% experienced ache or pain that they believed was associated with wearing lead aprons. One third of the respondents would tolerate a personal dose equivalent of 1 mSv per year to avoid wearing lead aprons, but only a fifth would tolerate the corresponding increase in future cancer risk (from 43% to 43.2%). In conclusion, discomforts associated with wearing lead aprons and thyroid collars for long periods of time are common for the staff using them. At the same time, only a minority of the staff would tolerate a small increase in future cancer risk to avoid wearing them. The present study gives an example of stakeholder involvement and points at the difficulties in making reasonable decisions about the use of these protective tools.
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Affiliation(s)
- Andreas Engström
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SE-413 45, Sweden
- Department of Radiology, Skaraborg Hospital, Region Västra Götaland, Skövde, SE-541 85, Sweden
| | - Mats Isaksson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SE-413 45, Sweden
| | - Per-Anders Larsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg SE-413 45, Sweden
- Department of Surgery, Skaraborg Hospital, Region Västra Götaland, Skövde, SE-541 85, Sweden
- Department of Research and Development, Skaraborg Hospital, Region Västra Götaland, SE-541 85 Skövde, Sweden
| | - Charlotta Lundh
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, SE-413 45, Sweden
| | - Magnus Båth
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, SE-413 45, Sweden
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5
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Milman RJ, McCollough CH, Sechopoulos I. Radiation safety: minimise risks by properly positioning patients, equipment, and operators. BMJ 2023; 381:p1472. [PMID: 37385644 DOI: 10.1136/bmj.p1472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Affiliation(s)
- Rebecca J Milman
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cynthia H McCollough
- CT Clinical Innovation Center and X-ray Imaging Core, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ioannis Sechopoulos
- Advanced X ray Tomographic Imaging Lab, Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
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6
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Keenen TL, Demirel S, Gheen A, Casabarro B, Fleishman D. Intraoperative Fluoroscopy Radiation Using OEC 9900 Elite C-arm: Risk and Method for Decreasing Exposure. HEALTH PHYSICS 2023; 124:380-390. [PMID: 36880954 DOI: 10.1097/hp.0000000000001679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
ABSTRACT The use of intraoperative fluoroscopy in surgery produces scattered radiation that can expose all operating room personnel to measurable and, in some cases, substantial radiation doses. The goal of this work is to assess and document potential radiation doses to various staff positions in a simulated standard operating room environment. Adult-sized mannequins wearing standard lead protective aprons were placed at seven positions around large and small BMI cadavers. Doses were recorded in real time at thyroid level with Bluetooth-enabled dosimeters for a variety of fluoroscope settings and imaging views. A total of 320 images were acquired, resulting in 2,240 dosimeter readings from the seven mannequins. Doses were compared to cumulative air kerma (CAK) calculations provided by the fluoroscope. There was a strong correlation between the CAK and the recorded scattered radiation doses ( P < 0.001). Radiation doses could be reduced by manipulating C-arm manual technique settings [e.g., turning off the automatic exposure control (AEC) and using pulse (PULSE) or low dose (LD) settings]. Staff position and patient size also affected the recorded doses. The highest radiation doses were recorded across all settings for the mannequin positioned immediately adjacent to the C-arm x-ray tube. The larger BMI cadaver generated greater scattered radiation than the smaller BMI cadaver for all views and settings. This work provides suggestions for reducing exposure to operating room personnel beyond standard techniques of reducing beam-on time, increasing the distance from the radiation source, and use of shielding. Simple changes in C-arm settings (turning AEC off, avoiding DS setting, use of PULSE or LD settings) can markedly reduce dose to staff.
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Affiliation(s)
- Timothy L Keenen
- Oregon Health and Sciences University, Dept of Orthopedics and Rehabilitation, Portland, OR
| | | | | | - Benjamin Casabarro
- Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd., Indianapolis, IN 46202
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7
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Ingleby HR, Bonilha HS, Steele CM. A Tutorial on Diagnostic Benefit and Radiation Risk in Videofluoroscopic Swallowing Studies. Dysphagia 2023; 38:517-542. [PMID: 34254167 DOI: 10.1007/s00455-021-10335-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
The videofluoroscopic swallowing study (VFSS) is a key tool in assessing swallowing function. As with any diagnostic procedure, the probable benefits of the study must be weighed against possible risks. The probable benefit of VFSS is an accurate assessment of swallowing function, enabling patient management decisions potentially leading to improved patient health status and quality of life. A possible (though highly unlikely) risk in VFSS is carcinogenesis, arising from the use of ionizing radiation. Clinicians performing videofluoroscopic swallowing studies should be familiar with both sides of the risk benefit equation in order to determine whether the study is medically justified. The intent of this article is to provide the necessary background for conversations about benefit and risk in videofluoroscopic swallowing studies.
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Affiliation(s)
- Harry R Ingleby
- Division of Medical Physics, CancerCare Manitoba; Departments of Radiology and Physics & Astronomy, University of Manitoba, 675 McDermot Avenue, Winnipeg, MB, R3E 0V9, Canada.
| | - Heather S Bonilha
- Departments of Rehabilitation Sciences; Health Science and Research; and Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Catriona M Steele
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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8
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Choi TW, Chung JW, Kwon Y. Modified design of x-ray protective clothing to enhance radiation protection for interventional radiologists. Med Phys 2023. [PMID: 36794321 DOI: 10.1002/mp.16309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND In interventional radiology procedures, the operator typically stands on the right side of the patient's right thigh to manipulate devices through the femoral sheath. Because the standard x-ray protective clothing is designed as sleeveless and scatter radiations from the patient are mainly incident from the left-anterior direction to the operator, the arm hole of the clothing may be a significant unprotected area, contributing to an increase in the operator's organ doses and effective dose. PURPOSE This study aimed to compare the organ doses and effective dose received by the interventional radiologist when wearing the standard x-ray protective clothing and when wearing the modified clothing with an additional shoulder guard. METHODS The experimental setup aimed to simulate actual clinical practice in interventional radiology. The patient phantom was located at the beam center to generate scatter radiation. An adult female anthropomorphic phantom loaded with 126 nanoDots (Landauer Inc., Glenwood, IL) was used to measure organ and effective doses to the operator. The standard wrap-around type x-ray protective clothing offered 0.25-mm lead-equivalent protection, and the frontal overlap area offered 0.50-mm lead-equivalent protection. The shoulder guard was custom-made with a material providing x-ray protection equivalent to lead of 0.50 mm thickness. The organ and effective doses were compared between the operator wearing the standard protective clothing and the one wearing the modified clothing with a shoulder guard. RESULTS After adding the shoulder guard, doses to the lungs, bone marrow, and esophagus decreased by 81.9%, 58.6%, and 58.7%, respectively, and the effective dose to the operator decreased by 47.7%. CONCLUSIONS Widespread use of modified x-ray protective clothing with shoulder guards can significantly decrease the overall occupational radiation risk in interventional radiology.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
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Abstract
The benefit of radiation is immense in the field of gastroenterology. Radiation is used daily in different gastrointestinal imaging and diagnostic and therapeutic interventional procedures. Radiotherapy is one of the primary modalities of treatment of gastrointestinal malignancies. There are various modalities of radiotherapy. Radiotherapy can injure malignant cells by directly damaging DNA, RNA, proteins, and lipids and indirectly by forming free radicals. External beam radiation, internal beam radiation and radio-isotope therapy are the major ways of delivering radiation to the malignant tissue. Radiation can also cause inflammation, fibrosis, organ dysfunction, and malignancy. Patients with repeated exposure to radiation for diagnostic imaging and therapeutic procedures are at slightly increased risk of malignancy. Gastrointestinal endoscopists performing fluoroscopy-guided procedures are also at increased risk of malignancy and cataract formation. The radiological protection society recommends certain preventive and protective measures to avoid side effects of radiation. Gastrointestinal complications related to radiation therapy for oncologic processes, and exposure risks for patients and health care providers involved in diagnostic or therapeutic imaging will be discussed in this review.
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Affiliation(s)
- Monjur Ahmed
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA 19107, USA,Corresponding Author: Monjur Ahmed, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Razin Ahmed
- California Cancer Associates for Research and Excellence, Fresno, CA, USA
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10
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Balter S, Patel A. Radiation Management in Interventional Cardiology. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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11
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Chida K. What are useful methods to reduce occupational radiation exposure among radiological medical workers, especially for interventional radiology personnel? Radiol Phys Technol 2022; 15:101-115. [PMID: 35608759 DOI: 10.1007/s12194-022-00660-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
Protection against occupational radiation exposure in clinical settings is important. This paper clarifies the present status of medical occupational exposure protection and possible additional safety measures. Radiation injuries, such as cataracts, have been reported in physicians and staff who perform interventional radiology (IVR), thus, it is important that they use shielding devices (e.g., lead glasses and ceiling-suspended shields). Currently, there is no single perfect radiation shield; combinations of radiation shields are required. Radiological medical workers must be appropriately educated in terms of reducing radiation exposure among both patients and staff. They also need to be aware of the various methods available for estimating/reducing patient dose and occupational exposure. When the optimizing the dose to the patient, such as eliminating a patient dose that is higher than necessary, is applied, exposure of radiological medical workers also decreases without any loss of diagnostic benefit. Thus, decreasing the patient dose also reduces occupational exposure. We propose a novel four-point policy for protecting medical staff from radiation: patient dose Optimization, Distance, Shielding, and Time (pdO-DST). Patient dose optimization means that the patient never receives a higher dose than is necessary, which also reduces the dose received by the staff. The patient dose must be optimized: shielding is critical, but it is only one component of protection from radiation used in medical procedures. Here, we review the radiation protection/reduction basics for radiological medical workers, especially for IVR staff.
