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Del Río-Solá ML, Rial R, Lopez-Espada C, Rodríguez-Morata A, Vañó E. National Diagnostic Reference Levels for Standard Descending Thoracic Endovascular Aortic Repair and Optimisation Strategies. Eur J Vasc Endovasc Surg 2024; 68:210-217. [PMID: 38754725 DOI: 10.1016/j.ejvs.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/06/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE The International Commission on Radiological Protection has highlighted the large number of medical specialties that use fluoroscopy outside diagnostic imaging departments without radiation protection programmes for patients and staff. Vascular surgery is one of these specialties. Thoracic endovascular aortic repair (TEVAR) is a complicated procedure requiring radiation protection guidance and optimisation. The recent EU Basic Safety Standards Directive requires the use and periodic updating of diagnostic reference levels (DRLs) for interventional procedures. The aim of this study was to determine doses for patients undergoing TEVAR with mobile Xray systems and hybrid rooms (fixed Xray systems) to obtain national DRLs and to suggest optimisation actions. METHODS This was a retrospective cross sectional study. The Spanish Chapter of Endovascular Surgery conducted a national survey in 11 autonomous communities representing around 77.6% of the Spanish population (47.33 million inhabitants). A total of 266 TEVAR procedures from 17 Spanish centres were analysed, of which 53.0% were performed in hybrid operating rooms. National DRLs were obtained and defined as the third quartile of the median values from the different participating centres. RESULTS The proposed national DRLs are: for kerma area product (KAP), 113.81 Gy·cm2 for mobile Xray systems and 282.59 Gy·cm2 for hybrid rooms; and for cumulative air kerma (CAK) at the patient entry reference point, 228.38 mGy for mobile systems and 910.64 mGy for hybrid rooms. CONCLUSION Based on the requirement to know radiation doses for standard endovascular procedures, this study of TEVARs demonstrated that there is an increased factor of 2.48 in DRLs for KAP when the procedure is performed in a hybrid room compared with mobile C-arm systems, and an increased factor of 3.98 in DRLs for CAK when the procedure is performed with hybrid equipment. These results will help to optimise strategies to reduce radiation doses during TEVAR procedures.
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Affiliation(s)
- Maria L Del Río-Solá
- Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, University Clinical Hospital of Valladolid, University of Valladolid, Valladolid, Spain
| | - Rodrigo Rial
- Vascular and Endovascular Surgery Department, University Hospital HM Madrid-Torrelodones, Madrid, Spain
| | - Cristina Lopez-Espada
- Vascular Surgery Unit, University Hospital Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria - ibs.GRANADA, Granada, Spain; Department of Surgery, Faculty of Medicine, University of Granada, Granada, Spain.
| | | | - Eliseo Vañó
- Radiology Department, Complutense University, Madrid, Spain
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Roberto MR, Leite LMA, Cruz ARP, Khoury H, de Barros VSM, Neves JR, Cartaxo JM, Ubeda C, Asfora VK. Medical staff dose estimation during pediatric cardiac interventional procedures. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021516. [PMID: 38722296 DOI: 10.1088/1361-6498/ad4905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
The purpose of this study is to evaluate the occupational doses (eye lens, extremities and whole body) in paediatric cardiac interventional and diagnostic catheterization procedures performed in a paediatric reference hospital located in Recife, Pernambuco. For eye lens dosimetry, the results show that the left eye receives a higher dose than the right eye, and there is a small difference between the doses received during diagnostic (D) and therapeutic (T) procedures. The extrapolated annual values for the most exposed eye are close to the annual limit. For doses to the hands, it was observed that in a significant number of procedures (37 out of 45 therapeutic procedures, or 82%) at least one hand of the physician was exposed to the primary beam. During diagnostic procedures, the physician's hand was in the radiation field in 11 of the 17 catheterization procedures (65%). This resulted in a 10-fold increase in dose to the hands. The results underscore the need for optimization of radiation safety and continued efforts to engage staff in a radiation safety culture.
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Affiliation(s)
| | - Luiz M A Leite
- Nuclear Energy Departament, Universidade Federal de Pernambuco-UFPE, Recife, Brazil
| | - Arícia R P Cruz
- Nuclear Energy Departament, Universidade Federal de Pernambuco-UFPE, Recife, Brazil
| | - Helen Khoury
- Nuclear Energy Departament, Universidade Federal de Pernambuco-UFPE, Recife, Brazil
| | | | - Juliana R Neves
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
| | - Jéssica M Cartaxo
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
| | - Carlos Ubeda
- Medical Technology Department, Health Sciences Faculty, Tarapaca University, Arica, Chile
| | - Viviane K Asfora
- Nuclear Energy Departament, Universidade Federal de Pernambuco-UFPE, Recife, Brazil
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3
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De Coninck V, Hendrickx L, Mortiers X, Somani B, Emiliani E, Sener ET, Pietropaolo A, Jones P, Skolarikos A, Tailly T, De Wachter S, Traxer O, Keller EX. Radiation exposure of urologists during endourological procedures: a systematic review. World J Urol 2024; 42:310. [PMID: 38722553 DOI: 10.1007/s00345-024-05023-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/23/2024] [Indexed: 07/10/2024] Open
Abstract
INTRODUCTION Ionizing radiation is used daily during endourological procedures. Despite the dangers of both deterministic and stochastic effects of radiation, there is a lack of knowledge and awareness among urologists. This study reviewed the literature to identify the radiation exposure (RE) of urologists during endourological procedures. METHODS A literature search of the Medline, Web of Science, and Google Scholar databases was conducted to collect articles related to the radiation dose to urologists during endourological procedures. A total of 1966 articles were screened. 21 publications met the inclusion criteria using the PRIMA standards. RESULTS Twenty-one studies were included, of which 14 were prospective. There was a large variation in the mean RE to the urologist between studies. PCNL had the highest RE to the urologist, especially in the prone position. RE to the eyes and hands was highest in prone PCNL, compared to supine PCNL. Wearing a thyroid shield and lead apron resulted in a reduction of RE ranging between 94.1 and 100%. Educational courses about the possible dangers of radiation decreased RE and increased awareness among endourologists. CONCLUSIONS This is the first systematic review in the literature analyzing RE to urologists over a time period of more than four decades. Wearing protective garments such as lead glasses, a thyroid shield, and a lead apron are essential to protect the urologist from radiation. Educational courses on radiation should be encouraged to further reduce RE and increase awareness on the harmful effects of radiation, as the awareness of endourologists is currently very low.
