A Review of Radiation Protection Solutions for the Staff in the Cardiac Catheterisation Laboratory

How efficient are metal-polymer and dual-metals-polymer non-lead radiation shields?

INTRODUCTION

Lead shields are often used to attenuate ionising radiations. However, to make lighter, recyclable and more efficient shields compared to lead, combinations of new metallic compounds together with polymer, for example, flexible polyvinyl chloride (PVC) have been developed recently. In this study, the capabilities of non-lead radiation shields made of one or two metallic compounds and polymer were evaluated.

METHODS

Monte Carlo (MC)-based BEAMnrc code was used to build a functional model based on a Philips X-ray machine in the range of radiographic energies. The MC model was then verified by IPEM Report 78 as a standardised global reference. The MC model was then used to evaluate the efficiency of non-lead-based garments made of metallic compound and polymer (MCP) including BaSO4 -PVC, Bi2 O3 -PVC, Sn-PVC and W-PVC, as well as dual-metallic compounds and polymer (DMCP) including Bi2 O3 -BaSO4 -PVC, Bi2 O3 -Sn-PVC, W-Sn-PVC and W-BaSO4 -PVC. The absorbed doses were determined at the surface of a water phantom and compared directly with the doses obtained for 0.5 mm pure lead (Pb).

RESULTS

Bi2 O3 -BaSO4 -PVC and W-BaSO4 -PVC were found to be efficient shields for most of the energies. In addition to the above radiation shields, Bi2 O3 -Sn-PVC was also found to be effective for the spectrum of 60 keV. Bi2 O3 -BaSO4 -PVC as a non-lead dual metals-PVC shield was shown to be more efficient than pure lead in diagnostic X-ray range.

CONCLUSION

Combination of two metals-PVC, a low atomic number (Z) metal together with a high atomic number metal, and also single-metal-PVC shields were shown to be efficient enough to apply as radiation protection shields instead of lead-based garments.

Measurement of Occupational Eye and Thyroid Radiation Doses in Pediatric Interventional Cardiologists at a Tertiary Hospital

Background Advances in imaging techniques have led to increased utilization of imaging devices in catheterization laboratories. Invasive surgical procedures for cardiac disorders have been largely replaced by fluoroscopic cardiac catheterization. With this increase, concerns and risks associated with exposure to ionizing radiation among interventional cardiologists are growing. This study aims to measure and compare the occupational doses to the eye lens and thyroid of pediatric interventional cardiologists during different procedures in the catheterization laboratory and its significance. Methodology In this study, cardiologists wore bandanas with attached dosimeters to measure the absorbed doses to the eyes and thyroid gland. The dosimeters were collected for reading. The procedure types were also collected. In addition, the total fluoroscopy time and tube voltage of the biplane machine were measured. SPSS version 23 (IBM Corp., Armonk, NY, USA) was used to analyze the data. The characteristics of the study sample were described using simple counts and percentages, whereas means and standard deviations were used for continuous variables. Statistical significance was set at p-values <0.05. Results A total of 93 procedures were evaluated. The mean absorbed doses for all 93 procedures in both eyes and thyroid were 0.09 mGy and 0.08 mGy, respectively. A significant difference was found between the left and right eye measurements (p = 0.034), with higher doses administered to the left eye. However, no significant difference was observed between the right and left thyroid doses (p = 0.281). Significant correlations were found between the eye and thyroid doses and the procedure type (p = 0.02 and p = 0.009, respectively). Conclusions A significant amount of radiation was measured in the measurements of both organs. In addition, radiation dose measurements varied between different types of procedures. Our current results indicate the importance and necessity of applying the radiation protection concept of dose optimization.

Lead Cap Use in Interventional Cardiology: Time to Protect Our Head in the Cardiac Catheterisation Laboratory?

Background: Radiation exposure is an occupational hazard for interventional cardiologists and cardiac catheterisation laboratory staff that can manifest with serious long-term health consequences. Personal protective equipment, including lead jackets and glasses, is common, but the use of radiation protective lead caps is inconsistent. Methods: A systematic review qualitative assessment of five observational studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines protocol was performed. Results: It was concluded that lead caps significantly reduce radiation exposure to the head, even when a ceiling-mounted lead shield was present. Conclusion: Although newer protective systems are being studied and introduced, tools, such as lead caps, need to be strongly considered and employed in the catheterisation laboratory as mainstay personal protective equipment.

