Radiation Dose of Nurses during IR Procedures: A Controlled Trial Evaluating Operator Alerts before Nursing Tasks

Occupational radiation exposure among medical personnel in university and general hospitals in Japan

OBJECTIVE

This study aimed to compare the occupational radiation exposure of medical workers between general hospitals and university hospitals.

METHODS

Radiation exposure data from three hospitals in Hiroshima city, including one university hospital and two general hospitals, were collected using personal dosimeters. Monthly radiation doses were analyzed, and the annual sum of radiation exposure dose was calculated for 538 subjects in general hospitals and 1224 subjects in the university hospital. To assess the impact of locality, additional data from Nagasaki University Hospital and Fukushima Medical University Hospital were included for comparative analysis. Professional affiliations, such as doctors, nurses, and radiological technologists, were considered in the evaluation.

RESULTS

The study revealed slight but significant differences in radiation doses between general and university hospitals. In general hospitals, except for radiological technologists, a slightly higher radiation dose was observed compared to university hospitals. Despite the annual increase in the use of medical radiation, the majority of hospital workers in both settings adhered to safety guidelines, with occupational radiation exposure remaining below the limit of detection (LOD). Workers who involved in fluoroscopic procedure, whether at university or general hospitals, had higher radiation doses than those who did not.

CONCLUSION

The study's primary conclusion is that workers in general hospitals experience a slight but significantly higher radiation dose and a lower percentage below the LOD compared to university hospitals. The observed difference is attributed to the greater workload at general hospitals than at university hospitals, and also may be due to the different nature of university hospital and general hospital. University hospitals, characterized by greater academic orientation, tend to benefit from comprehensive support systems, specialized expertise, and advanced technology, leading to more structured and regulated radiation control. These findings provide a basis for targeted interventions, improved safety protocols.

Practical Radiation Protection for Interventional Radiologist

As per the International Commission on Radiological Protection 2010 recommendation, it was stated that "interventional radiologists performing difficult procedures with high workloads may be exposed to high doses" and that education and training of medical staffs in radiation exposure is "an urgent priority." There are many reports on the textbook aspects of radiation protection, but reports on the practical aspects of radiation protection have remained to be scarce. Various methods of reducing radiation exposure are described as "useful" or "can be reduced," but the priority of these methods and the "extent" to which they contribute to reducing radiation exposure are not clear. Thus, in this article, we will look into the protection of interventional radiologist from radiation exposure in a practical way, giving priority to clarity rather than academic accuracy.

Radiation exposure during angiographic interventions in interventional radiology - risk and fate of advanced procedures

PURPOSE

Advanced angiographic procedures in interventional radiology are becoming more important and are more frequently used, especially in the treatment of several acute life-threatening diseases like stroke or aortic injury. In recent years, technical advancement has led to a broader spectrum of interventions and complex procedures with longer fluoroscopy times. This involves the risk of higher dose exposures, which, in rare cases, may cause deterministic radiation effects, e.g. erythema in patients undergoing angiographic procedures. Against this background, these procedures recently also became subject to national and international regulations regarding radiation protection. At the same time, individual risk assessment of possible stochastic radiation effects for each patient must be weighed up against the anticipated benefits of the therapy itself. Harmful effects of the administered dose are not limited to the patient but can also affect the radiologist and the medical staff. In particular, the development of cataracts in interventionalists is a rising matter of concern. Furthermore, long-term effects of repeated and prolonged x-ray exposure have long been neglected by radiologists but have come into focus in the past years.

CONCLUSIONS

With all this in mind, this review discusses different efforts to reduce radiation exposition levels for patients and medical staff by means of technical, personal as well as organizational measures.

Combined Angio-CT Systems: A Roadmap Tool for Precision Therapy in Interventional Oncology

Combined angiography-CT (angio-CT) systems, which combine traditional angiographic imaging with cross-sectional imaging, are a valuable tool for interventional radiology. Although cone-beam CT (CBCT) technology from flat-panel angiography systems has been established as an adjunct cross-sectional imaging tool during interventional procedures, the intrinsic advantages of angio-CT systems concerning superior soft-tissue imaging and contrast resolution, along with operational ease, have sparked renewed interest in their use in interventional oncology procedures. Owing to increases in affordability and usability due to an improved workflow, angio-CT systems have become a viable alternative to stand-alone flat-panel angiographic systems equipped with CBCT. This review aims to provide a comprehensive technical and clinical guide for the use of angio-CT systems in interventional oncology. The basic concepts related to the use of angio-CT systems, including concepts related to workflow setup, imaging characteristics, and acquisition parameters, will be discussed. Additionally, an overview on the clinical applications and the benefits of angio-CT systems in routine therapeutic and palliative interventional oncology procedures will be reviewed. Keywords: Ablation Techniques, CT-Angiography, Interventional-Body, Interventional-MSK, Chemoembolization, Embolization, Radiation Therapy/Oncology, Abdomen/GI, Skeletal-Axial Supplemental material is available for this article. © RSNA, 2021.

