Clinical evaluation of a radio-protective cream for the hands of the pediatric interventional cardiologist

Influence of radiation dose reduction gloves on exposure parameters, entrance dose rates and eye doses of interventionalists during mobile C-arm fluoroscopic procedures: A phantom study

INTRODUCTION

During fluoroscopic examinations, radiation dose reduction gloves (RRGs) protect the hands of the interventionalist against ionising scattered radiation from the patient. Some fluoroscopic procedures may require the hands of the interventionalist in the path of the primary X-ray beam. This study investigates the influence of RRGs in the field of view (FOV) on exposure parameters, entrance dose rates and eye doses of interventionalists during mobile C-arm fluoroscopic procedures.

METHOD

Polymethylmethacrylate (PMMA) slabs were stacked on each other to simulate patient thicknesses. The abdomen protocol of the unit was selected for the study. The entrance dose rates to the surface of the PMMA slabs and the scattered radiation were measured for an undercouch configuration with and without RRGs in the FOV. The exposure parameters were noted. The scattered radiation for an overcouch configuration was measured.

RESULTS

The entrance dose rate increases as the FOV decreases for a fixed thickness of PMMA. The presence of RRGs in the FOV increases the exposure parameters, entrance dose rates and the scattered radiation to the eyes of the interventionalist. For the first level of RRG coverage, percentage increases in entrance dose rates and eye doses for the 23 cm FOV for all thicknesses of PMMA slabs ranged from 1.0% to 17.0% and 20.0%-30.0%, respectively; for the second level of RRG coverage, the entrance dose rates ranged from 17.0% to 45.0% and the eye doses from 50.0% to 60.0%. Percentage increases depend on the FOV, the patient's thickness, and the size and orientation of the RRGs in the FOV. Scattered radiation to the eyes of the interventionalist increases with an overcouch configuration compared to an undercouch configuration.

CONCLUSION

Sterile RRGs protects the hands of the interventionalist against scattered radiation. But in the FOV, they increase the scattered radiation to the personnel and the patient entrance dose rate.

IMPLICATIONS FOR PRACTICE

For best practice in C-arm fluoroscopy-guided procedures, appropriate FOV and C-arm orientation should be selected, whilst RRGs should not be in the path of the primary beam unless necessary.

Radiation protection for the interventional cardiologist: Practical approach and innovations

Use of ionizing radiation during cardiac catheterization interventions adversely impacts both the patients and medical staff. In recent years, radiation dose in cardiac catheterization interventions has become a topic of increasing interest in interventional cardiology and there is a strong interest in reducing radiation exposure during the procedures. This review presents the current status of radiation protection in the cardiac catheterization laboratory and summarizes a practical approach for radiation dose management for minimizing radiation exposure. This review also presents recent innovations that have clinical potential for reducing radiation during cardiac interventions.

Self-reported radiation safety behaviors among veterinary specialists and residents performing fluoroscopic procedures on small animals

OBJECTIVE

To describe the radiation safety behaviors of veterinary specialists performing small animal fluoroscopic procedures and examine potential risk factors for these behaviors, including knowledge of radiation risk and training regarding machine operating parameters.

SAMPLE

197 veterinary specialists and residents in training.

PROCEDURES

An electronic questionnaire was distributed to members of the American Colleges of Veterinary Internal Medicine (subspecialties of cardiology and small animal internal medicine), Veterinary Radiology, and Veterinary Surgery.

RESULTS

The overall survey response rate was 6% (240/4,274 email recipients). Of the 240 respondents, 197 (82%) had operated an x-ray unit for a small animal fluoroscopic procedure in the preceding year and fully completed the questionnaire. More than 95% of respondents believed that radiation causes cancer, yet approximately 60% of respondents never wore hand or eye protection during fluoroscopic procedures, and 28% never adjusted the fluoroscopy machine operating parameters for the purpose of reducing their radiation dose. The most common reasons for not wearing eye shielding included no requirement to wear eyeglasses, poor fit, discomfort, and interference of eyeglasses with task performance. Respondents who had received training regarding machine operating parameters adjusted those parameters to reduce their radiation dose during procedures significantly more frequently than did respondents who had not received training.

CONCLUSIONS AND CLINICAL RELEVANCE

On the basis of the self-reported suboptimal radiation safety practices among veterinary fluoroscopy users, we recommend formal incorporation of radiation safety education into residency training programs. All fluoroscopy machine operators should be trained regarding the machine operating parameters that can be adjusted to reduce occupational radiation exposure.

Reduced radiation exposure in the cardiac catheterization laboratory with a novel vertical radiation shield

Objectives

Investigation of novel vertical radiation shield (VRS) in reducing operator radiation exposure.

Background

Radiation exposure to the operator remains an occupational health hazard in the cardiac catheterization laboratory (CCL).

Methods

A mannequin simulating an operator was placed near a computational phantom, simulating a patient. Measurement of dose equivalent and Air Kerma located the angle with the highest radiation, followed by a common magnification (8 in.) and comparison of horizontal radiation absorbing pads (HRAP) with or without VRS with two different: CCL, phantoms, and dosimeters. Physician exposure was subsequently measured prospectively with or without VRS during clinical procedures.

Results

Dose equivalent and Air Kerma to the mannequin was highest at left anterior oblique (LAO)‐caudal angle (p < .005). Eight‐inch magnification increased mGray by 86.5% and μSv/min by 12.2% compared to 10‐in. (p < .005). Moving 40 cm from the access site lowered μSv/min by 30% (p < .005). With LAO‐caudal angle and 8‐in. magnification, VRS reduced μSv/min by 59%, (p < .005) in one CCL and μSv by 100% (p = .016) in second CCL in addition to HRAP. Prospective study of 177 procedures with HRAP, found VRS lowered μSv by 41.9% (μSv: 15.2 ± 13.4 vs. 26.2 ± 31.4, p = .001) with no difference in mGray. The difference was significant after multivariate adjustment for specified variables (p < .001).

Conclusions

Operator radiation exposure is significantly reduced utilizing a novel VRS, HRAP, and distance from the X‐ray tube, and consideration of lower magnification and avoiding LAO‐caudal angles to lower radiation for both operator and patient.