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Affiliation(s)
- Vincent De Coninck
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium.
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, 6846, Arnhem, Netherlands.
| | - Laura Hendrickx
- Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Xavier Mortiers
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
- Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Esteban Emiliani
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - Emre Tarik Sener
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Patrick Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Andreas Skolarikos
- Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stefan De Wachter
- Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Olivier Traxer
- GRC No. 20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Wendler JJ, Schittko J, Lux A, Liehr UB, Pech M, Schostak M, Porsch M. [Radiation-induced cataract-an occult risk for urologists]. UROLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00120-023-02073-w. [PMID: 37138102 PMCID: PMC10310569 DOI: 10.1007/s00120-023-02073-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Radiation-induced cataracts represent a relevant risk to people occupationally exposed to radiation. The annual limit dose for the eye lens was reduced to 20 mSv per year by German legislation (radiation protect law StrlSchG 2017; 2013/59/Euratom) based on recommendation of International Commission on Radiation Protection (2011 ICRP) to avoid radiation-induced cataracts. OBJECTIVES Is there a risk of exceeding the annual limit dose for the eye lens in routine urological practice without special radiation protection for the head? METHODS As part of a prospective, monocentric dosimetry study, of 542 different urological, fluoroscopically guided interventions, the eye lens dose was determined using a forehead dosimeter (thermo-luminescence dosemeter TLD, Chipstrate) over a period of 5 months. RESULTS An average head dose of 0.05 mSv per intervention (max. 0.29 mSv) was found with an average dose area product of 485.33 Gy/cm2. Significant influencing factors for a higher dose were a higher patient body mass index (BMI), a longer operation time, and a higher dose area product. The level of experience of the surgeon showed no significant influence. DISCUSSION With 400 procedures per year or an average of 2 procedures per working day, the critical annual limit value for the eye lenses or for the risk of radiation-induced cataract would be exceeded without special protective measures. CONCLUSION Consistently effective radiation protection of the eye lens is essential for daily work in uroradiological interventions. This may require further technical developments.
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Affiliation(s)
- J J Wendler
- Klinik für Urologie, Uroonkologie, robotergestützte und fokale Therapie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland.
- Praxis für Urologie, BAG, Magdeburg, Deutschland.
| | - J Schittko
- Klinik für Urologie, Uroonkologie, robotergestützte und fokale Therapie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland
| | - A Lux
- Institut für Biometrie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
| | - U-B Liehr
- Klinik für Urologie, Uroonkologie, robotergestützte und fokale Therapie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland
| | - M Pech
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
| | - M Schostak
- Klinik für Urologie, Uroonkologie, robotergestützte und fokale Therapie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland
| | - M Porsch
- Klinik für Urologie, Uroonkologie, robotergestützte und fokale Therapie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland
- Praxis für Urologie, BAG, Magdeburg, Deutschland
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Morishima Y, Chida K, Meguro T, Hirota M, Chiba H, Fukuda H. LENS EQUIVALENT DOSE OF STAFF DURING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: DOSE COMPARISON USING TWO TYPES OF DOSEMETERS. RADIATION PROTECTION DOSIMETRY 2022; 198:1368-1376. [PMID: 36055968 DOI: 10.1093/rpd/ncac160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/30/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Yoshiaki Morishima
- Department of Radiological Technology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai 983-8512, Japan
- Department of Radiological Technology, Tohoku University School of Health Sciences, Sendai 980-8575, Japan
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University School of Health Sciences, Sendai 980-8575, Japan
| | - Takayoshi Meguro
- Gastroenterology Center, Tohoku Medical and Pharmaceutical University Hospital, Sendai 983-8512, Japan
| | - Morihisa Hirota
- Gastroenterology Center, Tohoku Medical and Pharmaceutical University Hospital, Sendai 983-8512, Japan
| | - Hiroo Chiba
- Department of Radiological Technology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai 983-8512, Japan
| | - Hiroshi Fukuda
- Department of Radiology Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai 983-8356, Japan
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Ozaki K, Fukawa T, Kawanaka T, Daizumoto K, Sasaki Y, Ueno Y, Tsuda M, Kusuhara Y, Yamamoto Y, Yamaguchi K, Takahashi M, Kanayama H. Appropriate management reduces radiation exposure in daily urological practice. Int J Urol 2022; 29:1207-1212. [DOI: 10.1111/iju.14971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Keisuke Ozaki
- Department of Urology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Tomoya Fukawa
- Department of Urology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Takashi Kawanaka
- Department of Radiology and Radiation Oncology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Kei Daizumoto
- Department of Urology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Yutaro Sasaki
- Department of Urology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Yoshiteru Ueno
- Department of Urology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Megumi Tsuda
- Department of Urology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Yoshito Kusuhara
- Department of Urology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Yasuyo Yamamoto
- Department of Urology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Masayuki Takahashi
- Department of Urology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
| | - Hiro‐omi Kanayama
- Department of Urology, Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan
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Chida K. What are useful methods to reduce occupational radiation exposure among radiological medical workers, especially for interventional radiology personnel? Radiol Phys Technol 2022; 15:101-115. [PMID: 35608759 DOI: 10.1007/s12194-022-00660-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai, 980-8575, Japan. .,Division of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 468-1 Aoba, Aramaki, Aoba-ku, Sendai, 980-8572, Japan.