Radiation dose during fluoroscopically guided central venous access device insertion: retrospective observational study

INTRODUCTION

Central venous access devices (CVAD) are used to deliver intravenous therapy to the bloodstream. CVAD insertion is sometimes fluoroscopically guided and thus associated with radiation dose to both the patient and the staff members within the room. The objective of this study is to assess the radiation dose to the patient through a retrospective audit and directly measure the exposure to staff members in simulated procedures. A secondary objective is to evaluate the radiation exposure to the staff and patients when utilising fluoroscopic pulse rate of 7.5 pps and 4 pps.

MATERIAL AND METHODS

A retrospective audit of patients undergoing Permcath and Hickman line insertions was conducted. The patients were grouped by the pulse rate used for the duration of the study; 4 pulses per second (pps) (n=24) and 7.5 pps (n=33). A STEP OD-2 monitor and PMMA was used in a simulated environment to estimate the radiation exposure to locations that a Radiologist, Nurse and Radiographer would be standing during the procedures using the average procedure details collected in the retrospective audit. Measurements were conducted at heights to reflect a whole body estimate and an estimate to the lens of the eye.

RESULTS

The results show that the median dose area product (DAP) for CVAD insertion is 0.7Gy.cm² and 0.3Gy.cm² for procedures done at 7.5 pps and 4 pps, respectively. This corresponded to an effective dose of 0.22 mSv and 0.1 mSv. The radiologist, nurse and radiographer were exposed to a whole-body shielded dose of 0.36μSv, 0.1μSv and 0.05μSv when 7.5 pps was utilised and 0.13μSv, 0.03μSv and 0.02μSv when 4 pps was used. The exposure to the head of radiologist, nurse and radiographer was 2.1μSv, 1.4μSv, and 0.6μSv in the 7.5 pps studies and 0.7μSv, 0.5μSv, and 0.2μSv when 4pps was used.

CONCLUSION

The patient effective dose was estimated to be 0.1-0.22 mSv depending on the fluoroscopic pulse rate utilised during CVAD insertions. Additionally, The radiologist, nurse and radiographer whole body and lens exposure was estimated in a simulated setting. In all cases, there was a statistically significant dose reduction when the lower fluoroscopic pulse rate was used. Thus, where possible, consideration should be given to utilising a lower pulse rate during CVAD insertions to reduce the exposure to both staff and patients.

Occupational radiation exposure to the head is higher for scrub nurses than cardiologists during cardiac angiography

AIMS

This study aimed to compare the head dose of a cardiologist to scrub and scout nurses during cardiac angiography.

DESIGN

A correlational longitudinal quantitative design was used to examine the relationship between the variable of occupational dose to the medical operator when compared with the dose to the scrub and scout nurses.

METHODS

A quantitative analysis was performed on data collected during coronary angiograms (N = 612) for one cardiologist and 22 nurses performing either the scrub or scout role between May 2015 and February 2017. Analysis was based on log-transformed dose levels and reported as geometric means and associated 95% confidence intervals.

RESULTS

It was found that scrub nurses received on average 41% more head dose than the cardiologist during diagnostic procedures and 52% higher doses during interventional cases.

CONCLUSION

Nurses working in fluoroscopic cardiovascular procedures should be provided with appropriate training and protective equipment, notably lead skull caps, to minimize their occupational radiation exposure.

IMPACT

There is a notable lack of research evaluating the occupational head and eye exposure to nurses involved in fluoroscopic procedures. This study found that during diagnostic coronary angiograms, the scrub nurses received 41% more occupational head dose than the cardiologist and 52% higher head doses during interventional cases. Radial access resulted in higher doses to scrub nurses than femoral artery access. It is advisable that staff wear protective lead glasses and skull caps and use appropriately positioned ceiling mounted lead shields to minimize the risk of adverse effects of occupational exposure to ionizing radiation.

A Phantom Menace to Medical Personnel During Endovascular Treatment of Cerebral Aneurysms: Real-Time Measurement of Radiation Exposure During Procedures

BACKGROUND

The number of endovascular treatment procedures performed for cerebral aneurysms has markedly increased. However, little is known about the annual effective radiation dose to medical staff in neurointervention fields. We performed a retrospective observational study to investigate the real-time radiation dose to surgeons, nurses, anesthesiologists, and radiologic technologists during endovascular treatment of intracranial aneurysms.

METHODS

We measured the real-time radiation doses for 2 weeks using standard and reinforced protection, during which 28 procedures were performed, including 23 coil embolizations for unruptured intracranial aneurysms. Four procedures were excluded because of an inadequately equipped sensor, which resulted in inappropriate data collection. The procedure time was defined from intubation to extubation. Five RaySafe i2 detectors were installed at the chest level of the operator, attending nurse, radiologic technologist, and anesthesiologist and just inside the front door of the hybrid operating room.