Spectra, fluence and absorbed doses in sensitive organs due to scattered X-rays during a chest CT

The use of ionizing radiation for the treatment and diagnosis of diseases is becoming more frequent. The technologies associated with diagnostic imaging are constantly evolving, allowing faster and cheaper diagnoses to benefit the patient. However, this has caused an increase in the exposure to ionizing radiation of patients and health professionals. One of the diagnostic techniques for obtaining high-resolution anatomical images of patients is computed tomography (CT). Due to the detail and quality of the images obtained with CT, its use is becoming more frequent. The information provided by these images allows the specialist to make better diagnoses; however, exposure to X-rays deposits a dose in the patient. CT represents approximately 20% of all X-ray examinations but it is responsible for 70% of the medical dose accumulated by the patient. During the acquisition of the images, the highest dose is deposited in the area of the body whose image is to be obtained. During the incidence of X-rays, there is dispersion of these that reach sensitive organs whose dose is not evaluated. The objective of this work was to estimate, using Monte Carlo methods, the fluence and X-ray spectra and to obtain a factor that allows knowing the absorbed dose in sensitive organs due to scattered radiation during a chest CT. With the MCNP5 code, the CT equipment and a hybrid anthropomorphic phantom, type BOMAB it was found that the absorbed dose in these organs depends on the size of the organ and the distance between the organ and the surface of the slice on the thorax where the X-rays are incident.

CURRENT TRENDS OF RADIATION PROTECTION EQUIPMENT IN INTERVENTIONAL RADIOLOGY

Interventional radiology represents subspecialty of radiology, which does not use imaging modalities only for diagnostics, but mostly for therapeutic purposes. Realisation of interventional procedures is done through X-rays, which replaces direct visual control done by interventional radiologist or cardiologist. For the targeted reduction of the radiation exposure, the interventional radiology staff use personal protective equipment. Usually, aprons with lead-equivalent are used, which provide protection for 75% of the radiosensitive organs. As the eye lens and thyroid gland belong to the radiosensitive organs, lead eyeglasses and thyroid collar are commonly used for their protection. Cap and gloves with lead-equivalent can be utilised as an additional personal protective equipment, that is commercially available. Innovative protection systems, such as mobile radiation protection cabin and suspended radiation protection, have been designed to ensure better radiation protection and safety. These systems provide the comfort for the interventional radiologists at work, while offering better protection against ionising radiation.

What are useful methods to reduce occupational radiation exposure among radiological medical workers, especially for interventional radiology personnel?

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.

Impact of the incorrect use of lead drapes on staff and patient doses in interventional radiology

To evaluate the usefulness of commercially available scatter reduction drapes in mitigating staff exposure in interventional radiology and the potential harmful effects of drape malpositioning in terms of exposure levels to both patients and staff. An anthropomorphic phantom was irradiated on an angiography device under three scenarios: no drape and correct and incorrect drape positioning. Different levels of incorrect drape positioning relative to the field-of-view (FOV) were evaluated: slight, mild and severe. Real-time dosimeter systems (positioned on the operator's eye, chest and thyroid) were used to evaluate accumulative doses and dose rates. Different obstruction levels were evaluated and compared to the observer's perception. Additionally, patient exposure was evaluated for all scenarios using a dose area product (DAP). Up to a mild obstruction, by using the drape a dose reduction of up to 86% was obtained while a severe obstruction produced a 1000% increase in exposure, respectively for all dosimeter positions compared to the use of no drape. A similar order of magnitude was observed for patient exposure. Good agreement was obtained for the observer perception of the FOV obstruction up to 25% of the FOV; for larger obstructions, an overestimate of the obstruction was observed. Patient lead drapes can reduce staff doses in interventional radiology procedures even when mildly malpositioned and obscuring the FOV. Special attention to protective drape positioning is necessary, since the severe obstruction of the FOV results in a large increase in both operator and patient exposure.

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.

Safety and effectiveness of strategies to reduce radiation exposure to proceduralists performing cardiac catheterization procedures: a systematic review

OBJECTIVE

The objective of this systematic review was to synthesize the best available evidence on the effect of various radiation protection strategies on radiation dose received by proceduralists performing cardiac catheterization procedures involving fluoroscopy.

INTRODUCTION

Cardiac catheterization procedures under fluoroscopy are the gold standard diagnostic and treatment method for patients with coronary artery disease. The growing demand of procedures means that proceduralists are being exposed to increasing amounts of radiation, resulting in an increased risk of deterministic and stochastic effects. Standard protective strategies and equipment such as lead garments reduce radiation exposure; however, the evidence surrounding additional equipment is contradictory.

