Radiation Protection in Interventional Radiology

An investigation into the knowledge, attitudes, and practice of radiation protection in interventional radiology and cardiac catheter-laboratories

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.

Intraoperative fusion imaging during transcarotid artery revascularization

Background

Transcarotid artery revascularization (TCAR) with reverse-flow neuroprotection has emerged as an alternative to transfemoral carotid artery stenting and carotid endarterectomy. However, it requires fluoroscopic guidance, exposing the patient and surgeon to radiation. Although fusion-guided endovascular aneurysm repair has been demonstrated to significantly decrease this radiation risk, not much is known about similar outcomes for TCAR. The purpose of this study is to evaluate the outcomes at a single institution using fusion-guided imaging during TCAR compared with regional TCAR cases in the Vascular Quality Initiative (VQI) registry without fusion imaging.

Methods

A retrospective analysis was conducted of data collected from all patients undergoing TCAR with fusion-guided imaging (TCAR-F) at our hospital and patients undergoing TCAR alone within the VQI database. The primary outcomes included the total operative time, dose area product, fluoroscopy time, contrast usage, and flow-reversal time. The demographics and preoperative risk factors were also assessed in both groups. Continuous outcomes were compared using the Welch t test. Categorical outcomes were compared using the Fisher exact test.

Results

A total of 30 TCAR-F cases (January 2019 to May 2022) at our institution were compared against the regional VQI dataset (n = 2535). The TCAR-F cases had a lower dose area product (5.67 vs 93.1 Gy cm2; P < .0001), shorter fluoroscopy time (8.07 vs 16.4 minutes; P < .0001), and less contrast usage (13.49 vs 76.7 mL; P < .0001) compared with the regional averages of the same. The TCAR-F cases had a longer total operative time (117.3 vs 80.9 minutes; P < .0001) and flow-reversal time (14.4 vs 11.7 minutes; P = .025) compared with the regional cases.

Conclusions

The results from this pilot study comparing TCAR-F patients at a single institution with VQI regional TCAR patients suggest that TCAR-F cases use less radiation and contrast compared with TCAR without fusion imaging. Fusion-guided imaging might provide radiation protection to both patients and surgeons and decrease contrast usage for the patient.

LENS EQUIVALENT DOSE OF STAFF DURING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: DOSE COMPARISON USING TWO TYPES OF DOSEMETERS

This study aimed to compare the lens equivalent dose (LED) measured during endoscopic retrograde cholangiopancreatography (ERCP) using DOSIRIS™ as a dedicated dosemeter to that measured using glass badges to determine if glass badges can be alternative tools for LED measurement. LEDs for physicians during ERCP were measured using the DOSIRIS™ [3-mm dose equivalent] worn on the outer edge of the eyes and personal dosemeters (glass badges) [0.07-mm dose equivalent] worn on the right and left sides of the neck. The cumulated doses over 6 months for the left eye using DOSIRIS™ were 9.5 and 11.8 mSv for physicians A and B, whereas doses measured using glass badges were 7.5 and 11.6 mSv, respectively. The LEDs of the physicians at the left eye and left neck side showed almost similar values and were significantly correlated (r = 0.95; p < 0.01). For an accurate LED measurement during ERCP, using a dosemeter such as DOSIRIS™ is recommended, although similar LED estimation values were reported using glass badges on the left neck side.