Evaluation of non-lead-based protective radiological material in spinal surgery

Development of Lead-Free Materials for Radiation Shielding in Medical Settings: A Review

Radiation protection is an essential issue in diagnostic radiology to ensure the safety of patients, healthcare professionals, and the general public. Lead has traditionally been used as a shielding material due to its high atomic number, high density, and effectiveness in attenuating radiation. However, some concerns related to the long-term health effects of toxicity, environmental disease as well as heavy weight of lead have led to the search for alternative lead-free shielding materials. Leadfree multilayered polymer composites and non-lead nano-composite shields have been suggested as effective shielding materials to replace conventional lead-based and single metal shields. Using several elements with high density and atomic number, such as bismuth, barium, gadolinium, and tungsten, offer significant enhancements in the shielding ability of composites. This review focuses on the development and use of lead-free materials for radiation shielding in medical settings. It discusses the drawbacks of traditional lead shielding, such as toxicity, weight, and recycling challenges, and highlights the benefits of lead-free alternatives.

Development of Lead-Free Radiation Shielding Material Utilizing Barium Sulfate and Magnesium Oxide as Fillers in Addition Cure Liquid Silicone Rubber

The radiological protection has the purpose of safeguarding the physical well-being of the user, preventing exposure to detrimental levels of ionizing radiation. This study introduces a novel, cost-effective category of lead-free elastomeric material designed for radiation shielding. The filler compounds utilized are notably lighter than conventional lead-based materials, enhancing user ergonomics during application. They comprise of a blend of barium sulfate combined or not with magnesium oxide with addition-cure liquid silicone rubber. To ensure the effectiveness of the radiation shielding, X-ray transmission measurements were performed for the different thicknesses of the materials and the results compared with Monte Carlo simulations. Additionally, the physical properties of the new materials, such as density, homogeneity, tensile strength, viscosity, and wettability, were also evaluated. The findings indicate that both materials fulfill the requirement for application in radiation protection garments.

Attenuation properties of hybrid nanocomposite film containing Ce2O, GO, and α-Al2O3 nanoparticles for high energy radiations

The use of diagnostic radiation in medical centers has spread due to the incidence of various diseases. Thus, it is essential that patients and medical staff wear protective clothing to protect themselves from their harmful effects. In the past, lead protective clothing has been used; however, the toxicity and heaviness of lead have limited the tendency to use these clothing. Recently, nanocomposites containing heavy element nanoparticles have been introduced as an alternative to lead coatings. In this study, hybrid nanocomposites containing ceria (CeO2), alumina (Al2O3), and graphene oxide (GO) nanoparticles were studied for this purpose. Ceria, alumina, and graphene oxide nanoparticles were mixed with polyethylenevinylacetate (EVA) dissolved in chloroform and casted on a glass plate to form nanocomposite films. The prepared nanoparticles and films were characterized by Fourier Transform Infrared Spectroscopy, Field Emission Scanning Electron Microscope, Thermal Gravimetric Analysis, and Energy Dispersive X-ray Analysis, and then the attenuation properties of the films against high-energy radiation (120 kV) were studied in two narrow and broad beam geometries. The results showed that hybrid films, despite having a lower percentage of nanoparticles, showed better attenuation properties, which indicated the synergistic effect of nanoparticles with different mechanisms in attenuating the radiations. The attenuation ability of these films was considerable due to their lower density compared to lead. The fabricated hybrid nanocomposite films with a suitable performance in attenuation of high-energy radiations used in therapeutic diagnostics, can be proposed as a suitable alternative to conventional lead clothing.

Efficiency of tungsten-polymer composite shields on fetal dose reduction in chest CT scans

Given their desirable shielding properties, 5 polymer composite shields reinforced with tungsten were selected and their effects as gamma shields on fetal dose reduction were investigated. According to the results, the selected shields reduce the fetus brain, the fetus lungs, the fetus kidneys, and the total fetus dose almost 34.17%-41.19%, 20.47%-25.08%, 9.27%-12.13%, and 15.39%-18.69%, respectively, at tube voltage of 80 kVp. At the higher tube potentials, the values of dose reduction were smaller. Moreover, it was observed that polymers named PHEMA-WO3 and RS-U-30 had an excellent shielding ability among the other studied composites.