INCLUSION CRITERIA

Randomized controlled trials that compared the use of an additional radiation protection strategy with conventional radiation protection methods were considered for inclusion. The primary outcome of interest was the radiation dose received by the proceduralist during cardiac catheterization procedures.

METHODS

A three-step search was conducted in MEDLINE, CINAHL, Embase, and the Cochrane Library (CENTRAL). Trials published in the English language with adult participants were included. Trials published from database inception until July 2019 were eligible for inclusion. The methodological quality of the included studies was assessed using the JBI critical appraisal checklist for randomized controlled trials. Quantitative data were extracted from the included papers using the JBI data extraction tool. Results that could not be pooled in meta-analysis were reported in a narrative form.

RESULTS

Fifteen randomized controlled trials were included in the review. Six radiation protection strategies were assessed: leaded and unleaded pelvic or arm drapes, transradial protection board, remotely controlled mechanical contrast injector, extension tubing for contrast injection, real-time radiation monitor, and a reduction in frame rate to 7.5 frames per second. Pooled data from two trials demonstrated a statistically significant decrease in the mean radiation dose (P < 0.00001) received by proceduralists performing transfemoral cardiac catheterization on patients who received a leaded pelvic drape compared to standard protection. One trial that compared the use of unleaded pelvic drapes placed on patients compared to standard protection reported a statistically significant decrease (P = 0.004) in the mean radiation dose received by proceduralists.Compared to standard protection, two trials that used unleaded arm drapes for patients, one trial that used a remotely controlled mechanical contrast injector, and one trial that used a transradial protection board demonstrated a statistically significant reduction in the radiation dose received by proceduralists.Similarly, using a frame rate of 7.5 versus 15 frames per second and monitoring radiation dose in real-time radiation significantly lowered the radiation dose received by the proceduralist. One trial demonstrated no statistically significant difference in proceduralist radiation dose among those who used the extension tubing compared to standard protection (P = 1).

CONCLUSIONS

This review provides evidence to support the use of leaded pelvic drapes for patients as an additional radiation protection strategy for proceduralists performing transradial or transfemoral cardiac catheterization. Further studies on the effectiveness of using a lower fluoroscopy frame rate, real-time radiation monitor, and transradial protection board are needed.

Effects of Occupational Radiation Exposure on Job Stress and Job Burnout of Medical Staff in Xinjiang, China: A Cross-Sectional Study

BACKGROUND Although the potential effects of long-term and low-dose radiation exposure on physical health have attracted considerable attention, few systematic evaluations have been reported regarding the mental health of occupational groups. This study sought to investigate the effects of occupational radiation exposure on job stress and job burnout of medical radiation staff. MATERIAL AND METHODS Using cluster random sampling, a total of 1573 medical radiation workers were initially selected from 10 hospitals in Xinjiang, China, and 1396 valid questionnaires were finally collected. Job stress and job burnout were assessed using the Effort-Reward Imbalance (ERI) questionnaire and the Chinese Maslach Burnout Inventory (CMBI), respectively. RESULTS The percentages of medical radiation staff experiencing job stress and job burnout were 53.08% and 63.32%, respectively. A statistically significant difference in job stress was observed in association with age, ethnicity, professional title, marital status, radiation work type, radiation working years, family history, hypertension, obesity, smoking, and drinking (P<0.05). A statistically significant difference in job burnout was observed in association with age, sex, ethnicity, professional title, educational level, marital status, job post, radiation work type, radiation working years, family history, hypertension, diabetes, and obesity (P<0.05). Female (odds ratio [OR]=0.75, 95% confidence interval [CI]: 0.58-0.98), senior professional title (OR=0.64, 95% CI: 0.43-0.96), and radiation work types of nuclear medicine (OR=0.15, 95% CI: 0.07-0.33) and radiotherapy (OR=0.54, 95% CI: 0.36-0.79) were protective factors, and job stress (OR=4.57, 95% CI: 3.55-5.91) was the risk factor for job burnout of medical radiation staff. CONCLUSIONS Medical radiation staff experience high levels of job stress and job burnout. The interventions of occupational physical examination, personal dose monitoring, occupational health education, and management optimization are recommended to relieve job stress and job burnout and enhance occupational health of medical radiation staff.

Catheter strategy to ease the procedure and reduce radiation exposure when requiring neck access

Objectives

To assess the potential occupational radiation reduction and technical feasibility in patients rotated 180° (upside-down) when requiring neck access for transcervical or trans-subclavian catheterisation.