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Alnaaimi M, Alduaij M, Shenawy F, Algaily M, Mohammedzein T, Shaaban M, Rehani MM. Assessment of eye doses to staff involved in interventional cardiology procedures in Kuwait. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:639-645. [PMID: 34351496 PMCID: PMC8339394 DOI: 10.1007/s00411-021-00929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/24/2021] [Indexed: 06/13/2023]
Abstract
In this study, which is the first of its kind in the gulf region, eye doses of interventional cardiologists and nurses were measured using active dosimeters for left and right eyes, in 60 percutaneous coronary interventions in three main hospitals in Kuwait. The dose given in terms of Hp(0.07) per procedure when ceiling suspended screens were used by main operators ranged from 18.5 to 30.3 µSv for the left eye and from 12.6 to 23.6 µSv for the right eye. Taking into account typical staff workload, the results show that the dose limit of 20 mSv/year to the eyes can be exceeded for interventional cardiologists in some situations, which demonstrates the need of using additional effective radiation protection tools, e.g. protective eye spectacles, in addition to the regular and proper use of ceiling suspended screens. With indications of increase in workload, the need for availability of a dedicated active dosimeter for the regular monitoring of eye doses is emphasized.
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Affiliation(s)
- Meshari Alnaaimi
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait.
| | - Mousa Alduaij
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Faisal Shenawy
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Musab Algaily
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Talal Mohammedzein
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Mohamed Shaaban
- Radiation Protection Department, Shuwaikh, Kuwait City, Kuwait
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Endo M, Haga Y, Sota M, Tanaka A, Otomo K, Murabayashi Y, Abe M, Kaga Y, Inaba Y, Suzuki M, Meguro T, Chida K. Evaluation of novel X-ray protective eyewear in reducing the eye dose to interventional radiology physicians. JOURNAL OF RADIATION RESEARCH 2021; 62:414-419. [PMID: 33839782 PMCID: PMC8127654 DOI: 10.1093/jrr/rrab014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/17/2020] [Indexed: 05/28/2023]
Abstract
The new recommendation of the International Commission on Radiological Protection for occupational eye dose is an equivalent dose limit to the eye of 20 mSv year-1, averaged over a 5-year period. This recommendation is a drastic reduction from the previous limit of 150 mSv year-1. Hence, it is important to protect physicians' eyes from X-ray radiation. Particularly in interventional radiology (IVR) procedures, many physicians use protective lead (Pb) glasses to reduce their occupational exposure. This study assessed the shielding effects of novel 0.07 mm Pb glasses. The novel glasses (XR-700) have Pb-acrylic lens molded in three dimensions. We studied the novel type of 0.07 mm Pb glasses over a period of seven consecutive months. The eye dose occupational radiation exposure of seven IVR physicians was evaluated during various procedures. All IVR physicians wore eye dosimeters (DOSIRIS™) close to the left side of the left eye. To calculate the shielding effects of the glasses, this same type of eye dosimeter was worn both inside and outside of the Pb lenses. The average shielding effect of the novel glasses across the seven physicians was 61.4%. Our results suggest an improved shielding effect for IVR physicians that use these glasses. No physician complained that the new glasses were uncomfortable; therefore comfort is not a problem. The lightweight glasses were acceptable to IVR physicians, who often must perform long procedures. Thus, the novel glasses are comfortable and reasonably protective. Based on the results of this study, we recommend that IVR physicians use these novel 0.07 mm Pb glasses to reduce their exposure.