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Affiliation(s)
- Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai, 980-8575, Japan. .,Division of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 468-1 Aoba, Aramaki, Aoba-ku, Sendai, 980-8572, Japan.
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12
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Park S, Kim M, Kim JH. Radiation safety for pain physicians: principles and recommendations. Korean J Pain 2022; 35:129-139. [PMID: 35354676 PMCID: PMC8977205 DOI: 10.3344/kjp.2022.35.2.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 11/05/2022] Open
Abstract
C-arm fluoroscopy is a useful tool for interventional pain management. However, with the increasing use of C-arm fluoroscopy, the risk of accumulated radiation exposure is a significant concern for pain physicians. Therefore, efforts are needed to reduce radiation exposure. There are three types of radiation exposure sources: (1) the primary X-ray beam, (2) scattered radiation, and (3) leakage from the X-ray tube. The major radiation exposure risk for most medical staff members is scattered radiation, the amount of which is affected by many factors. Pain physicians can reduce their radiation exposure by use of several effective methods, which utilize the following main principles: reducing the exposure time, increasing the distance from the radiation source, and radiation shielding. Some methods reduce not only the pain physician's but also the patient's radiation exposure. Taking images with collimation and minimal use of magnification are ways to reduce the intensity of the primary X-ray beam and the amount of scattered radiation. It is also important to carefully select the C-arm fluoroscopy mode, such as pulsed mode or low-dose mode, for ensuring the physician's and patient's radiation safety. Pain physicians should practice these principles and also be aware of the annual permissible radiation dose as well as checking their radiation exposure. This article aimed to review the literature on radiation safety in relation to C-arm fluoroscopy and provide recommendations to pain physicians during C-arm fluoroscopy-guided interventional pain management.
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Affiliation(s)
- Sewon Park
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Minjung Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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13
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Sierra LAM, Katsnelson JY, Pineda DM. Occupational Radiation Exposure Among General Surgery Residents: Should We Be Concerned? JOURNAL OF SURGICAL EDUCATION 2022; 79:463-468. [PMID: 34922884 DOI: 10.1016/j.jsurg.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Low-dose ionizing radiation exposure is associated with development of solid organ tumors as well as increased risk of cataract formation in a linear-dose response. While occupational radiation exposure has been studied across subspecialties with regular fluoroscopy exposure such as interventional radiology and urology, the contribution of increasing endovascular case volume to occupational radiation exposure among general surgery residents remains largely unreported. In this study, we sought to determine typical occupational radiation exposure among a pool of general surgery residents as part of a formal radiation safety curriculum. METHODS A radiation safety program was introduced to a group of 28 general surgery residents who rotate on a vascular surgery service with a high endovascular volume in a hybrid room setting. All residents received training in proper use of a radiation dosimeter and minimizing exposure during fluoroscopy times in the operating room. Data was collected from radiation film dosimetry badges distributed to general surgery residents on a bimonthly basis throughout the year, and radiation exposure in mRem was compared between residents rotating on vascular and nonvascular surgical services during 4-week rotations. RESULTS A total of 14 months of data were collected. Resident compliance was 84% with regular use and return of dosimeters at the end of each bimonthly cycle. The radiation exposure among residents rotating on vascular surgery was significantly higher compared to those on nonvascular rotations (mean = 71 mRem vs 3.13 mRem, p = 0.02). Exposure among senior residents was not statistically different than that of attending vascular surgeons (mean = 212 mRem vs 164 mRem, p = 0.20). All exposures were significantly lower than institutional ALARA dose limits for radiation exposure (5000 mRem/year). CONCLUSION General surgery residents are routinely exposed to measurable occupational radiation levels, especially while participating in endovascular procedures during their training. However, data from our study suggests that these levels are below ALARA dose limits and senior surgical residents are not at greater risk than vascular surgery attending surgeons while on their vascular rotation. The results of this study will be used to help guide resident education on radiation safety and identify institution-specific practices which can minimize exposure and improve radiation safety adherence.
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Affiliation(s)
- Luis A Mejia Sierra
- Department of Surgery, Abington Memorial Hospital-Jefferson Health, Abington, Pennsylvania
| | - Jacob Y Katsnelson
- Department of Surgery, Abington Memorial Hospital-Jefferson Health, Abington, Pennsylvania
| | - Danielle M Pineda
- Department of Surgery, Abington Memorial Hospital-Jefferson Health, Abington, Pennsylvania.
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Noor Azman NZ, Irwaty Wan Mohamed WF, Ramli RM. Synthesis and characterization of electrospun n-ZnO/n-Bi2O3/epoxy-PVA nanofiber mat for low X-ray energy shielding application. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Alqahtani MS, Hussein KI, Afifi H, Reben M, Grelowska I, Zahran HY, Yahia IS, Yousef ES. Optical and radiation shielding characteristics of tellurite glass doped with different rare-earth oxides. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:293-305. [PMID: 34974448 DOI: 10.3233/xst-211017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Shielding glass materials doped with heavy metal oxides show an improvement in the effectiveness of the materials used in radiation shielding. In this work, the photon shielding parameters of six tellurite glass systems doped with several metal oxides namely, 70TeO2-10P2O5- 10ZnO- 5.0PbF2- 0.0024Er2O3- 5.0X (where X represents different doped metail oxides namely, Nb2O5, TiO2, WO3, PbO, Bi2O3, and CdO) in a broad energy spectrum, ranging from 0.015 MeV to 15 MeV, were evaluated. The shielding parameters were calculated using the online software Phy-X/PSD. The highest linear and mass attenuation coefficients recorded were obtaibed from the samples containing bismuth oxide (Bi2O3), and the lowest half-value layer and mean free path were recorded among the other samples. Furthermore, the shielding effectiveness of tellurite glass systems was compared with commercial shielding materials (RS-369, RS-253 G18, chromite, ferrite, magnetite, and barite). The optical parameters viz, dispersion energy, single-oscillator energy, molar refraction, electronic polarizability, non-linear refractive indices, n2, and third-order susceptibility were measured and reported at a different wavelength. Bi2O3 has a strong effect on enhancing the optical and shielding properties. The outcome of this study suggests the potential of using the proposed glass samples as radiation-shielding materials for a broad range of imaging and therapeutic applications.
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Affiliation(s)
- Mohammed S Alqahtani
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
- BioImaging Unit, Space Research Centre, Department of Physics and Astronomy, University of Leicester, Leicester, UK
| | - Khalid I Hussein
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
- Department of Medical Physics and Instrumentation, National Cancer Institute, University of Gezira, Wad Medani, Sudan
| | - Hesham Afifi
- Ultarsonic Laboratory, National Institute for Standards, El-Giza, Egypt
| | - Manuela Reben
- Faculty of Materials Science and Ceramics, AGH - University of Science and Technology, Cracow, Poland
| | - Iwona Grelowska
- Faculty of Materials Science and Ceramics, AGH - University of Science and Technology, Cracow, Poland
| | - Heba Y Zahran
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, Abha, Saudi Arabia
- Department of Physics, King Khalid University, Abha, Saudi Arabia
- Nanoscience Laboratory for Environmental and Bio-Medical Applications (NLEBA), Semiconductor Lab., Metallurgical Lab. 2 Physics Department, Ain Shams University, Cairo, Egypt
| | - I S Yahia
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, Abha, Saudi Arabia
- Department of Physics, King Khalid University, Abha, Saudi Arabia
- Nanoscience Laboratory for Environmental and Bio-Medical Applications (NLEBA), Semiconductor Lab., Metallurgical Lab. 2 Physics Department, Ain Shams University, Cairo, Egypt
| | - El Sayed Yousef
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, Abha, Saudi Arabia
- Department of Physics, King Khalid University, Abha, Saudi Arabia
- Department of Physics, Faculty of Science, Al Azhar University, Assiut branch, Egypt
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16
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Andrew S, Abdelmonem MR, Kohli S, Dabke H. Evaluation of Back Pain and Lead Apron Use Among Staff at a District General Hospital. Cureus 2021; 13:e18859. [PMID: 34804712 PMCID: PMC8597674 DOI: 10.7759/cureus.18859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives To evaluate the prevalence of back pain among staff who regularly use lead aprons, correlating this to their use, and improve the knowledge and understanding of lead apron use among staff. Methods A questionnaire study was undertaken from November 2018 to February 2019 on staff in departments using lead aprons on a routine basis (n = 59) defined as the study group (SG), and staff who did not wear lead aprons (n = 62) defined as the control group (CG). Additionally, a separate questionnaire (n = 43) was distributed to lead apron users regarding education and knowledge, following which an education session was set up and the staff was re-evaluated. Results The prevalence of back pain was higher in the SG; 63% (SG) versus 32% (CG). The proportion of staff that felt lead aprons (SG) or work (CG) was the cause of this back pain was also higher in the SG than the CG: 83% versus 37%. A significant proportion of staff was unaware of the lead equivalence, material, and types of lead aprons available, after education this improved; 92% of staff now think more carefully when choosing a lead apron. Discussion Back pain is prevalent among staff using lead aprons and a lack of education regarding their use is evident. This could result in time off work and lead to unsafe practices around ionizing radiation. Education improved the knowledge and understanding of lead apron use. This could lead to increased comfort and less strain on the back, potentially lowering the prevalence of back pain.