Methods

Upside-down positioning is defined as rotating patients in supine position by 180°, so that the feet come to rest where the head would otherwise be. We retrospectively evaluated all these procedures performed between March 2016 and May 2019. Furthermore, two different phantoms (paediatric and adult) were used prospectively to quantify the occupational dose between conventional or upside-down positioning. In this context, ambient dose equivalents were measured using real-time dosimeters. Three different projection angles were applied.

Results

44 patients with median age and body weight of 1.0 year (range 0–56) and 9.5 kg (range 1.3–74.3) underwent 63 procedures positioned upside-down. This position proved advantageous for practical reasons, since the length of the examination table could be optimally used. Additionally, it resulted in a significantly lower overall ambient dose equivalent for the primary operator (PO) of 94.8% (mean: 2569±807 vs 135±23 nSv; p<0.01) in the adult, and of 65.5% (mean: 351±104 vs 121±56 nSv; p<0.01) in the paediatric phantom, respectively.

Conclusion

Upside-down positioning facilitates handling in a straightforward manner when access from the neck is required. Moreover, it significantly reduces local radiation exposure for the PO in the paediatric and, most impressively, in the adult phantom.

THE EFFICACY OF RADPAD AS A RADIATION PROTECTION TOOL IN CT FLUOROSCOPY GUIDED LUNG BIOPSIES

Computed tomography fluoroscopy is now the preferred technique for percutaneous lung biopsies. However, concern regarding operator and patient radiation dose remains, which warrants further exploration into dose optimisation tools. This phantom-study aims to assess the dose reduction capabilities of RADPAD, a single-use patient drape designed to decrease staff exposure to scattered radiation. Dosemeters at the waist and eye levels were used to determine the whole-body and lens exposure during simulated lung biopsy procedures while using RADPAD and other combinations of personal protective equipment. RADPAD resulted in a 36% and 38% dose reduction for whole-body and eye exposure, respectively. However, when used in combination with radioprotective eyewear and aprons, RADPAD did not reduce the radiation dose further. Consequently, the use of standard personal protective equipment is a more cost-effective option for staff dose reduction. RADPAD is useful in the reduction of radiation dose to unprotected regions.

Efficiency of the RADPAD Surgical Cap in Reducing Brain Exposure During Pacemaker and Defibrillator Implantation

OBJECTIVES

This study sought to investigate the RADPAD No Brainer (Worldwide Innovation and Technologies, Overland Park, Kansas) efficiency in reducing brain exposure to scattered radiation.

BACKGROUND

Cranial radioprotective caps such as the RADPAD No Brainer are being marketed as devices that significantly reduce operator's brain exposure to scattered radiation. However, the efficiency of the RADPAD No Brainer in reducing brain exposure in clinical practice remains unknown to date.

METHODS

Five electrophysiologists performing device implantations over a 2-month period wore the RADPAD cap with 2 strips of 11 thermoluminescent dosimeter pellets covering the front head above and under the shielded cap. Phantom measurements and Monte Carlo simulations were performed to further investigate brain dose distribution.

RESULTS

Our study showed that the right half of the operators' front head was the most exposed region during left subpectoral device implantation; the RADPAD cap attenuated the skin front-head exposure but provided no protection to the brain. The exposure of the anterior part of the brain was decreased by a factor of 4.5 compared with the front-head skin value thanks to the skull. The RADPAD cap worn as a protruding horizontal plane, however, reduced brain exposure by a factor of 1.7 (interquartile range: 1.3 to 1.9).

CONCLUSIONS

During device implantation, the RADPAD No Brainer decreased the skin front head exposure but had no impact on brain dose distribution. The RADPAD No Brainer worn as a horizontal plane worn around the neck reduces brain exposure and confirms that the exposure comes from upward scattered radiation.

Radiation protection in the cardiac catheterization laboratory

The trend towards more minimally invasive procedures in the past few decades has resulted in an exponential growth in fluoroscopy-guided catheter-based cardiology procedures. As these techniques are becoming more commonly used and developed, the adverse effects of radiation exposure to the patient, operator, and ancillary staff have been a subject of concern. Although occupational radiation dose limits are being monitored and seldom reached, exposure to chronic, low dose radiation has been shown to have harmful biological effects that are not readily apparent until years after. Given this, it is imperative that reducing radiation dose exposure in the cardiac catheterization laboratory remains a priority. Staff education and training, radiation dose monitoring, ensuring use of proper personal protective equipment, employment of shields, and various procedural techniques in minimizing radiation must always be diligently employed. Special care and consideration should be extended to pregnant women working in the cardiac catheterization laboratory. This review article presents a practical approach to radiation dose management and discusses best practice recommendations in the cardiac catheterization laboratory.