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Affiliation(s)
- Mime Endo
- Department of Radiological Technology, Tohoku University Graduate
School of Medicine , 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Yoshihiro Haga
- Department of Radiological Technology, Tohoku University Graduate
School of Medicine , 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Department of Radiology, Sendai Kousei Hospital ,
Hirosemachi 4-15, Aobaku, Sendai 980-0873, Japan
| | - Masahiro Sota
- Department of Radiological Technology, Tohoku University Graduate
School of Medicine , 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Department of Radiology, Sendai Kousei Hospital ,
Hirosemachi 4-15, Aobaku, Sendai 980-0873, Japan
| | - Akiko Tanaka
- Department of Cardiovascular Medicine, Sendai Kousei
Hospital , Hirosemachi 4-15, Aobaku, Sendai 980-0873, Japan
| | - Kazuki Otomo
- Department of Radiological Technology, Tohoku University Graduate
School of Medicine , 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
| | - Yuuki Murabayashi
- Division of Disaster Medicine, International Research Institute of
Disaster Science, Tohoku University , 6-6-4 Aoba, Sendai 980-8579,
Japan
| | - Mitsuya Abe
- Department of Radiology, Sendai Kousei Hospital ,
Hirosemachi 4-15, Aobaku, Sendai 980-0873, Japan
| | - Yuji Kaga
- Department of Radiology, Sendai Kousei Hospital ,
Hirosemachi 4-15, Aobaku, Sendai 980-0873, Japan
| | - Yohei Inaba
- Department of Radiological Technology, Tohoku University Graduate
School of Medicine , 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Disaster Medicine, International Research Institute of
Disaster Science, Tohoku University , 6-6-4 Aoba, Sendai 980-8579,
Japan
| | - Msatoshi Suzuki
- Department of Radiological Technology, Tohoku University Graduate
School of Medicine , 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Disaster Medicine, International Research Institute of
Disaster Science, Tohoku University , 6-6-4 Aoba, Sendai 980-8579,
Japan
| | - Taiichiro Meguro
- Department of Cardiovascular Medicine, Sendai Kousei
Hospital , Hirosemachi 4-15, Aobaku, Sendai 980-0873, Japan
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate
School of Medicine , 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
- Division of Disaster Medicine, International Research Institute of
Disaster Science, Tohoku University , 6-6-4 Aoba, Sendai 980-8579,
Japan
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Bohari A, Hashim S, Ahmad NE, Ghoshal SK, Mohd Mustafa SN. Fluoroscopy-guided intervention procedure norms for occupational eye radiation dose: An overall evaluation. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2020.108909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vassileva J, Zagorska A, Basic D, Karagiannis A, Petkova K, Sabuncu K, Saltirov I, Sarica K, Skolarikos A, Stavridis S, Trinchieri A, Tzelves L, Ulus I, Yuruk E. Radiation exposure of patients during endourological procedures: IAEA-SEGUR study. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:1390-1405. [PMID: 33086202 DOI: 10.1088/1361-6498/abc351] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
Fluoroscopy is increasingly used to guide minimally invasive endourological procedures and optimised protocols are needed to minimise radiation exposure while achieving best treatment results. This multi-center study of radiation exposure of patients was conducted by the South-Eastern European Group for Urolithiasis Research (SEGUR), in cooperation with the International Atomic Energy Agency. Seven clinical centers from the SEGUR group collected data for 325 procedures performed within a three-months period, including standard percutaneous nephrolithotomy (PCNL), mini PCNL, retrograde intrarenal surgery (RIRS), semirigid ureterorenoscopy (URS) and flexible URS. Data included: air kerma area product (PKA), air kerma at the patient entrance reference point (Ka,r), fluoroscopy time (FT), number of radiographic images (N) and fluoroscopy pulse rate, as well as total procedure duration, size and location of stones. Data were centrally analysed and statistically compared. MedianPKAvalues per center varied 2-fold for RIRS (0.80-1.79 Gy cm2), 7.1 fold for mini-PCNL (1.39-9.90 Gy cm2), 7.3 fold for PCNL (2.40-17.50 Gy cm2), 19 fold (0.13-2.51 Gy cm2) for semi-rigid URS and 29-fold for flexible URS (0.10-2.90 Gy cm2). LowerPKAandKa,rwere associated with use of lower FT,Nand lower fluoroscopy pulse rate. FT varied from 0.1 to 14 min, a small fraction of the total procedure time, ranging from 10 to 225 min. HigherNwas associated with higherPKAandKa,r. Higher medianPKAin PCNL was associated with the use of supine compared to prone position. No correlation was found between the concrement size and procedure duration, FT,PKAorKa,r. Dose values for RIRS were significantly lower compared to PCNL. The maximumKa,rvalue of 377 mGy was under the threshold for radiation induced skin erythema. The study demonstrated a potential for patient dose reduction by lowering FT andN, using pulsed fluoroscopy and beam collimation.
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Affiliation(s)
- Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Anna Zagorska
- Second Nuclear Medicine Department, Acibadem City Clinic UMHAT, Sofia, Bulgaria
| | | | - Andreas Karagiannis
- 2nd Department of Urology, Sismanoglio Hospital, Athens, Greece
- Department of Urology, Athens Euroclinic Hospital, Athens, Greece
| | - Kremena Petkova
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Kubilay Sabuncu
- Karacabey State Hospital, Department of Urology, Bursa, Turkey
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey
| | | | - Sotir Stavridis
- University Clinic of Urology, Medical Faculty Skopje, Skopje, North Macedonia
| | - Alberto Trinchieri
- Department of Urology, Manzoni Hospital, Lecco, Italy
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Lazaros Tzelves
- 2nd Department of Urology, Sismanoglio Hospital, Athens, Greece
| | - Ismail Ulus
- Department of Urology, BHT ClinicIstanbul Tema Hospital, Istanbul, Turkey
| | - Emrah Yuruk
- Department of Urology, BHT ClinicIstanbul Tema Hospital, Istanbul, Turkey
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12
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Santos MF, Filho WCV, Melo GTP, Asfora VK, Khoury HJ, Barros VSM. Evaluation of a 3D printed OSL eye lens dosimeter for photon dosimetry. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:1247-1257. [PMID: 32470962 DOI: 10.1088/1361-6498/ab97fe] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
This work demonstrates the use of high-resolution 3D printing to fine-tune the low energy dependence of an eye lens dosimeter holder associated to a BeO OSL detector element (ezClip). Five geometries of the denominated iBe dosimeter were developed, three with a variation in the thickness of the wall in front of the sensitive element that tailor the response at low radiation energies; and three with variations of width and curvature in order to vary the angular response of the dosimeter badges. Additive manufacturing was accomplished using stereolithography which gave a high degree of accuracy and precision. The optimised dosimeter badges showed a low energy and angular dependence, within -20% to +20% in the energy range of 24 keV to 662 keV and from 0 to 60° incidence; and within -10% to +10% in the energy range of 24 keV to 164 keV and from 0 to 60° incidence. In contrast to other dosimeters with higher effective atomic numbers, the use of BeO as the sensitive element resulted in a flat energy and angular dependence response at low energies. A significant reduction in the measurement uncertainty in the diagnostic radiology energy range was achieved.