Occupational radiation exposure of orthopedists at different locations during pedicle screw insertion: An anthropomorphic phantom study

BACKGROUND

The purpose of this work was to evaluate orthopedic surgeons' exposure to occupational radiation doses from scattering using a mobile flat panel C-arm X-ray machine at different standing positions during an intraoperative pedicle screw implantation.

OBJECTIVE

Evaluate the radiation dose received by medical staff, by applying flat X-ray machine in surgical room during an intraoperative pedicle screw implantation.

METHODS

A mobile flat-panel C-arm X-ray machine at a dedicated orthopedic operating room was used to image an anthropomorphic female phantom which was set in a prone position on the operating table. The X-ray was projected horizontally, and 1 minute continuous fluoroscopy was used for lumbar spine and thoracolumbar spine during pedicle screw implantation. Scattering radiation doses to orthopedic surgeons were measured at different standing positions and body heights (50, 100, 150 cm above the ground) with and without limited collimations.

RESULTS

The dose area product (DAP) in this experiment is normalized as 343 μGy⋅m2. In the four areas, the lowest scattered radiation measured by DF is 11.2 vs. 0.7 μSv, outside and inside the lead suit, respectively, with or without restricted field, 150 cm above the ground, and the lowest scattered radiation dose inside the lead suit. It is 1.3 vs. 0.5 μSv. Comparing the highest dose of the TF at with the lowest dose of the DF, the average result is 73.7 vs. 11.1 μSv, P< 0.05.

CONCLUSIONS

Using a mobile flat-panel C-arm X-ray machine during a pedicle screw implantation, the minimum scattering radiation to surgeons was found to be at the terminal DF area based on the analysis of the scattering doses orthopedic surgeons were exposed to.

Designing and Fabricating Nano-structured and Micro-structured Radiation Shields for Protection against CBCT Exposure

Researchers have always been interested in finding new and effective materials for protection against radiation. This experimental study aimed to design and fabricate new types of nano-material and micro-material based shields against the ionizing effect of cone beam computed tomography (CBCT) X-rays. To fabricate a flexible prototype, we added dioctyl phthalate (DOP) oil to emulsion polyvinyl chloride (PVC) powder. The paste was mixed and dispersed. Then, nano- and micro-powders of WO₃ and Bi₂O₃ were added to the paste, with the weight ratio of 20% PVC, 20% DOP, and 60% nano- and micro-metals. Using an ultrasonic mixer, the polymer matrix and metals were mixed and a paste with a thick texture was developed. The resultant paste was poured into glass molds and the molds were then heated in an oven. After cooling, the resultant sheets were selected for further experiments. A CBCT unit and dosimeter were used to evaluate the characterization and X-ray shielding properties of the fabricated prototypes. The half-value layers (HVL) for nano-WO₃, micro-WO₃, nano-Bi₂O_3, and micro-Bi₂O₃ were 0.0390, 0.0524, 0.0351, and 0.0374 cm, respectively. In addition, the linear attenuation coefficient (µ) for these materials were 17.77, 13.20, 19.71, and 18.5 cm⁻¹, respectively. The findings indicate that nano-structured samples are more effective in the attenuation of X-ray energy. The nano-structured WO₃ prototype was nearly 34% more efficient in attenuating radiation compared to the micro-structured WO₃ prototype. This difference in nano- and micro-structured Bi₂O₃ prototypes was 6.5%.

Evaluation of scattered radiation dose received by medical staff during uterine artery embolization in the operating room

BACKGROUND:

The air kerma radiation doses have gained much attention since the operating room interventional radiology is a place where medical staff are exposed to a fluoroscopy environment and gain a cumulative dose during the uterine artery embolization procedure.