Strategies to Reduce Radiation Exposure in Electrophysiology and Interventional Cardiology

Clinical diagnosis sometimes involves the use of medical instruments that employ ionizing radiation. However, ionizing radiation exposure is a workplace hazard that goes undetected and is detrimental to patients and staff in the catheterization laboratory. Every possible effort should be made to reduce the amount of radiation, including scattered radiation. Implementing radiation dose feedback may have a role in reducing exposure. In medicine, it is important to estimate the potential biologic effects on, and the risk to, an individual. In general, implantation of cardiac resynchronization devices is associated with one of the highest operator exposure doses due to the proximity of the operator to the radiation source. All physicians should work on the principle of as low as reasonably achievable. Methods for reducing radiation exposure must be implemented in the catheterization laboratory. In this article, we review the available tools to lower the radiation exposure dose to the operator during diagnostic, interventional, and electrophysiological cardiac procedures.

A Lead Garment Structural System to Reduce Musculoskeletal Stress During Fluoroscopy

Cardiovascular, orthopedic, and interventional radiology procedures using fluoroscopy require healthcare professionals to wear heavy lead garments for radiation protection, which can lead to musculoskeletal injuries, discomfort, and fatigue. A mobile lead garment frame, MobiLead, was designed to mitigate these issues by moving the lower garment load off body to a structural frame and redistributing the load of the upper garment from the shoulders to the hips through a torso frame. The frame was designed to be compact with a minimal footprint for maneuverability in operating rooms with limited space, while still giving the surgeon adequate mobility for various emergency procedures. Preliminary analysis of device efficacy was conducted using electromyography (EMG) of load-bearing muscles during use and qualitative surgeon user feedback surveys. Nonparametric permutation tests showed that the MobiLead device mean activation was significantly lower than the standard lead garment (p<0.001). Surgeon feedback and use testing showed that the device fits under a sterile gown and is maneuverable in an operating room (OR).

Effectiveness of additional X-ray protection devices in reducing Scattered radiation in radial interventions: protocol of the ESPRESSO randomised trial

BACKGROUND

A number of devices have been developed to minimise operator radiation exposure in the setting of cardiac catheterisation. The effectiveness of these devices has traditionally been explored in transfemoral coronary procedures; however, less is known for the transradial approach. We set out to examine the impact of three different radiation protection devices in a real-world setting.

METHODS AND DESIGN

Consecutive coronary diagnostic and intervention procedures are randomised in a 1:1:1 ratio to a shield-only protection (shield group), shield and overlapping 0.5 mm Pb panel curtain (curtain group) or shield, curtain and additional 75×40 cm, 0.5 mm Pb drape placed across the waist of the patient (drape group).The primary outcome is the difference in relative exposure of the primary operator among groups. Relative exposure is defined as the ratio between operator's exposure (E in μSv) and patient exposure (dose area product in cGy·cm²).

ETHICS AND DISSEMINATION

The protocol complies with good clinical practice and the ethical principles described in the Declaration of Helsinki and is approved by the local ethics committee. The results of the trial will be published as original article(s) in medical journals and/or as presentation at congresses.

TRIAL REGISTRATION NUMBER

NCT03634657.

Retrospective study of patients radiation dose during cardiac catheterization procedures

OBJECTIVE

Cardiac catheterization procedures provide tremendous benefits to modern healthcare and the benefit derived by the patient should far outweigh the radiation risk associated with a properly optimized procedure. With increasing utilization of such procedures, there is growing concern regarding the magnitude and variations of dose to patients associated with procedure complexity and techniques parameters. Therefore, this study investigated radiation dose to patients from six cardiac catheterization procedures at our facility and suggest possible initial dose values for benchmark for patient radiation dose from these procedures. This initial benchmark data will be used for clinical radiation dose management which is essential for assessing the impact of any quality improvement initiatives in the cardiac catheterization laboratory.

METHODS

We retrospectively analyzed the dose parameters of 1000 patients who underwent various cardiac catheterization procedures: left heart catheterization (LH), percutaneous coronary intervention (PCI), complex PCI, LH with complex PCI, LH with PCI and cardiac resynchronization therapy (CRT) pacemaker in our cardiac catheterization laboratories. Patient's clinical radiation dose data [kerma-area-product (KAP) and air-kerma at the interventional reference point (Ka,r)] and technique parameters (fluoroscopy time, tube potential, current, pulse width and number of cine images) along with demographic information (age, height and weight) were collected from the hospital's RIS (Synapse), Sensis/Syngo Dynamics and Siemens Sensis Stats Manager electronic database. Statistical analysis was performed with the IBM SPSS Modeler v. 18.1 software.