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Affiliation(s)
- M F Santos
- Department of Nuclear Energy, Federal University of Pernambuco, Recife, Brazil
| | - W C V Filho
- Department of Nuclear Energy, Federal University of Pernambuco, Recife, Brazil
| | - G T P Melo
- Department of Nuclear Energy, Federal University of Pernambuco, Recife, Brazil
| | - V K Asfora
- Department of Nuclear Energy, Federal University of Pernambuco, Recife, Brazil
| | - H J Khoury
- Department of Nuclear Energy, Federal University of Pernambuco, Recife, Brazil
| | - V S M Barros
- Department of Nuclear Energy, Federal University of Pernambuco, Recife, Brazil
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13
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Wilson-Stewart KS, Fontanarosa D, Li D, Drovandi CC, Anderson RK, Trapp JV. Taller staff occupationally exposed to less radiation to the temple in cardiac procedures, but risk higher doses during vascular cases. Sci Rep 2020; 10:16103. [PMID: 32999372 PMCID: PMC7528059 DOI: 10.1038/s41598-020-73101-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/11/2020] [Indexed: 01/05/2023] Open
Abstract
This study aimed to evaluate the effect of nurse and doctor height on occupational dose to the temple during fluoroscopically guided cardiovascular procedures. Additionally, an evaluation of the relationship between doctor height and table height was performed. Staff exposed during fluoroscopic procedures may be at elevated risk of cardiovascular damage or oncogenesis and have demonstrated a higher incidence of subscapular cataracts. The heads of taller staff may be exposed to reduced levels of radiation due to the increased distance from the area of highest intensity X-ray scatter. Limited research has been performed investigating height as a predictor of head dose to nursing staff. The level of radiation dose at the level of the temple to the doctor (n = 25), scrub (n = 28), and scout nurse (n = 29) was measured in a prospective single-center, observational study using Philips DoseAware badges. Procedural characteristics were recorded for vascular and cardiac cases performed in three dedicated angiography suites. Data were also collected to investigate relationships between doctor height and table height. Data were collected for 1585 cardiac and 294 vascular procedures. Staff height was a statistically significant predictor of temple dose for doctors, scrub, and scout nurses when considering the full data sample. The log temple dose demonstrated an inverse relationship to staff height during cardiac procedures, but a positive relationship for scrub and scout nurses during vascular studies. This observational study has demonstrated that taller staff are exposed to less cranial exposure dose during fluoroscopically guided cardiac examinations but has revealed a positive correlation between height and temple dose during vascular procedures. It was also determined that doctor height was correlated with average procedural table height and that vascular access point influences the choice of table elevation.
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Affiliation(s)
- Kelly S Wilson-Stewart
- School of Chemistry and Physics, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia. .,Cardiovascular Suites, Greenslopes Private Hospital, Newdegate Street, Greenslopes, Brisbane, QLD, 4120, Australia.
| | - Davide Fontanarosa
- School of Clinical Sciences, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Q Block, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia
| | - Dan Li
- School of Mathematical Sciences, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,Centre for Data Science, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,ARC Centre of Excellence for Mathematical and Statistical Frontiers, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Chris C Drovandi
- School of Mathematical Sciences, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,Centre for Data Science, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia.,ARC Centre of Excellence for Mathematical and Statistical Frontiers, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Rebecca K Anderson
- Cardiovascular Suites, Greenslopes Private Hospital, Newdegate Street, Greenslopes, Brisbane, QLD, 4120, Australia
| | - Jamie V Trapp
- School of Chemistry and Physics, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4000, Australia
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14
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Vassileva J, Zagorska A, Karagiannis A, Petkova K, Sabuncu K, Saltirov I, Sarica K, Skolarikos A, Stavridis S, Trinchieri A, Tzelves L, Ulus I, Yuruk E. Radiation Exposure of Surgical Team During Endourological Procedures: International Atomic Energy Agency-South-Eastern European Group for Urolithiasis Research Study. J Endourol 2020; 35:574-582. [PMID: 32791856 DOI: 10.1089/end.2020.0630] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction: Fluoroscopy-guided endourology procedures require proper radiation protection to minimize radiation risk. This multicenter study aimed at investigating radiation protection practice and related radiation exposure of operating team members. Materials and Methods: Six endourology centers from the South-Eastern European Group for Urolithiasis Research answered questionnaires and collected data of 315 procedures performed within a 3-months period, with simultaneous measurement of dose to staff and dose area product (DAP) to patient. A pair of calibrated personal dosimeters, one for body and one for eye-lens dose, was worn by all key staff members. Dosimeters were centrally calibrated, measured, and analyzed. Results: The annual workload ranged from 173 to 865 procedures per center. Practice of personal dose monitoring and use of radiation protection shielding was found to be inconsistent. Lead aprons and thyroid collars were used by all, whereas protective eyewear was used in only half of centers. Due to the regular use of protective aprons, the whole-body dose of all 44 monitored staff members was safely below the regulatory dose limits. Eye-lens dose of 17 (14 urologists and 3 assisting staff) was above the dosimeter detection level, and dose per procedure varied from <10 to 63 μSv. The highest annual eye-lens dose of 13.5 mSv was found for the surgeon in the busiest department by using an over-the-couch X-ray tube without a ceiling suspended screen. Working closer to patient body with no protection resulted in a six-time higher eye-lens dose per DAP for a surgeon compared with others in the same center. Lower eye-dose per procedure was associated with lower DAP to patient and with the use of an under-the-couch tube, lower fluoroscopy pulse rate, collimation, fluoroscopy time, and acquired images. Conclusions: The study results call for the need to establish standard protocols about use of fluoroscopy during endourology procedures and to increase radiation protection knowledge and awareness of surgical staff.