OBJECTIVE:

We aimed to evaluate the radiation dose received by medical staff by applying a flat X-ray machine in the surgical room during uterine artery embolization.

METHODS:

An ATOM humanoid model was laid on the operating table and simulated a patient. The scattered radiation dose received by the radiologist, anesthetist and radiologic technologist was evaluated. The scintillation detector was adopted. The measurement points were 50 cm, 100 cm and 150 cm above the floor, representing the limbs, abdomen and thyroid level, respectively. We compared the X-rays under different tube voltages of 70, 80, and 90, respectively and frames per second (FPS) of 30, 15, and 7.5, respectively. We configured the dose level per pulse of 40 nGy with a fixed detector.

RESULTS:

In Section 1, when the tube voltage was 70 kVp and 7.5 FPS, the average radiation doses of limbs, abdomen and thyroid level was 0.48, 1.3 and 1.9 μSv/min respectively. When the tube voltage was 80 kVp and the fluoroscopy decreases from 30 FPS to 7.5 FPS, 58% of the radiation dose was reduced. When the tube voltage was 90 kVp, the radiation dose in the lead garment increased 31–177% in comparison to when the tube voltage was 80 kVp. Sections 2 and 3 were far away from the central ray, so the highest radiation dose 100 cm above the floor were 0.05 and 0.02 μSv/min.

CONCLUSIONS:

Lead garment can effectively reduce medical staff from occupational doses with an average attenuation rate of 90%. 80 kVp was most commonly used. Fluoroscopy 7.5 FPS was used 100 cm above the floor in A section and the lowest radiation dose was 1.33 μSv/min. The operator should decrease the duration of X-rays or adopt suspended lead shielding to decrease the radiation dose received by the operator. When kVp increases, the penetration increases. Decreasing FPS cannot decrease occupational doses of medical staff.

A new method for reducing operation time and radiation exposure in the placement of Jamshidi needles: Technical note

Percutaneous pedicle screws have been used in the treatment of thoracolumbar fractures for decades, and conventional fluoroscopy is commonly used to confirm the positions of the Jamshidi needles during the procedure. In this article, a modified method is reported for the placement of Jamshidi needles. The attending surgeons did not receive any radiation during the procedure and the fluoroscopy time for the patients was little. In our method, all six Jamshidi needles were placed on the pedicles and hammered 2 mm into each entry site. When the verification images were acquired, the medical personnel went behind a lead-lined wall. The positions of the needles were first reviewed and adjusted as needed based on the anterior-posterior (AP) image. Then, the C-arm was rotated and lateral images were obtained to further verify the needle placement. The rest of the screw placement procedure remained the same. The proposed technique was applied in 45 patients with thoracolumbar fractures. It took an average (range) of 5 (4-7) single-shot images to ensure all the needles were positioned at the ideal entry site and 12 (10-17) minutes to complete this step. No neurological symptoms were reported by the patients. Using the proposed technique, the radiation exposure for the surgeons is zero, and the patients are well-protected from excessive radiation exposure. This modified method of embedding all the Jamshidi needles at the entry sites before fluoroscopy is an improved technique compared with the conventional method.

Biological polymeric shielding design for an X-ray laboratory using Monte Carlo codes

Photon irradiation facilities are often shielded using lead despite its toxicity and high cost. In this study, three Monte Carlo codes, EGS5, MCNPX, and Geant4, were utilized to investigate the efficiency of a relatively new polymeric base compound (C_nH_2n), as a radiation shielding material for photons with energies below 150 keV. The proposed compound with the densities of 6 and 8 g cm^-3 were doped with the weight percentages of 8.0 and 15.0% gadolinium. The probabilities of photoelectric effect and Compton scattering were relatively equal at low photon energies, thus the shielding design was optimized using three Monte Carlo codes for the conformity of calculation results. Consequently, 8% Gd-doped polymer with thickness less than 2 cm and density of 6 g cm^-3 was adequate for X-ray room shielding to attenuate more than 95% of the 150-keV incident photons. An average dose rate reduction of 88% can be achieved to ensure safety of the radiation area.