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Affiliation(s)
- Stefanie Andrew
- Trauma and Orthopaedics, Salisbury NHS Foundation Trust, Salisbury, GBR
| | - Mohamed R Abdelmonem
- Trauma and Orthopaedics, University Hospitals, Plymouth NHS Trust, Plymouth, GBR
| | - Suraj Kohli
- Trauma and Orthopaedics, Salisbury NHS Foundation Trust, Salisbury, GBR
| | - Harshad Dabke
- Trauma and Orthopaedics, Salisbury NHS Foundation Trust, Salisbury, GBR
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17
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Wilson-Stewart KS, Fontanarosa D, Malacova E, Trapp JV. Radiation dose to nurses, cardiologists, and patients during coronary angiography: a comparison of femoral and radial access. Eur J Cardiovasc Nurs 2021; 21:325-331. [PMID: 34718509 DOI: 10.1093/eurjcn/zvab096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/26/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exposure to radiation during fluoroscopically guided cardiac procedures is a cause for concern for both the patient and staff. AIMS This study sought to compare the occupational and patient radiation dose during femoral and radially accessed invasive coronary angiography (CA). METHODS AND RESULTS Occupational dose (µSv) was measured at the left temple of the cardiologist (n = 17), scrub (n = 27), and circulator nurse (n = 27) during 761 femoral and 671 radially accessed diagnostic coronary angiograms and percutaneous coronary intervention (PCI) procedures. Patient dose parameters of dose area product (DAP) (Gy.cm2) and air kerma (AK) (Gy) were also measured. Coronary angiography performed via the radial artery is associated with greater mean dose to the cardiologist, with the exception of procedures including only PCI. Results demonstrated that scrub nurses are exposed to higher mean doses than the cardiologist when using femoral access and similar doses during radial cases. Both AK and DAP were associated with a higher average dose for femoral PCI than radial, with DAP being significantly higher. CONCLUSIONS Awareness of factors that increase the dose to staff and patients is vital to inform and improve practice. This study has demonstrated that access route during diagnostic CA and PCI influences both patient and staff dose. Radiation dose to in-room staff other than the fluoroscopic operator should be a focus of future research. In addition, all staff present during X-ray guided procedures should be provided with radiation education and adopt dose minimization strategies to reduce occupational exposures.
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Affiliation(s)
- Kelly S Wilson-Stewart
- School of Chemistry and Physics, Faulty of Science and Engineering, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia.,Greenslopes Private Hospital, Ramsay Health Care, Newdegate Street, Greenslopes, Brisbane, QLD 4120 Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia.,Centre for Biomedical Technologies (CBT), Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia
| | - Eva Malacova
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia.,QMIR Berghofer Medical Research Institute, 200 Herston Road, Herston, QLD 4006 Australia
| | - Jamie V Trapp
- School of Chemistry and Physics, Faulty of Science and Engineering, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia
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18
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Kwok K, Hasan N, Duloy A, Murad F, Nieto J, Day LW. American Society for Gastrointestinal Endoscopy radiation and fluoroscopy safety in GI endoscopy. Gastrointest Endosc 2021; 94:685-697.e4. [PMID: 34399965 DOI: 10.1016/j.gie.2021.05.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Karl Kwok
- Department of Medicine, Division of Gastroenterology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | - Nazia Hasan
- Department of Medicine, Division of Gastroenterology, NorthBay Healthcare, Fairfield, California, USA
| | - Anna Duloy
- Department of Medicine, Division of Gastroenterology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Faris Murad
- Department of Gastroenterology, FHN Memorial Hospital, Freeport, Illinois, USA
| | - Jose Nieto
- Department of Gastroenterology, Borland Groover Clinic, Jacksonville, Florida, USA
| | - Lukejohn W Day
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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19
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Hong SW, Kim TW, Kim JH. RADIATION EXPOSURE TO THE BACK WITH DIFFERENT TYPES OF APRONS. RADIATION PROTECTION DOSIMETRY 2021; 193:185-189. [PMID: 33839791 DOI: 10.1093/rpd/ncab044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/17/2021] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
Physicians and nurses stand with their back towards the C-arm fluoroscope when using the computer, taking things out of closets and preparing drugs for injection or instruments for intervention. This study was conducted to investigate the relationship between the type of lead apron and radiation exposure to the backs of physicians and nurses while using C-arm fluoroscopy. We compared radiation exposure to the back in the three groups: no lead apron (group C), front coverage type (group F) and wrap-around type (group W). The other wrap-around type apron was put on the bed instead of on a patient. We ran C-arm fluoroscopy 40 times for each measurement. We collected the air kerma (AK), exposure time (ET) and effective dose (ED) of the bedside table, upper part and lower part of apron. We measured these variables 30 times for each location. In group F, ED of the upper part was the highest (p < 0.001). ED of the lower part in group C and F was higher than that in group W (p = 0.012). The radiation exposure with a front coverage type apron is higher than that of the wrap-around type and even no apron at the neck or thyroid. For reducing radiation exposure to the back of physician or nurse, the wrap-around type apron is recommended. This type of apron can reduce radiation to the back when the physician turns away from the patient or C-arm fluoroscopy.
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Affiliation(s)
- Seung Wan Hong
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Tae Won Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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20
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Ong K, Warren H, Nalagatla S, Kmiotek E, Obasi C, Shanmugathas N, Beech H, Chan L, Colemeadow J, Ibrahim I, Waqar M, Lane J, Rehman OF, Makanjuola J. Radiation Safety Knowledge and Practice in Urology Theaters: A Collaborative Multicenter Survey. J Endourol 2021; 35:1084-1089. [PMID: 33544020 DOI: 10.1089/end.2020.0955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate the knowledge and current radiation safety practice among health care professionals undertaking fluoroscopic procedures in urology. Materials and Methods: A 14-question survey was disseminated to multidisciplinary urology theater staff. Questions included demographic data, usual radiation safety practice, and knowledge. The questions were selected based on guidelines from the International Commission of Radiological Protection and Health and Safety Executive. The survey was disseminated through regional collaborators and social media. Results: The survey received a total of 309 completed responses, including 272 from the United Kingdom. Responses from the United Kingdom multidisciplinary team included 164 (60.3%) urologic surgeons, 68 (25.0%) theater nurses, 27 (9.9%) from the anesthetic team, and 13 (4.7%) radiographers. Results from the United Kingdom demonstrated use of lead aprons and thyroid shields as 99.3% and 52.2%, respectively. Lead glasses and lead glove use were 7.4% and 0.7%, respectively. Lack of availability was cited as a reason for noncompliance with shielding guidelines in 208 (76.5%) of the respondents. No form of training in radiation safety was reported by 120 (44.1%) respondents. However, there was no association between answering knowledge questions correctly and having completed some form of radiation safety training (p = 0.41). There was an association between dosimeter use and those who had received radiation safety training (p = 0.02). Consultant urologists were also more likely to use a dosimeter than training grade urologists (p = 0.035). Conclusion: Suboptimal compliance with radiation safety guidelines is prevalent in contemporary urologic practice, and presents a significant occupational health concern. Availability of protective equipment needs to be urgently addressed.
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Affiliation(s)
- Kelly Ong
- Department of Urology, King's College Hospital, London, United Kingdom
| | - Hannah Warren
- Department of Urology, King's College Hospital, London, United Kingdom
| | - Sarika Nalagatla
- Department of Urology, Royal Alexandra Hospital, Glasgow, United Kingdom
| | | | - Chekwas Obasi
- Department of Urology, Croydon University Hospital, London, United Kingdom
| | | | - Helen Beech
- Department of Urology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Luke Chan
- Department of Urology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Josie Colemeadow
- Department of Urology, North Middlesex Hospital, London, United Kingdom
| | - Ibrahim Ibrahim
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
| | - Muhammad Waqar
- Department of Urology, York District Hospital, York, United Kingdom
| | - Jenni Lane
- Department of Urology, Southampton Hospital, Southampton, United Kingdom
| | - Omer F Rehman
- Department of Urology, Armed Forces Institute of Urology AFIU, Rawalpindi, Pakistan
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21
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park IW, Kim SJ, Shin D, Shim SR, Chang HK, Kim CH. Radiation exposure to the urology surgeon during retrograde intrarenal surgery. PLoS One 2021; 16:e0247833. [PMID: 33720938 PMCID: PMC7959394 DOI: 10.1371/journal.pone.0247833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/12/2021] [Indexed: 11/19/2022] Open
Abstract
Retrograde intrarenal surgery is a common procedure that carries a risk of radiation exposure for urologists. This study aimed to measure the amount of radiation that urologists are exposed to during surgery, and to estimate how many procedures can be safely performed by one urologist per year. Variables that affect radiation exposure were also identified. Radiation exposure doses were measured for the eye, neck, chest, arms, and hands of a urologist who performed 226 retrograde intrarenal surgeries. To determine how many procedures could be safely performed per year, the Annual Permissible Occupational Exposure Radiation Dose Guidelines of the National Council on Radiation Protection and Measurements were consulted. Correlations between radiation exposure dose and the patient's age, sex, body mass index, stone number/burden/laterality/location/Hounsfield unit, and their renal calculi were calculated. The mean surgery and fluoroscopy durations were 83.2 and 5.13 min; the mean tube voltage and current were 68.88 kV and 2.48 mA, respectively. Cumulative radiation doses for the eye, neck, chest, right upper arm, left hand, and right hand were 65.53, 69.95, 131.79, 124.43, 165.66, and 126.64 mSv, respectively. Radiation reduction rates for lead collars and aprons were 97% and 98%, respectively. If the urologists wear only radiation shields and lead apron but do not wear safety glasses during RIRS, the recommended by the ICRP publication 103 is taken into consideration, our results showed that 517 RIRS can be performed per year safely. However, if no protective measures are taken, this number decreases to only 85 RIRS per year. At all measurement sites, significant correlations were observed between the radiation exposure dose and stone numbers and Hounsfield unit values. In conclusion, it is imperative that urologists wear protective gear. Greater effort should be made to reduce radiation exposure when renal calculi have a large number of stones or large Hounsfield unit values.