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Affiliation(s)
- Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Anna Zagorska
- Second Nuclear Medicine Department, Acibadem City Clinic UMHAT, Sofia, Bulgaria
| | - Andreas Karagiannis
- Second Department of Urology, Sismanoglio Hospital, Athens, Greece.,Department of Urology, Athens Euroclinic Hospital, Athens, Greece
| | - Kremena Petkova
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Kubilay Sabuncu
- Department of Urology, Karacabey State Hospital, Bursa, Turkey
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey
| | | | - Sotir Stavridis
- Medical Faculty Skopje, University Clinic of Urology, Skopje, North Macedonia
| | - Alberto Trinchieri
- Department of Urology, Manzoni Hospital, Lecco, Italy.,Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Lazaros Tzelves
- Second Department of Urology, Sismanoglio Hospital, Athens, Greece
| | - Ismail Ulus
- Department of Urology, BHT Clinic Istanbul Tema Hospital, Istanbul, Turkey
| | - Emrah Yuruk
- Department of Urology, BHT Clinic Istanbul Tema Hospital, Istanbul, Turkey
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15
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Rial R, Vañó E, Del Río-Solá ML, Fernández JM, Sánchez RM, Camblor Santervás LA, Bellmunt S, Blanco E, El Amrani Joutey M, González Cañas E, Gomez Palones FJ, González Fajardo JA, González Tabares E, Llagostera Pujol S, Rielo Arias F, Salmerón Febres LM, Aramendi Arieta-Araunabeña C, Iborra Ortega E, Guerra Requena M. National Diagnostic Reference Levels for Endovascular Aneurysm Repair and Optimisation Strategies. Eur J Vasc Endovasc Surg 2020; 60:837-842. [PMID: 32912764 DOI: 10.1016/j.ejvs.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 07/05/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The International Commission on Radiological Protection (ICRP) has highlighted the large number of medical specialties using fluoroscopy outside imaging departments without programmes of radiation protection (RP) for patients and staff. Vascular surgery is one of these specialties and endovascular aneurysm repair (EVAR) is one of the most challenging procedures requiring RP guidance and optimisation actions. The recent European Directive on Basic Safety Standards requires the use and regular update of diagnostic reference levels (DRL) for interventional procedures. The objective of the study was to know the doses of patients undergoing EVAR with mobile Xray systems and with hybrid rooms (fixed Xray systems), to obtain national DRLs and suggest optimisation actions. METHODS The Spanish Chapter of Endovascular Surgery launched a national survey that involved hospitals for 10 autonomous communities representing the 77% of the Spanish population (46.7 million inhabitants). Patient dose values from mobile Xray systems were available from nine hospitals (sample of 165 EVAR procedures) and data from hybrid rooms, from seven hospitals, with dosimetric data from 123 procedures. The initial national DRLs have been obtained, as the third quartile of the median values from the different centres involved in the survey. RESULTS The proposed national DRLs are 278 Gy cm2 for hybrid rooms and 87 Gy cm2 for mobile Xray systems, and for cumulative air kerma (cumulative AK) at the patient entrance reference point, 1403 mGy for hybrid rooms, and 292 mGy for mobile systems. CONCLUSION An audit of patient doses for EVAR procedures to identify optimised imaging protocol strategies is needed. It is also appropriate to evaluate the diagnostic information required for EVAR procedures. The increase by a factor of 3.2 (for kerma area product) and 4.8 (for cumulative AK) in the DRLs needs to be justified when the procedures are performed in the hybrid rooms rather than with mobile Xray systems.