Protection evaluation of non-lead radiation-shielding fabric: preliminary exposure-dose study

OBJECTIVES

The aim of this study was to evaluate the effectiveness and shielding performance of a novel recently developed non-lead radiation-shielding fabric containing bismuth oxide (BO-fabric).

METHODS

BO-fabric was fabricated using urethane resin and bismuth nanopowder. A dose-measurement method was employed to evaluate the radiation-attenuation characteristics of the shielding fabric in accordance with the Korean Standards standard. The shielding performances (%) were calculated by measuring the radiation doses after lamination with increasing layers of fabric (1-10 layers). The physical performance of the fabric in terms of flexural and abrasion resistances was evaluated by the Korea Apparel Testing and Research Institute (KATRI).

RESULTS

The radiation-attenuation capabilities of one layer of BO-fabric were 58.5, 49.9, and 43.0% at tube voltages of 60, 80, and 100 kVp, respectively. The radiation-shielding performance upon lamination of BO-fabric gradually increased as the number of layers increased. Excellent flexural and abrasion resistances were observed in the KATRI evaluation.

CONCLUSIONS

A non-lead radiation-shielding fabric based on urethane resin and bismuth was fabricated and examined, revealing an excellent shielding performance. Owing to the flexibility and simple operation of the fabric, it can be employed for various designs of clothing and protective apparel with many purposes.

Lead Aprons Are a Lead Exposure Hazard

PURPOSE

To determine whether lead-containing shields have lead dust on the external surface.

METHODS

Institutional review board approval was obtained for this descriptive study of a convenience sample of 172 shields. Each shield was tested for external lead dust via a qualitative rapid on-site test and a laboratory-based quantitative dust wipe analysis, flame atomic absorption spectrometry (FAAS). The χ² test was used to test the association with age, type of shield, lead sheet thickness, storage method, and visual and radiographic appearance.

RESULTS

Sixty-three percent (95% confidence interval [CI]: 56%-70%) of the shields had detectable surface lead by FAAS and 50% (95% CI: 43%-57%) by the qualitative method. Lead dust by FAAS ranged from undetectable to 998 μg/ft². The quantitative detection of lead was significantly associated with the following: (1) visual appearance of the shield (1 = best, 3 = worst): 88% of shields that scored 3 had detectable dust lead; (2) type of shield: a greater proportion of the pediatric patient, full-body, and thyroid shields were positive than vests and skirts; (3) use of a hanger for storage: 27% of shields on a hanger were positive versus 67% not on hangers. Radiographic determination of shield intactness, thickness of interior lead sheets, and age of shield were unrelated to presence of surface dust lead.

CONCLUSIONS

Sixty-three percent of shields had detectable surface lead that was associated with visual appearance, type of shield, and storage method. Lead-containing shields are a newly identified, potentially widespread source of lead exposure in the health industry.

Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure

BACKGROUND

Ionizing radiation is typically used during spine surgery for localization and guidance in instrumentation placement. Minimally invasive (MI) surgical procedures are increasingly popular and often require significantly more fluoroscopy, placing surgeons at risk for increased radiation exposure and radiation-induced complications. This study provides recommendations for minimizing risk of radiation-induced injury to spine surgeons and summarizes studies addressing radiation exposure in spine procedures.

METHODS

The PubMed database was queried for relevant articles pertaining to radiation exposure in spine surgery.