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Affiliation(s)
- Il woo park
- Department of Urology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Su Jin Kim
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Dongseong Shin
- Department of Pharmacology, Gachon University College of Medicine, Incheon, Korea
- Clinical Trials Center, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung Ryul Shim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Kyung Chang
- Department of Urology, Catholic Kwandong University, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Chang Hee Kim
- Department of Urology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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22
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Hussein KI, Alqahtani MS, Grelowska I, Reben M, Afifi H, Zahran H, Yaha IS, Yousef ES. Optically transparent glass modified with metal oxides for X-rays and gamma rays shielding material. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:331-345. [PMID: 33579888 DOI: 10.3233/xst-200780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Metal oxide glass composites have attracted huge interest as promising shielding materials to replace toxic, heavy, and costly conventional shielding materials. OBJECTIVE In this work, we evaluate shielding effectiveness of four novel tellurite-based glasses samples doped with oxide metals (namely, A, B, C, and D, which are 75TeO2- 10P2O5- 10ZnO- 5PbF2- 0.24Er2O3 ; 70TeO2- 10P2O5- 10ZnO- 5PbF2 -5MgO- 0.24Er2O3; 70TeO2- 10P2O5- 10ZnO- 5PbF2- 5BaO- 0.24Er2O3 ; and 70TeO2- 10P2O5-10ZnO- 5PbF2- 5SrO; respectively) by assessing them through a wide range of ionizing radiation energies (0.015-15 MeV). METHODS The radiation-shielding parameters including mass attenuation coefficient (MAC), linear attenuation coefficient (LAC), half-value layer (HVL), mean free path, (MFP), effective atomic number (Zeff), effective electron number (Neff), and the transmission factor are computed in the selected range of ionizing radiation energies. Furthermore, the proposed samples were compared with the most common shielding glass materials. The optical parameters viz oscillator, dispersion energy, nonlinear refractive indices, molar, and electronic polarizability of these transparent glasses are reported at different wavelengths. RESULTS The results show that the proposed samples have considerable effectiveness as transparent shielding glass materials at various ionizing radiation energies. They can be employed for effective radiation-protection outcomes. Sample C demonstrated slightly better shielding properties than the other samples with differences of 1.33%, 4.6%, and 4.2% for samples A, B, and D, respectively. A similar trend is observed regarding the mass attenuation coefficients. Nevertheless, sample B shows better optical properties than the other prepared glass samples. CONCLUSIONS Our findings indicate that the proposed novel glass samples have good shielding properties and optical characteristics, which can pave the way for their utilization as transparent radiation-shielding materials in medical and industrial applications.
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Affiliation(s)
- Khalid I Hussein
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
- Department of Medical Physics and Instrumentation, National Cancer Institute, University of Gezira, Wad Medani, Sudan
| | - Mohammed S Alqahtani
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Iwona Grelowska
- Faculty of Materials Science and Ceramics, AGH - University of Science and Technology, al. Mickiewicza, Cracow, Poland
| | - Manuela Reben
- Faculty of Materials Science and Ceramics, AGH - University of Science and Technology, al. Mickiewicza, Cracow, Poland
| | - Hesham Afifi
- Ultarsonic Laboratory, National Institute for Standards, Tersa Street El-haram, El-Giza, Egypt
| | - Heba Zahran
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, Abha, Saudi Arabia
- Physics Department, Faculty of Science, King Khalid University, Abha, Saudi Arabia
- Nanoscience Laboratory for Environmental and Bio-Medical Applications (NLEBA), Semiconductor Lab., Metallurgical Lab. 2 Physics Department, Faculty of Education, Ain Shams University, Roxy, Cairo, Egypt
| | - I S Yaha
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, Abha, Saudi Arabia
- Physics Department, Faculty of Science, King Khalid University, Abha, Saudi Arabia
- Nanoscience Laboratory for Environmental and Bio-Medical Applications (NLEBA), Semiconductor Lab., Metallurgical Lab. 2 Physics Department, Faculty of Education, Ain Shams University, Roxy, Cairo, Egypt
| | - El Sayed Yousef
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, Abha, Saudi Arabia
- Physics Department, Faculty of Science, King Khalid University, Abha, Saudi Arabia
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23
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Kijima K, Krisanachinda A, Tamura M, Monzen H, Nishimura Y. Reduction of Occupational Exposure Using a Novel Tungsten-Containing Rubber Shield in Interventional Radiology. HEALTH PHYSICS 2020; 118:609-614. [PMID: 31855596 DOI: 10.1097/hp.0000000000001177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study investigates whether a novel tungsten-containing rubber shield could be used as substitute shielding material in interventional radiology to reduce the occupational exposure of operators to scattered radiation from a patient. The tungsten-containing rubber is a lead-free radiation-shielding material that contains as much as 90% tungsten powder by weight. Air kerma rates of scattered radiation from solid-plate phantoms, simulating a patient, were measured with a semiconductor dosimeter at the height of the operator's eye (1,600 mm from the floor), chest (1,300 mm), waist (1,000 mm), and knee (600 mm) with and without tungsten-containing rubber shielding (1-5 mm thickness). The tungsten-containing rubber and a commercial shielding material (RADPAD) were affixed onto the phantom on the operator's side, and reductions in air kerma rates were compared. Reduction rates for tungsten-containing rubber shielding with thicknesses of 1, 2, 3, 4, and 5 mm at each height level were as follows: 70.37 ± 0.40%, 72.17 ± 0.29%, 72.95 ± 0.31%, 72.58 ± 0.35%, and 73.63 ± 0.63% at eye level; 76.36 ± 0.19%, 77.13 ± 0.10%, 77.36 ± 0.14%, 77.62 ± 0.25%, and 77.66 ± 0.14% at chest level; 67.78 ± 0.31%, 68.12 ± 0.19%, 68.88 ± 0.28%, 68.97 ± 0.14%, and 68.85 ± 0.45% at waist level; and 0.14 ± 0.94%, 0.72 ± 0.56%, 1.08 ± 0.74%, 1.77 ± 0.80%, and 1.79 ± 1.82% at knee level, respectively. Reduction rates with RADPAD were 61.80 ± 0.67%, 60.33 ± 0.61%, 64.70 ± 0.25%, and 0.14 ± 0.66% at eye, chest, waist, and knee levels, respectively. The shielding ability of the 1 mm tungsten-containing rubber was superior to that of RADPAD. The tungsten-containing rubber could be employed to minimize an operator's radiation exposure instead of the commercial shielding material in interventional radiology.
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Affiliation(s)
- Kenta Kijima
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osaka, Japan
| | - Anchali Krisanachinda
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osaka, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osaka, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
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24
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Knowledge, Attitude, and Practice (KAP) of Radiographic Protection by Dental Undergraduate and Endodontic Postgraduate Students, General Practitioners, and Endodontists. Int J Dent 2020; 2020:2728949. [PMID: 32399032 PMCID: PMC7201738 DOI: 10.1155/2020/2728949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/09/2020] [Indexed: 11/18/2022] Open
Abstract
The aim of this study is to evaluate the knowledge, attitude, and perception of radiation hazard and preventive measures among dental undergraduate students, general practitioners, endodontic postgraduate students, and endodontists in Saudi Arabia. Multiple choice questions questionnaires were distributed among undergraduate and endodontic postgraduate dental students, general practitioners, and endodontists in the colleges of dentistry in Saudi Arabia, government hospitals, and private clinics. The questionnaire included sociodemographic data, assessment of the knowledge of radiation physics and biology, assessment of the practice of dental radiography, and assessment of knowledge of radiation protection. Chi-square test was used for individual and multiresponse analysis. Level of statistical significance was set at P ≤ 0.05. Three hundred and twenty-nine responded to the questionnaire. More than half of the respondents agreed that dental X-ray is hazardous to health (60.79%), and 68.1% were familiar with ALARA (as low as reasonably achievable) principle. However, only 34% are familiar with the recommendations of the National Council on Radiation Protection (NCRP) and International Commission on Radiological Protection (ICRP). The use of lead apron and thyroid collar for patients' protection from X-ray radiation was practiced among endodontic postgraduate students more frequently as well as those who are proactive in the academic field. Undergraduate students, endodontic postgraduate students, and endodontists in the academic field were the most aware towards radiation reduction measures. The use of the preventive measures needs to be emphasized more among general practitioners, endodontic postgraduate students, and endodontists especially in governmental hospitals and private sectors.