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Affiliation(s)
- Rodrigo Rial
- Vascular Surgery Department, University Hospital Clinico San Carlos, Madrid, Spain.
| | - Eliseo Vañó
- Medical Physics Service, Hospital Clínico San Carlos and IdISSC, Madrid, Spain; Radiology Department, Complutense University, Madrid, Spain
| | - Maria L Del Río-Solá
- Vascular Surgery Department, University Hospital Clinico Valladolid, Valladolid, Spain
| | - José M Fernández
- Medical Physics Service, Hospital Clínico San Carlos and IdISSC, Madrid, Spain
| | - Roberto M Sánchez
- Medical Physics Service, Hospital Clínico San Carlos and IdISSC, Madrid, Spain; Radiology Department, Complutense University, Madrid, Spain
| | | | - Sergi Bellmunt
- Vascular Surgery Department, University Hospital Vall D'hebron, Barcelona, Spain
| | - Estrella Blanco
- Vascular Surgery Department, Guadalajara University Hospital, Guadalajara, Spain
| | | | | | - Francisco J Gomez Palones
- Head of Vascular Surgery, Vascular Surgery Department, University Hospital Dr. Peset, Valencia, Spain
| | | | | | | | | | | | | | - Elena Iborra Ortega
- Vascular Surgery Department, University Hospital Bellvitge, L'Hospitalet de Llobregat, Spain
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16
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Lian ME, Tsai YH, Li IG, Hong YH, Chang SL, Tsai HY. Occupational radiation dose to the eye lens of physicians from departments of interventional radiology. RADIAT MEAS 2020. [DOI: 10.1016/j.radmeas.2020.106276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Miller DL. Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures. Med Phys 2020; 47:975-982. [DOI: 10.1002/mp.13990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Donald L. Miller
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring MD 20993USA
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18
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Harbron RW, Ainsbury EA, Barnard SGR, Lee C, McHugh K, Berrington de González A, Edyvean S, Pearce MS. Radiation dose to the lens from CT of the head in young people. Clin Radiol 2019; 74:816.e9-816.e17. [PMID: 31375261 DOI: 10.1016/j.crad.2019.06.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 06/28/2019] [Indexed: 11/28/2022]
Abstract
AIM To determine cumulative scan frequencies and estimate lens dose for paediatric computed tomography (CT) head examinations in the context of potential cataract risk. MATERIALS AND METHODS The cumulative number of head-region CT examinations among a cohort of 410,997 children and young adults who underwent CT in the UK between 1985 and 2014 was calculated. Images from a sample of these head examinations (n=668) were reviewed to determine the level of eye inclusion. Lens dose per scan was estimated using the computer program, NCICT V1.0, for different levels of eye inclusion and exposure settings typical of past and present clinical practice. RESULTS In total 284,878 patients underwent 448,108 head-region CT examinations. The majority of patients (72%) had a single recorded head-region examination. A small subset (∼1%, n=2,494) underwent ≥10 examinations, while 0.1% (n=387) underwent ≥20. The lens was included within the imaged region for 57% of reviewed routine head examinations. In many cases, this appeared to be intentional, i.e. protocol driven. In others, there appeared to have been an attempt to exclude the eyes through gantry angulation. Estimated lens doses were 20-75 mGy (mean: 47 mGy) where the eye was fully included within the examination range and 2-7 mGy (mean: 3.1 mGy) where the lens was fully excluded. Potential cumulative lens doses ranged from ∼3 mGy to ∼4,700 mGy, with 2,335 patients potentially receiving >500 mGy. CONCLUSION The majority of young people will receive cumulative lens doses well below 500 mGy, meaning the risk of cataract induction is likely to be very small.
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Affiliation(s)
- R W Harbron
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, UK; NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, UK.
| | - E A Ainsbury
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, UK
| | - S G R Barnard
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, UK
| | - C Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - K McHugh
- Radiology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - A Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Edyvean
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, UK
| | - M S Pearce
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, UK; NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, UK
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Demeter S, Goertzen AL, Patterson J. Demonstrating Compliance With Proposed Reduced Lens of Eye Dose Limits in Nuclear Medicine Settings. HEALTH PHYSICS 2019; 117:313-318. [PMID: 30907782 DOI: 10.1097/hp.0000000000001059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Based on ongoing research on ionizing radiation thresholds for cataracts, the International Commission on Radiological Protection has proposed new guidelines lowering the annual occupational lens of eye dose limit from 150 mSv to 20 mSv. The International Atomic Energy Agency has operationalized these new guidelines. Subsequently, national/regional radiation protection regulators are reviewing their lens of eye dose limits with an aim of moving towards the proposed new limits, resulting in licensees having to demonstrate compliance. In health care settings, fluoroscopic interventional practices generally have higher lens of eye doses and nuclear medicine settings generally have lower doses. A prospective cohort (n = 19) of nuclear medicine technologists wore dedicated lens of eye dosimeters for a 3 mo period synchronized with their body dosimeter schedules. The lens of eye dosimeters were validated to have a linear response in the anticipated dose ranges. The participants worked in a relatively high-volume nuclear medicine practice, which included general and cardiac, positron emission tomography/computed tomography, radiopharmacy, and cyclotron operations. The annualized dose ranges were 0.0-3.68 mSv (lens of eye) and 0.48-4.72 mSv (whole body). There was a good correlation between lens of eye and body dosimeter readings (R = 0.67). There were no significant differences in lens of eye dose by work type, worker sex, or side on which the dosimeter was worn. The findings should be generalizable to other similar practices, especially in North America, and should be sufficient to demonstrate regulatory compliance in nuclear medicine settings with the proposed new lens of eye dose limits.