RESULTS

Discectomy, percutaneous pedicle screw placement, MI transforaminal lumbar interbody fusion, MI lateral lumbar interbody fusion, and vertebroplasty/kyphoplasty procedures were assessed. The highest radiation doses were seen with MI pedicle screw placement, MI transforaminal lumbar interbody fusion, vertebroplasty and kyphoplasty, and percutaneous endoscopic lumbar discectomy. Use of lead aprons and thyroid shields reduces effective dose by several orders of magnitude. Proper operator positioning also minimizes radiation exposure. Lead gloves decrease dose to the surgeon's hand from scatter if the hand is out of the x-ray beam most of the time. If prolonged exposure of the hand cannot be avoided, the technician should collimate the surgeon's hand out of the beam or use instruments to position the hand farther from the beam. In addition to using less fluoroscopy, pulsed fluoroscopy can decrease overall dose in a procedure.

CONCLUSIONS

Spine surgeons should reduce their exposure to radiation to minimize risk of potential long-term complications. Strategies include minimizing fluoroscopy use and dose, proper use of protective gear, and appropriate manipulation of fluoroscopic equipment.

Strategies towards injectable, load-bearing materials for the intervertebral disc: a review and outlook

Currently available treatments for the degenerated intervertebral disc present disadvantages, such as surgical invasiveness and inadequate load distribution results. Load-bearing, injectable materials may be interesting for future therapies, but have not been studied in depth. In this study, the existing literature was screened for studies on injectable materials for the intervertebral disc and a rationale for load-bearing, injectable materials was formulated. Requirements for such a material were discussed, partly based on the experience of materials used for similar applications. Important properties were discussed and found to include biocompatibility, bioactivity, porosity, handling, injectability, working time, setting time, radiopacity, containment and mechanical properties, where several of these properties are linked to one another. In conclusion, there is a need for consensus on the properties of new materials developed for use in minimally invasive procedures in the spine. A substantial amount of attention may need to be given to non-toxic setting reactions.

Utilização de vestimentas de proteção radiológica para redução de dose absorvida: uma revisão integrativa da literatura

OBJETIVO: Avaliar a relação entre o uso de vestimenta de proteção radiológica e a diminuição da dose absorvida de radiação ionizante, reforçando a eficácia do seu uso tanto para pacientes quanto para indivíduos ocupacionalmente expostos. MATERIAIS E MÉTODOS: O estudo foi desenvolvido utilizando-se o método de revisão integrativa de literatura, e teve como materiais: 21 artigos, 2 livros, 1 tese, 1 trabalho de conclusão de curso, 1 programa de computador, 4 pesquisas em base de dados (Instituto Brasileiro de Geografia e Estatística e Departamento de Informática do Sistema Único de Saúde) e 2 diretrizes de proteção radiológica. RESULTADOS: A utilização da vestimenta de proteção radiológica, teoricamente, reduz 86% a 99% a dose absorvida. Na prática, a redução nos pacientes pode ser de 88% na radiologia convencional e chegar a 95% no exame tomográfico. Nos indivíduos ocupacionalmente expostos, a redução durante um cateterismo cardíaco é em torno de 90% e durante uma cirurgia ortopédica é de 75%. CONCLUSÃO: Conforme demonstrado em várias pesquisas, o uso de vestimenta de proteção radiológica é eficaz e de baixo custo e reduz a dose desnecessária nos pacientes e nos indivíduos ocupacionalmente expostos. Logo, sua utilização é necessária para a implementação de um efetivo programa de proteção radiológica em um serviço de radiodiagnóstico.

X-ray transmission through nanostructured and microstructured CuO materials

This study presents a comparison of the X-ray transmission through microsized and nanosized materials. For this purpose CuO nanoparticles, with 13.4 nm average grain size, and CuO microparticles, with a mean particle size of 56 μm, were incorporated separately to beeswax in a concentration of 5%. Results show that the transmission through the above material plates with microsized and nanosized CuO was almost the same for X-ray beams generated at 60 and 102 kV tube voltages. However, for the radiation beams generated at 26 and 30 kV tube voltages the X-rays are more attenuated by the nanostructured CuO plates by a factor of at least 14%. Results suggest that the difference in the low energy range may be due to the higher number of particles/gram in the plates designed with CuO nanoparticles and due to the grain size effect on the X-ray transmission.