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Moon Y, Park S, Won J, Seo JB, Choi J. Design and Development of Light-weight Needle Control Device for Automated Tissue Sampling. INTERNATIONAL JOURNAL OF CONTROL, AUTOMATION AND SYSTEMS 2020; 18:38-45. [DOI: 10.1007/s12555-019-0257-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/23/2019] [Accepted: 07/28/2019] [Indexed: 08/30/2023]
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McLoughlin E, Iqbal A, Patel A, James SL, Botchu R. Dual steristrip technique: a novel use of steristrips to reduce operator radiation dose during CT-guided intervention. Skeletal Radiol 2019; 48:1617-1620. [PMID: 30927033 DOI: 10.1007/s00256-019-03211-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We describe a novel and safe needle-holding method that we have termed the 'dual steristrip technique'. This technique can be used to stabilize the bone biopsy needle without the need for the radiologist's hand to be in close proximity to the X-ray beam during CT-guided intervention. MATERIALS AND METHODS The dual steristrip technique uses steristrips to stabilize the bone biopsy needle and allows for accurate assessment of needle position and trajectory. This involves affixing one end of a steristrip to the skin 2 cm from the needle skin entry point, wrapping the mid-section of the steristrip around the biopsy needle and affixing the other end of the steristrip to the skin at the opposite side of the needle 2 cm from the needle skin entry point. A second steristrip is then applied in a similar fashion at 90° to the first steristrip. RESULTS In our institution, we have used the dual steristrip technique to stabilize the biopsy needle in certain cases where assessment of needle position/trajectory can be more challenging. This includes cases where there is a paucity of soft tissues overlying the bone or if the bone lesion is located in the superficial cortex. We have found it to be successful in 80% of cases. CONCLUSIONS The dual steristrip technique is a safe and effective needle stabilization method that should be considered by the interventional radiologist in challenging CT-guided bone biopsy cases.
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Affiliation(s)
- E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - A Iqbal
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - A Patel
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK.
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Whitney GM, Thomas JJ, Austin TM, Fanfan J, Yaster M. Radiation Safety Perceptions and Practices Among Pediatric Anesthesiologists: A Survey of the Physician Membership of the Society for Pediatric Anesthesia. Anesth Analg 2019; 128:1242-1248. [PMID: 31094794 DOI: 10.1213/ane.0000000000003773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pediatric anesthesiologists are exposed to ionizing radiation from x-rays on an almost daily basis. Our goal was to determine the culture of safety in which they work and how they adhere to preventative strategies that minimize exposure risk in their daily practice. METHODS After Institutional Review Board waiver and approval of the Society for Pediatric Anesthesia's research and quality and safety committees, an electronic e-mail questionnaire was sent to the Society's physician, nontrainee members and consisted of questions specific to provider use of protective lead shielding, the routine use of dosimeters, and demographic information. Univariate analyses were performed using the Wilcoxon rank sum test for ordinal variables, the Fisher exact test for categorical variables, and the Spearman test to analyze correlation between 2 ordinal variables, while a proportional odds logistic regression was used for a multivariable ordinal outcome analysis. P values of <.05 were considered statistically significant. RESULTS Twenty-one percent (674/3151) of the surveyed anesthesiologists completed the online questionnaire. Radiation exposure is ubiquitous (98.7%), and regardless of sex, most respondents were either concerned or very concerned about radiation exposure (76.8%); however, women were significantly more concerned than men (proportional odds ratio, 1.66 [95% confidence interval, 1.20-2.31]; P = .002). Despite this and independent of sex, level of concern was not associated with use of a radiation dosimeter (P = .85), lead glasses (odds ratio, 1.07 [95% confidence interval, 0.52-2.39]; P = 1.0), or a thyroid shield (P = .12). Dosimeters were rarely (13%) or never used (52%) and were mandated in only 28.5% of institutions. Virtually none of the respondents had ever taken a radiation safety course, received a personal radiation dose report, notification of their radiation exposure, or knew how many millirem/y was considered safe. Half of the respondents were female, and while pregnant, 73% (151/206) tried to avoid radiation exposure by requesting not to be assigned to cases requiring x-rays. These requests were honored 78% (160/206) of the time. DISCUSSION Despite universal exposure to ionizing radiation from x-rays, pediatric anesthesiologists do not routinely adhere to strategies designed to limit the intensity of this exposure and rarely work in institutions in which a culture of radiation safety exists. Our study highlights the need to improve radiation safety education, the need to change the safety culture within the operating rooms and imaging suites, and the need to more fully investigate the utility of dosimeters, lead shielding, and eye safety measures in pediatric anesthesia practice.
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Affiliation(s)
- Gina M Whitney
- From the Department of Anesthesiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
| | - James J Thomas
- From the Department of Anesthesiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
| | - Thomas M Austin
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Jemel Fanfan
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Myron Yaster
- From the Department of Anesthesiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
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Isobe A, Kogure Y, Ikeda H, Houshito H. [Construction of Management System Using Application Software for X-ray Protective Clothing Management]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:546-552. [PMID: 31217405 DOI: 10.6009/jjrt.2019_jsrt_75.6.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We jointly developed dedicated application with protective clothing manufacturers for the purpose of improving the diagnostic X-ray protective clothing inspection record and visualization of quality control. Also, we clearly distributed roles and responsibilities for managing protective clothing. Visualization of quality control could be realized by using a tablet as an inspection recording device. By establishing the criteria for unified X-ray protective clothing inspection, we were able to establish the X-ray protective clothing update procedure.
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Affiliation(s)
- Akira Isobe
- Department of Radiology, Juntendo University Hospital
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University
| | | | - Hiroki Ikeda
- Department of Radiology, Juntendo University Hospital
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Cheon BK, Kim CL, Kim KR, Kang MH, Lim JA, Woo NS, Rhee KY, Kim HK, Kim JH. Radiation safety: a focus on lead aprons and thyroid shields in interventional pain management. Korean J Pain 2018; 31:244-252. [PMID: 30310549 PMCID: PMC6177538 DOI: 10.3344/kjp.2018.31.4.244] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/26/2018] [Accepted: 06/18/2018] [Indexed: 12/19/2022] Open
Abstract
C-arm fluoroscopy is useful equipment in interventional pain management because it helps to guide correct needle targeting for the accurate injection and drug delivery. However, due to increased use of C-arm fluoroscopy in various pain procedures, the risk of radiation exposure is a significant concern for pain physicians. The harmful biological effects of ionizing radiation on the human body are well known. It is therefore necessary to strive to reduce radiation exposure. Lead aprons with thyroid shields are the most fundamental radiation protective devices for interventional procedures, and are very effective. However, the operator's radiation safety cannot be guaranteed because pain physicians seem to lack sufficient interest, knowledge, and awareness about radiation safety. Also, inappropriate care and use of radiation protective devices may result in a higher risk of radiation exposure. The purpose of this article was to review the literature on radiation safety with a focus on lead aprons and thyroid shields and present recommendations related to those devices during C-arm fluoroscopic-guided interventions by pain physicians.
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Affiliation(s)
- Bo Kyung Cheon
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Cho Long Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Ka Ram Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Min Hye Kang
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Ae Lim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Nam Sik Woo
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Ka Young Rhee
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hae Kyoung Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Johansen S, Hauge IHR, Hogg P, England A, Lança L, Gunn C, Sanderud A. Are Antimony-Bismuth Aprons as Efficient as Lead Rubber Aprons in Providing Shielding against Scattered Radiation? J Med Imaging Radiat Sci 2018; 49:201-206. [PMID: 32074039 DOI: 10.1016/j.jmir.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/12/2017] [Accepted: 02/01/2018] [Indexed: 10/17/2022]
Abstract
AIM The aim of this study is to compare the absorption ability of two lead-free aprons with a lead apron. METHOD The absorption ability of three aprons was measured and compared; Opaque Fusion 0.35 mm (OpaqFu) bilayer apron containing bismuth and antimony, No Lead 0.35 mm (NoLead) one-layer apron containing antimony, and a lead apron. The measurements were repeated with and without each of the aprons present in both primary and scattered beams. The selected tube voltages were between 60 and 113 kVp with constant mAs, a fixed field size, and fixed source-to-object distance. RESULTS No significant difference in absorption ability of the two lead-free aprons compared with that of the lead apron was observed when the dose was measured in the primary beam. When measurements were performed in the scatter radiation field, the absorption ability of the OpaqFu apron was 1.3 times higher than that of NoLead apron and nearly equal to the absorption ability of the lead apron. An increase in the difference between the OpaqFu and NoLead aprons was observed for the tube energies higher than 100 kVp in favour of OpaqFu apron. CONCLUSION It is safe to use the lead-free aprons that were tested in this study in a clinical environment for the tube energy range of 60 kVp-113 kVp.