RESULTS

The overall patient median age was 67.0 (range: 26.0-97.0) years and the median body mass index (BMI) was 28.8 (range: 15.9-61.7) kg/m2 . The median KAP for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 44.4 (4.1-203.2), 80.2 (18.9-208.5), 83.7 (48.0-246.1), 113.8 (60.9-284.5), 91.7 (6.0-426.0) and 51.1 (7.0-175.9) Gy-cm2 . The median Ka,r for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 701.0 (35.3-3794.0), 1384.7 (291.7-4021.8), 1607.0 (883.5-4448.3), 2260.2 (867.4-5311.9), 1589.3 (100.2-7237.4) and 463.8 (67.7-1695.9) mGy respectively.

CONCLUSION

We have analyzed patient radiation doses from six commonly used procedures in our cardiac catheterization laboratories and suggested possible initial values for benchmark from these procedures for the fluoroscopy time, KAP and air-kerma at the interventional reference point based on our current practices. Our data compare well with published values reported in the literature by investigators who have also studied patient doses and established benchmark dose levels for their facilities. Procedure-specific benchmark dose data for various groups of patients can provide the motivation for monitoring practices to promote improvements in patient radiation dose optimization in the cardiac catheterization laboratories.

ADVANCES IN KNOWLEDGE

We have investigated local patients' radiation doses and established benchmark radiation data which are essential for assessing the impact of any quality improvement initiatives for radiation dose optimization.

Personal Protective Equipment Availability and Utilization Among Interventionalists

OBJECTIVE

This study explored personal protective equipment (PPE) availability and PPE utilization among interventionalists in the catheterization laboratory, which is a highly contextualized workplace.

METHODS

This is a cross-sectional study using mixed methods. Participants (108) completed a survey. A hyperlink was sent to the participants, or they were asked to complete a paper-based survey. Purposively selected participants (54) were selected for individual (30) or group (six) interviews. The interviews were conducted at conferences, or appointments were made to see the participants. Logistic regression analysis was performed. The qualitative data were analyzed thematically.

RESULTS

Lead glasses were consistently used 10.2% and never used 61.1% of the time. All forms of PPE were inconsistently used by 92.6% of participants. Women were 4.3 times more likely to report that PPE was not available. PPE compliance was related to fit and availability.

CONCLUSIONS

PPE use was inconsistent and not always available. Improving the culture of radiation protection in catheterization laboratories is essential to improve PPE compliance with the aim of protecting patients and operators. This culture of radiation protection must include all those involved including the users of PPE and the administrators and managers who are responsible for supplying sufficient, appropriate, fitting PPE for all workers requiring such protection.

Effectiveness of protection strategies for reducing radiation exposure in proceduralists during cardiac catheterization procedures: a systematic review protocol

REVIEW QUESTION

What is the effectiveness of radiation protection strategies for reducing the radiation dose received by the proceduralist during cardiac catheterization procedures?

Radiation safety: a focus on lead aprons and thyroid shields in interventional pain management

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.

Interventionalists' perceptions on a culture of radiation protection

BACKGROUND

Occupational exposure to ionising radiation poses potential health risks to radiation workers unless adequate protection is in place. The catheterisation laboratory is a highly contextualised workplace with a distinctive organisational and workplace culture.

OBJECTIVE

This study was conducted to understand the culture of radiation protection (CRP).

METHODS

This study was a qualitative study and data were collected through 30 in-depth and 6 group interviews with 54 purposively selected South African interventionalists (interventional radiologists and cardiologists). The participants included a diversity of interventionalists who varied in sex, geographic location and years of experience with fluoroscopy. The transcribed data were analysed thematically using a deductive and inductive approach.

RESULTS

'Culture of radiation protection' emerged as a complex theme that intersected with other themes: 'knowledge and awareness of radiation', 'radiation safety practice', 'personal protective equipment (PPE) utilisation' and 'education and training'.

CONCLUSION

Establishing and sustaining a CRP provides an opportunity to mitigate the potentially detrimental health effects of occupational radiation exposure. Education and training are pivotal to establishing a CRP. The time to establish a culture of radiation in the catheterisation laboratory is now.