RESULTS

The median doses per session with standard protection to the operator, attending nurse, anesthesiologist, and radiologic technologist were 11.16, 2.60, 4.76, and 1.93 μSv, respectively. The dose to the operator, attending nurse, and anesthesiologist had decreased to 6.63, 0.39, and 1.52 μSv under reinforced protection, respectively. However, the session dose for the radiologic technologist had increased to 3.12 μSv.

CONCLUSIONS

We confirmed the differences in the amount of radiation exposure for different roles. An additional lead screen, which provided more effective protection on the operator side, was proved effective for attenuating radiation exposure during endovascular treatment. All personnel involved in the hybrid operating room were exposed to acceptable effective doses.

Occupational radiation exposure to nursing staff during cardiovascular fluoroscopic procedures: A review of the literature

Fluoroscopy is a method used to provide real time x-ray imaging of the body during medical procedures to assist with medical diagnosis and treatment. Recent technological advances have seen an increase in the number of fluoroscopic examinations being performed. Nurses are an integral part of the team conducting fluoroscopic investigations and are often located close to the patient resulting in an occupational exposure to radiation. The purpose of this review was to examine recent literature which investigates occupational exposure received by nursing staff during cardiovascular fluoroscopic procedures. Articles published between 2011 and 2017 have been searched and comprehensively reviewed on the referenced medical search engines. Twenty-four relevant studies were identified among which seventeen investigated nursing dose comparative to operator dose. Seven researched the effectiveness of interventions in reducing occupational exposure to nursing staff. While doctors remain at the highest risk of exposure during procedures, evidence suggests that nursing staff may be at risk of exceeding recommended dose limits in some circumstances. There is also evidence of inconsistent use of personal protection such as lead glasses and skull caps by nursing staff to minimize radiation exposure. Conclusions: The review has highlighted a lack of published literature focussing on dose to nurses. There is a need for future research in this area to inform nursing staff of factors which may contribute to high occupational doses and of methods for minimizing the risk of exposure, particularly regarding the importance of utilizing radiation protective equipment.

Changes in Occupational Radiation Exposures after Incorporation of a Real-time Dosimetry System in the Interventional Radiology Suite

A statistical pilot study was retrospectively performed to analyze potential changes in occupational radiation exposures to Interventional Radiology (IR) staff at Lawrence General Hospital after implementation of the i2 Active Radiation Dosimetry System (Unfors RaySafe Inc, 6045 Cochran Road Cleveland, OH 44139-3302). In this study, the monthly OSL dosimetry records obtained during the eight-month period prior to i2 implementation were normalized to the number of procedures performed during each month and statistically compared to the normalized dosimetry records obtained for the 8-mo period after i2 implementation. The resulting statistics included calculation of the mean and standard deviation of the dose equivalences per procedure and included appropriate hypothesis tests to assess for statistically valid differences between the pre and post i2 study periods. Hypothesis testing was performed on three groups of staff present during an IR procedure: The first group included all members of the IR staff, the second group consisted of the IR radiologists, and the third group consisted of the IR technician staff. After implementing the i2 active dosimetry system, participating members of the Lawrence General IR staff had a reduction in the average dose equivalence per procedure of 43.1% ± 16.7% (p = 0.04). Similarly, Lawrence General IR radiologists had a 65.8% ± 33.6% (p=0.01) reduction while the technologists had a 45.0% ± 14.4% (p=0.03) reduction.

Action research regarding the optimisation of radiological protection for nurses during vascular interventional radiology

The optimisation and decision-making processes for radiological protection have been broadened by the introduction of re-examination or feedback after introducing protective measures. In this study, action research was used to reduce the occupational exposure of vascular interventional radiology (IR) nurses. Four radiological protection improvement measures were continuously performed in cooperation with the researchers, nurses and stakeholders, and the nurses' annual effective doses were compared before and after the improvements. First, the dosimetry equipment was changed from one electronic personal dosimeter (EPD) to two silver-activated phosphate glass dosimeters (PGDs). Second, the nurses were educated regarding maintaining a safe distance from the sources of scattered and leakage radiation. Third, portable radiation shielding screens were placed in the IR rooms. Fourth, the x-ray units' pulse rates were reduced by half. On changing the dosimetry method, the two PGDs recorded a 4.4 fold greater dose than the single EPD. Educating nurses regarding radiological protection and reducing the pulse rates by half decreased their effective doses to one-third and two-fifths of the baseline dose, respectively. No significant difference in their doses was detected after the placement of the shielding screens. Therefore, the action research effectively decreased the occupational doses of the vascular IR nurses.