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Affiliation(s)
- Safora Johansen
- Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway; Division of Cancer Medicine, Department of Oncology, Oslo University Hospital-Radium Hospital, Oslo, Norway.
| | - Ingrid Helen Ryste Hauge
- Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway; Division of Radiology and Nuclear Medicine, Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Peter Hogg
- School of Health Sciences, University of Salford, Manchester, UK
| | - Andrew England
- School of Health Sciences, University of Salford, Manchester, UK
| | - Luís Lança
- ESTeSL - Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisboa, Portugal; Karolinska Institutet, Stockholm, Sweden
| | - Catherine Gunn
- School of Health Sciences, Dalhousie University, Halifax, Canada
| | - Audun Sanderud
- Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
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Pandey P, Guy P, Hodgson AJ, Abugharbieh R. Fast and automatic bone segmentation and registration of 3D ultrasound to CT for the full pelvic anatomy: a comparative study. Int J Comput Assist Radiol Surg 2018; 13:1515-1524. [PMID: 29804181 DOI: 10.1007/s11548-018-1788-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/09/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Ultrasound (US) is a safer alternative to X-rays for bone imaging, and its popularity for orthopedic surgical navigation is growing. Routine use of intraoperative US for navigation requires fast, accurate and automatic alignment of tracked US to preoperative computed tomography (CT) patient models. Our group previously investigated image segmentation and registration to align untracked US to CT of only the partial pelvic anatomy. In this paper, we extend this to study the performance of these previously published techniques over the full pelvis in a tracked framework, to characterize their suitability in more realistic scenarios, along with an additional simplified segmentation method and similarity metric for registration. METHOD We evaluated phase symmetry segmentation, and Gaussian mixture model (GMM) and coherent point drift (CPD) registration methods on a pelvic phantom augmented with human soft tissue images. Additionally, we proposed and evaluated a simplified 3D bone segmentation algorithm we call Shadow-Peak (SP), which uses acoustic shadowing and peak intensities to detect bone surfaces. We paired this with a registration pipeline that optimizes the normalized cross-correlation (NCC) between distance maps of the segmented US-CT images. RESULTS SP segmentation combined with the proposed NCC registration successfully aligned tracked US volumes to the preoperative CT model in all trials, in contrast to the other techniques. SP with NCC achieved a median target registration error (TRE) of 2.44 mm (maximum 4.06 mm), when imaging all three anterior pelvic structures, and a mean runtime of 27.3 s. SP segmentation with CPD registration was the next most accurate combination: median TRE of 3.19 mm (maximum 6.07 mm), though a much faster runtime of 4.2 s. CONCLUSION We demonstrate an accurate, automatic image processing pipeline for intraoperative alignment of US-CT over the full pelvis and compare its performance with the state-of-the-art methods. The proposed methods are amenable to clinical implementation due to their high accuracy on realistic data and acceptably low runtimes.
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Affiliation(s)
- Prashant Pandey
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada.
| | - Pierre Guy
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Antony J Hodgson
- Department of Mechanical Engineering, University of British Columbia, Vancouver, Canada
| | - Rafeef Abugharbieh
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada
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Sheen JJ, Jiang YY, Kim YE, Maeng JY, Kim TI, Lee DH. Increase in fluoroscopic radiation dose in successive sessions of multistage Onyx embolization of brain arteriovenous malformations compared with the first session. J Neurointerv Surg 2018; 10:e36. [PMID: 29572266 DOI: 10.1136/neurintsurg-2017-013706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/02/2018] [Accepted: 03/04/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Onyx embolization is a treatment for brain arteriovenous malformations (AVMs). However, multistage embolization usually involves the presence of radiodense Onyx cast from the previous sessions, which may influence the fluoroscopic radiation dose. We compared the fluoroscopic dose between the initial and final embolization sessions. MATERIALS AND METHOD From January 2014 to September 2016, 18 patients underwent multistage Onyx embolization (more than twice) for brain AVMs. The total fluoroscopic duration (minutes), dose-area product (DAP, Gy×cm2), and cumulative air kerma (CAK, mGy) of both the frontal and lateral planes were obtained. We compared the frontal and lateral fluoroscopic dose rates (dose/time) of the final embolization session with those of the initial session. The relationship between the injected Onyx volume and radiation dose was tested. RESULTS The initial and final procedures on the frontal plane showed significantly different fluoroscopic dose rates (DAP: initial 0.668 Gy×cm2/min, final 0.848 Gy×cm2/min, P=0.02; CAK: initial 12.7 mGy/min, final 23.1 mGy/min, P=0.007). Those on the lateral plane also showed a similar pattern (DAP: initial 0.365 Gy×cm2/min, final 0.519 Gy×cm2/min, P=0.03; CAK: initial 6.2 mGy/min, final 12.9 mGy/min, P=0.01). The correlation between the cumulative Onyx volume (vials) and radiation dose ratio of both planes showed an increasing trend (rho 0.4325-0.7053; P=0.0011-0.0730). CONCLUSION Owing to the automatic exposure control function during fluoroscopy, successive Onyx embolization procedures increase the fluoroscopic radiation dose in multistage brain AVM embolization because of the presence of radiodense Onyx mass.
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Affiliation(s)
- Jae Jon Sheen
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Yuan Yuan Jiang
- Department of Biotechnology, Dongguk University, Ilsan, Korea (the Republic of)
| | - Young Eun Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Jun Young Maeng
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Tae-Il Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
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Impact of the Ceiling-Mounted Radiation Shielding Position on the Physician's Dose from Scatter Radiation during Interventional Procedures. Radiol Res Pract 2018; 2018:4287973. [PMID: 29666706 PMCID: PMC5831950 DOI: 10.1155/2018/4287973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/12/2017] [Accepted: 12/21/2017] [Indexed: 11/18/2022] Open
Abstract
The effect of the ceiling-mounted radiation shielding on the amount of the scatter radiation was assessed under conditions simulating obese patients for clinically relevant exposure parameters. Measurements were performed in different projections and with different positions of the ceiling-mounted shielding: without shielding; shielding closest to the patient; and shielding closest to the physician performing the procedure. The protection provided by the shielding was assessed for cardiology when the femoral access is used and for radiology when the physician performs the procedure in the abdominal area. The results show that the use of the ceiling-mounted shielding can decrease the dose from the scatter radiation by 95% at the position of the performing physician. In cardiology, the impact is more pronounced when the left oblique projection is used. In radiology, a large decrease was observed for right oblique projections, compared to cardiology. The ceiling-mounted shielding should be placed as close to the physician as possible. The idea of creating the largest radiation shadow by placing the radiation shielding as close to the patient as possible does not provide as effective radiation protection of the operator as it might be thought.
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Smith JR, Marsh RM, Silosky MS. Is lead shielding of patients necessary during fluoroscopic procedures? A study based on kyphoplasty. Skeletal Radiol 2018; 47:37-43. [PMID: 28821928 DOI: 10.1007/s00256-017-2756-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the benefits, risks, and limitations associated with wrapping a patient with lead shielding during fluoroscopy-guided kyphoplasty procedures as a way to reduce operator radiation exposure. MATERIALS AND METHODS An anthropomorphic phantom was used to mimic a patient undergoing a kyphoplasty procedure under fluoroscopic guidance. Radiation measurements of the air kerma rate (AKR) were made at several locations and under various experimental conditions. First, AKR was measured at various angles along the horizontal plane of the phantom and at varying distances from the phantom, both with and without a lead apron wrapped around the lower portion of the phantom (referred to here as phantom shielding). Second, the effect of an operator's apron was simulated by suspending a lead apron between the phantom and the measurement device. AKR was measured for the four shielding conditions-phantom shielding only, operator apron only, both phantom shielding and operator apron, and no shielding. Third, AKR measurements were made at various heights and with varying C-arm angle. RESULTS At all locations, the phantom shielding provided no substantial protection beyond that provided by an operator's own lead apron. Phantom shielding did not reduce AKR at a height comparable to that of an operator's head. CONCLUSIONS Previous reports of using patient shielding to reduce operator exposure fail to consider the role of an operator's own lead apron in radiation protection. For an operator wearing appropriate personal lead apparel, patient shielding provides no substantial reduction in operator dose.
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Affiliation(s)
- Joshua R Smith
- Department of Radiology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop C278, Aurora, CO, 80045, USA
| | - Rebecca M Marsh
- Department of Radiology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop C278, Aurora, CO, 80045, USA.
| | - Michael S Silosky
- Department of Radiology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop C278, Aurora, CO, 80045, USA
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Eye lens radiation exposure of the medical staff performing interventional urology procedures with an over-couch X-ray tube. Phys Med 2017; 43:140-147. [DOI: 10.1016/j.ejmp.2017.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/21/2017] [Accepted: 11/02/2017] [Indexed: 01/28/2023] Open
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Kim MJ, Kim JH. Radiation exposure and protection for eyes in pain management. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.4.297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Min Jung Kim
- Department Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Monzen H, Tamura M, Shimomura K, Onishi Y, Nakayama S, Fujimoto T, Matsumoto K, Hanaoka K, Kamomae T. A novel radiation protection device based on tungsten functional paper for application in interventional radiology. J Appl Clin Med Phys 2017; 18:215-220. [PMID: 28422397 PMCID: PMC5689848 DOI: 10.1002/acm2.12083] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/17/2017] [Accepted: 02/17/2017] [Indexed: 11/11/2022] Open
Abstract
Tungsten functional paper (TFP), which contains 80% tungsten by weight, has radiation‐shielding properties. We investigated the use of TFP for the protection of operators during interventional or therapeutic angiography. The air kerma rate of scattered radiation from a simulated patient was measured, with and without TFP, using a water‐equivalent phantom and fixed C‐arm fluoroscopy. Measurements were taken at the level of the operator's eye, chest, waist, and knee, with a variable number of TFP sheets used for shielding. A Monte Carlo simulation was also utilized to analyze the dose rate delivered with and without the TFP shielding. In cine mode, when the number of TFP sheets was varied through 1, 2, 3, 5, and 10, the respective reduction in the air kerma rate relative to no TFP shielding was as follows: at eye level, 24.9%, 29.9%, 41.6%, 50.4%, and 56.2%; at chest level, 25.3%, 33.1%, 34.9%, 46.1%, and 44.3%; at waist level, 45.1%, 57.0%, 64.4%, 70.7%, and 75.2%; and at knee level, 2.1%, 2.2%, 2.1%, 2.1%, and 2.1%. In fluoroscopy mode, the respective reduction in the air kerma rate relative to no TFP shielding was as follows: at eye level, 24.8%, 30.3%, 34.8%, 51.1%, and 58.5%; at chest level, 25.8%, 33.4%, 35.5%, 45.2%, and 44.4%; at waist level, 44.6%, 56.8%, 64.7%, 71.7%, and 77.2%; and at knee level, 2.2%, 0.0%, 2.2%, 2.8%, and 2.5%. The TFP paper exhibited good radiation‐shielding properties against the scattered radiation encountered in clinical settings, and was shown to have potential application in decreasing the radiation exposure to the operator during interventional radiology.
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Affiliation(s)
- Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, Osakasayama, 589-8511, Japan
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, Osakasayama, 589-8511, Japan.,Clinical Radiology Service Division, Kindai University Hospital, Osakasayama, 589-8511, Japan
| | - Kohei Shimomura
- Clinical Radiology Service Division, Kindai University Hospital, Osakasayama, 589-8511, Japan
| | - Yuichi Onishi
- Division of Clinical Radiology Service, Okayama Central Hospital, Okayama, 700-0017, Japan
| | - Shinichi Nakayama
- Division of Clinical Radiology Service, Okayama Central Hospital, Okayama, 700-0017, Japan
| | - Takahiro Fujimoto
- Clinical Radiology Service Division, Kyoto University Hospital, Kyoto, 606-8507, Japan
| | - Kenji Matsumoto
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, Osakasayama, 589-8511, Japan.,Clinical Radiology Service Division, Kindai University Hospital, Osakasayama, 589-8511, Japan
| | - Kohei Hanaoka
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, Osakasayama, 589-8511, Japan.,Clinical Radiology Service Division, Kindai University Hospital, Osakasayama, 589-8511, Japan
| | - Takeshi Kamomae
- Department of Therapeutic Radiology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
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Kim TH, Hong SW, Woo NS, Kim HK, Kim JH. The radiation safety education and the pain physicians' efforts to reduce radiation exposure. Korean J Pain 2017; 30:104-115. [PMID: 28416994 PMCID: PMC5392654 DOI: 10.3344/kjp.2017.30.2.104] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND C-arm fluoroscopy equipment is important for interventional pain management and can cause radiation injury to physicians and patients. We compared radiation safety education and efforts to reduce the radiation exposure of pain specialists. METHODS A survey of 49 pain specialists was conducted anonymously in 2016. The questionnaire had 16 questions. That questionnaire was about radiation safety knowledge and efforts to reduce exposure. We investigated the correlation between radiation safety education and efforts of radiation protection. We compared the results from 2016 and a published survey from 2011. RESULTS According to the 2016 survey, all respondents used C-arm fluoroscopy in pain interventions. Nineteen respondents (39%) had received radiation safety education. Physicians had insufficient knowledge about radiation safety. When the radiation safety education group and the non-education group are compared, there was no significant difference in efforts to reduce radiation exposure and radiation safety knowledge. When the 2011 and 2016 surveys were compared, the use of low dose mode (P = 0.000) and pulsed mode had increased significantly (P = 0.001). The number checking for damage to radiation protective garments (P = 0.000) and use of the dosimeter had also increased significantly (P = 0.009). But there was no significant difference in other efforts to reduce radiation exposure. CONCLUSIONS Pain physicians seem to lack knowledge of radiation safety and the number of physicians receiving radiation safety education is low. According to this study, education does not lead to practice. Therefore, pain physicians should receive regular radiation safety education and the education should be mandatory.
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Affiliation(s)
- Tae Hee Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Seung Wan Hong
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Nam Sik Woo
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hae Kyoung Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Balter S. PROMOTING FLUOROSCOPIC PERSONAL RADIATION PROTECTION EQUIPMENT: UNFAMILIARITY, FACTS AND FEARS. RADIATION PROTECTION DOSIMETRY 2017; 173:180-184. [PMID: 27885096 DOI: 10.1093/rpd/ncw307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
An incomplete understanding of risk can cause inappropriate fear. Personal protective equipment (PPE) offered for the prevention of brain cancer in interventional fluoroscopists (IR-PPE). Similar items are offered for cell-phone use (RF-PPE). Publications on fluoroscopy staff brain cancer and similar papers on cell-phone induced brain cancer were reviewed. An internet safety product search was performed, which resulted in many tens of thousands of hits. Vendor claims for either ionizing radiation or radio frequency products seldom addressed the magnitude of the risk. Individuals and institutions can buy a wide variety of safety goods. Any purchase of radioprotective equipment reduces the funds available to mitigate other safety risks. The estimated cost of averting an actuarial fatal brain cancer appears to be in the order of magnitude $10 000 000-$100 000 000. Unwarranted radiation fears should not drive the radiation protection system to the point of decreasing overall safety.
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Affiliation(s)
- Stephen Balter
- Columbia University Medical Center, New York, NY 10032, USA
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Subramanian S, Waller BR, Winders N, Bird LE, Agrawal V, Zurakowski D, Kuhls-Gilcrist A, Khandkar A, Sathanandam SK. Clinical evaluation of a radio-protective cream for the hands of the pediatric interventional cardiologist. Catheter Cardiovasc Interv 2017; 89:709-716. [PMID: 27888578 DOI: 10.1002/ccd.26845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/08/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effectiveness of UltraBLOX™ radiation attenuating hand cream during lengthy cardiac catheterization procedures in children. BACKGROUND The hands of interventional cardiologists receive high doses of radiation due to their proximity to the X-ray beam. Radiation attenuating gloves have about a 26% attenuation rate, but reduce dexterity and tactile sensation. The UltraBLOX™ cream is a new FDA-approved X-ray attenuating cream that can be applied to the operator's hands for radio-protection. METHODS Two nanoDot™ dosimeters were secured side by side on the dorsum of the operator's (n = 2) left hand close to the wrist. One dosimeter and the rest of the hand were covered with 0.2 mm layer of the cream. The other dosimeter was unshielded. Procedures were performed using 110 kVp fluoroscopy at 15 pulses/sec. The measurements were categorized into four groups dependent on the duration of the procedure. The patients in all four groups were well matched for age and size. RESULTS Procedural and cumulative hand radiation doses were higher with longer procedural duration. The overall % attenuation by the cream was 39.7% (28.6-51.5) and was unaffected by the length of the procedure (median: 40.9% at 30 min and 41.4% at 180 min; P = 0.66) or the dose of radiation. The kappa statistic for interobserver agreement for good tactile sensitivity was 0.82. CONCLUSIONS UltraBLOX™ cream provides a new option for radio-protection for the hands of interventional cardiologists without impairing tactile sensitivity. There was no decrease in attenuation up to 180 min. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Saradha Subramanian
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - B Rush Waller
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | | | - Lindsey E Bird
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Vijaykumar Agrawal
- Department of Radiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - David Zurakowski
- Department of Biostatistics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Shyam K Sathanandam
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
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Kaplan DJ, Patel JN, Liporace FA, Yoon RS. Intraoperative radiation safety in orthopaedics: a review of the ALARA (As low as reasonably achievable) principle. Patient Saf Surg 2016; 10:27. [PMID: 27999617 PMCID: PMC5154084 DOI: 10.1186/s13037-016-0115-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/05/2016] [Indexed: 11/23/2022] Open
Abstract
The use of fluoroscopy has become commonplace in many orthopaedic surgery procedures. The benefits of fluoroscopy are not without risk of radiation to patient, surgeon, and operating room staff. There is a paucity of knowledge by the average orthopaedic resident in terms proper usage and safety. Personal protective equipment, proper positioning, effective communication with the radiology technician are just of few of the ways outlined in this article to decrease the amount of radiation exposure in the operating room. This knowledge ensures that the amount of radiation exposure is as low as reasonably achievable. Currently, in the United States, guidelines for teaching radiation safety in orthopaedic surgery residency training is non-existent. In Europe, studies have also exhibited a lack of standardized teaching on the basics of radiation safety in the operating room. This review article will outline the basics of fluoroscopy and educate the reader on how to safe fluoroscopic image utilization.
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Affiliation(s)
- Daniel J Kaplan
- Department of Orthopaedic Surgery, RWJBarnabas Health - Jersey City Medical Center, 355 Grand St, Jersey City, NJ 07302 USA
| | - Jay N Patel
- Department of Orthopaedic Surgery, RWJBarnabas Health - Jersey City Medical Center, 355 Grand St, Jersey City, NJ 07302 USA
| | - Frank A Liporace
- Department of Orthopaedic Surgery, RWJBarnabas Health - Jersey City Medical Center, 355 Grand St, Jersey City, NJ 07302 USA
| | - Richard S Yoon
- Division of Orthopaedic Traumatology & Complex Adult Reconstruction, Department of Orthopaedic Surgery, Orlando Regional Medical Center, 1222 S Orange Ave, 5th Floor, Orlando, FL 32806 USA
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Alahmari MAS, Sun Z, Bartlett A. RADIATION PROTECTION IN AN INTERVENTIONAL LABORATORY: A COMPARATIVE STUDY OF AUSTRALIAN AND SAUDI ARABIAN HOSPITALS. RADIATION PROTECTION DOSIMETRY 2016; 172:453-465. [PMID: 26838067 DOI: 10.1093/rpd/ncv547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 06/05/2023]
Abstract
This study aimed to investigate whether the use of protection devices and attitudes of interventional professionals (including radiologists, cardiologists, vascular surgeons, medical imaging technicians and nurses) towards radiation protection will differ between Saudi Arabian and Australian hospitals. Hard copies of an anonymous survey were distributed to 10 and 6 clinical departments in the Eastern province of Saudi Arabia and metropolitan hospitals in Western Australia, respectively. The overall response rate was 43 % comprising 110 Australian participants and 63 % comprising 147 Saudi participants. Analysis showed that Australian respondents differed significantly from Saudi respondents with respect to their usages of leaded glasses (p < 0.001), ceiling-suspended lead screen (p < 0.001) and lead drape suspended from the table (p < 0.001). This study indicates that the trained interventional professionals in Australia tend to adhere to benefit from having an array of tools for personal radiation protection than the corresponding group in Saudi Arabia.
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Affiliation(s)
- Mohammed Ali S Alahmari
- Department of Medical Radiation Sciences, School of Science, Curtin University, Perth, Western Australia 6845, Australia
- Department of Radiology, King Fahad Hospital of the University of Dammam, Dammam 31444, Saudi Arabia
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, School of Science, Curtin University, Perth, Western Australia 6845, Australia
| | - Andrew Bartlett
- Cardiac and Vascular Laboratory, St John of God Subiaco Hospital, Subiaco, Western Australia 6008 Australia
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Balter S, Chambers CE. Radiation Management in Interventional Cardiology. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
STUDY DESIGN Anthropomorphic phantoms were used to measure radiation exposure to the surgeon phantom's eye. Groups analyzed were: Group 1-no glasses (None); Group 2-leaded lenses without lead sides (WOLS); Group 3-leaded lenses with lead sides (WLS); and Group 4-sport wraparound leaded glasses (Sport). Glasses were 0.75 mm lead equivalent. OBJECTIVE To evaluate the efficacy of three types of leaded eyeglasses at reducing radiation exposure to the lens during typical views of minimally invasive spine surgery. SUMMARY OF BACKGROUND DATA Minimally invasive spine surgery relies upon fluoroscopic x-ray. Ocular radiation exposure is associated with cataract formation. Leaded glasses can reduce ocular radiation exposure. METHODS Fifteen individual 20-second exposures with the fluoroscopic C-arm in the anteroposterior (AP) and lateral positions, with phantom head positioned at 0, 45, and 90 degrees to the fluoroscope were performed. Radiation was measured using a solid-state dosimeter. Student t test was used to calculate significance. RESULTS All glasses (WOLS, WLS, and Sport) had significant reductions in ocular radiation versus no glasses, at all individual head positions (P ≤ 1.31 × 10). Sport had significantly lower ocular radiation dose than WLS at all head positions except at 90 degrees AP (P = 0.001). WOLS had significantly lower ocular radiation dose than Sport in three out of six cases including phantom head at 0 degrees AP (P = 0.0003), 90 degrees AP (P = 4.46 × 10), and 90 degrees lateral (P = 7.38 × 10). WOLS had significantly lower radiation dosage at all head positions than WLS except at 45 degrees AP (P = 0.303). All glasses resulted in a significant reduction in total radiation dose from all head positions over no glasses (P ≤ 8.37 × 10). CONCLUSION We demonstrate a significant reduction in ocular radiation exposure with all three types of leaded glasses. Lead glasses, WOLS and Sport, were the most effective at reducing ocular radiation. LEVEL OF EVIDENCE 3.
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Kirkwood ML, Guild JB, Arbique GM, Anderson JA, Valentine RJ, Timaran C. Surgeon radiation dose during complex endovascular procedures. J Vasc Surg 2015; 62:457-63. [DOI: 10.1016/j.jvs.2015.02.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/25/2015] [Indexed: 10/23/2022]
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Editor's Choice – Minimizing Radiation Exposure During Endovascular Procedures: Basic Knowledge, Literature Review, and Reporting Standards. Eur J Vasc Endovasc Surg 2015; 50:21-36. [DOI: 10.1016/j.ejvs.2015.01.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/27/2015] [Indexed: 12/30/2022]
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Moon Y, Won J, Choi J. Spring-Loaded Type Robotic Mechanism and Sequential Procedure for Automatic Biopsy1. J Med Device 2015. [DOI: 10.1115/1.4030148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Youngjin Moon
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul 138-736, Korea
| | - Jongseok Won
- Graduate School of Convergence Science and Technology, Seoul National University, Seoul 151-742, Korea
| | - Jaesoon Choi
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul 138-736, Korea
- College of Medicine, University of Ulsan, Ulsan 680-749, Korea
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Moon Y, Jae Choi H, Beom Seo J, Choi J. Design and Kinematic Analysis of a New End-Effector for a Robotic Needle Insertion-Type Intervention System. INT J ADV ROBOT SYST 2014. [DOI: 10.5772/59350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This paper presents a new end-effector as a key component for a robotic needle insertion-type intervention system and its kinematic analysis. The mechanism is designed as a spherical mechanism with a revolute joint and a curved sliding joint, and its links always move on the surface of a sphere. The remote centre of motion (RCM) of the designed mechanism is placed below the base of the mechanism to avoid contact with the patient's body, unlike the conventional end-effectors developed for needle insertion. For the proposed mechanism, the forward kinematics are solved in terms of input joint parameters and then the reverse kinematics are solved by using the cross-product relationship between each joint vector and a vector mutually perpendicular to the vectors. The kinematic solutions are confirmed by numerical examples.
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Domienik J, Bissinger A, Zmyślony M. The impact of x-ray tube configuration on the eye lens and extremity doses received by cardiologists in electrophysiology room. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2014; 34:N73-N79. [PMID: 25325561 DOI: 10.1088/0952-4746/34/4/n73] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of the study was to analyse the influence of the x-ray tube configuration on the radiation doses to eye lens and extremities of cardiologists performing pacemaker implantation procedures in electrophysiology laboratory. The measurements were performed on one, widely used, portable C-arm system, first with x-ray tube mounted above the patient table and image intensifier below it and then on a reinstalled (but essentially the same) system with under-table x-ray tube configuration. Thermoluminescent dosimeters, placed in various positions near the eye lens, on the hands and ankle, were used during every procedure. The comparison of doses received by cardiologists after changing the x-ray tube configuration from over- to under-table shows statistically significant dose reduction (p < 0.009) for the eye lens closest to the x-ray tube, left finger, left wrist, while for the ankle a dose increase is observed. The corresponding over- to under-table x-ray tube median dose ratios are 4.1 for the right eye, 4.8 for the left finger, 3.0 for left wrist and, finally, 0.13 for the right ankle. Systems with under-table x-ray tube are preferable from a radiation protection point of view. The observed significant increase in doses to the legs should be partially compensated by the use of a protective lead curtain.
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Affiliation(s)
- J Domienik
- Nofer Institute of Occupational Medicine, Radiation Protection Department, Lodz, Poland
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Pasciak AS, Jones AK. Time to take the gloves off: the use of radiation reduction gloves can greatly increase patient dose. J Appl Clin Med Phys 2014; 15:5002. [PMID: 25493525 PMCID: PMC5711104 DOI: 10.1120/jacmp.v15i6.5002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 08/03/2014] [Accepted: 07/24/2014] [Indexed: 12/22/2022] Open
Abstract
Sterile radiation reduction gloves have been widely used over the past several decades in an effort to reduce hand doses during fluoroscopically guided procedures. While multiple studies have quantified the potential dose reduction to the fluoroscope operator from the use of such gloves, possible effects on the patient have not yet been quantified. The aim of this study was to examine the impact on patient dose when radiation reduction gloves are used. The impact on patient dose when using radiation reduction gloves in the field of view (FOV) was evaluated by measuring patient entrance surface dose rates (ESDR) using three C‐arm fluoroscopes for a range of patient sizes and different operating and magnification modes. Multiple measuring fields were used in combination with both peripheral and central glove placement. ESDR were measured with no glove in the FOV, with one radiation reduction glove, and with double gloves in the FOV, to replicate the actions of some fluoroscope operators. Compared to an ungloved hand, the use of a single radiation reduction glove in the measuring field resulted in up to a 2.8‐fold increase in ESDR. The use of double radiation reduction gloves resulted in up to a 4.9‐fold increase in ESDR. In both cases, the increase in ESDR was dependent on the size of the patient and on the operating and magnification modes used, and ranged from no increase up to the aforementioned maximum. When used in the FOV, and particularly within the measuring field, radiation reduction gloves can substantially increase ESDR. This increase in dose, when considered against the relatively small published reduction in dose to the operator's hands, may mean that the increased risks from the use of radiation reduction gloves outweigh the benefits. In any case, hands should not be placed in the FOV if not required by the goals of the procedure. PACS number: 87.59.C‐
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