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Affiliation(s)
- Sandor Demeter
- HSC Section of Nuclear Medicine, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Andrew L Goertzen
- HSC Section of Nuclear Medicine, Health Sciences Centre, Winnipeg, Manitoba, Canada
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Judy Patterson
- HSC Section of Nuclear Medicine, Health Sciences Centre, Winnipeg, Manitoba, Canada
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20
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Doizi S, Audouin M, Villa L, Rodríguez-Monsalve Herrero M, De Coninck V, Keller EX, Traxer O. The eye of the endourologist: what are the risks? A review of the literature. World J Urol 2019; 37:2639-2647. [DOI: 10.1007/s00345-019-02667-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/01/2019] [Indexed: 01/07/2023] Open
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21
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Eye lens monitoring programme for medical staff involved in fluoroscopy guided interventional procedures in Switzerland. Phys Med 2019; 57:33-40. [DOI: 10.1016/j.ejmp.2018.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 10/18/2018] [Accepted: 12/05/2018] [Indexed: 11/15/2022] Open
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22
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Hartmann J, Distler F, Baumüller M, Guni E, Pahernik S, Wucherer M. Risk of Radiation-Induced Cataracts: Investigation of Radiation Exposure to the Eye Lens During Endourologic Procedures. J Endourol 2018; 32:897-903. [PMID: 29901404 DOI: 10.1089/end.2018.0324] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Due to new radiobiologic data, the International Commission on Radiological Protection recommends a dose limit of 20 mSv per year to the eye lens. Therefore, the IAEA International Basic Safety Standard and the European council directive 2013/59/EURATOM require a reduction of the annual dose limit from 150 to 20 mSv. Urologists are exposed to an elevated radiation exposure in the head region during fluoroscopic interventions, due to the commonly used overtable X-ray tubes and the rarely used radiation protection for the head. Aim of the study was to analyze real radiation exposure to the eye lens of the urologist during various interventions, during which the patient is in the lithotomy position. MATERIALS AND METHODS The partial body doses (forehead and apron collar) of the urologists and surgical staff were measured over a period of 2 months. 95 interventions were performed on Uroskop Omnia Max workplaces (Siemens Healthineers, Erlangen, Germany). Interventions were class-divided in less (stage I) and more complex (stage II) interventions. Two dosimeter-types were applied, well-calibrated electronic personal dosimeter Mk2 and self-calibrated thermoluminescent dosimeter-100H (both Thermo Fisher Scientific, Waltham, MA). The radiation exposure parameters were documented using the dose area product (DAP) and the fluoroscopy time. RESULTS The correlation between DAP and the apron dose of the urologist was in average 0.07 μSv per 1 μGym2. The more experienced urologists yielded a mean DAP of 166 μGym2 for stage I and 415 μGym2 for stage II procedures. The interventionist was exposed with 10 μSv in mean outside the lead apron collar. The mean dose value of the eye lenses per intervention was ascertained to 20 μSv (mean DAP: 233 μGym2). CONCLUSIONS The study setup allows a differentiated and time-resolved measurement of the radiation exposure, which was found heterogeneous depending on intervention and surgeon. In this setting, ∼1000 interventions can be performed until the annual eye lens dose limit is achieved.
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Affiliation(s)
- Josefin Hartmann
- 1 Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University , Nuremberg, Germany
| | - Florian Distler
- 2 Department of Urology, Nuremberg General Hospital, Paracelsus Medical University , Nuremberg, Germany
| | - Martin Baumüller
- 1 Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University , Nuremberg, Germany
| | - Ewald Guni
- 1 Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University , Nuremberg, Germany
| | - Sascha Pahernik
- 2 Department of Urology, Nuremberg General Hospital, Paracelsus Medical University , Nuremberg, Germany
| | - Michael Wucherer
- 1 Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University , Nuremberg, Germany
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24
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Eye lens radiation exposure of the medical staff performing interventional urology procedures with an over-couch X-ray tube. Phys Med 2017; 43:140-147. [DOI: 10.1016/j.ejmp.2017.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/21/2017] [Accepted: 11/02/2017] [Indexed: 01/28/2023] Open
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Omar A, Kadesjö N, Palmgren C, Marteinsdottir M, Segerdahl T, Fransson A. Assessment of the occupational eye lens dose for clinical staff in interventional radiology, cardiology and neuroradiology. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2017; 37:145-159. [PMID: 28118149 DOI: 10.1088/1361-6498/aa559c] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In accordance with recommendations by the International Commission on Radiological Protection, the current European Basic Safety Standards has adopted a reduced occupational eye lens dose limit of 20 mSv yr-1. The radiation safety implications of this dose limit is of concern for clinical staff that work with relatively high dose x-ray angiography and interventional radiology. Presented in this work is a thorough assessment of the occupational eye lens dose based on clinical measurements with active personal dosimeters worn by staff during various types of procedures in interventional radiology, cardiology and neuroradiology. Results are presented in terms of the estimated equivalent eye lens dose for various medical professions. In order to compare the risk of exceeding the regulatory annual eye lens dose limit for the widely different clinical situations investigated in this work, the different medical professions were separated into categories based on their distinct work pattern: staff that work (a) regularly beside the patient, (b) in proximity to the patient and (c) typically at a distance from the patient. The results demonstrate that the risk of exceeding the annual eye lens dose limit is of concern for staff category (a), i.e. mainly the primary radiologist/cardiologist. However, the results also demonstrate that the risk can be greatly mitigated if radiation protection shields are used in the clinical routine. The results presented in this work cover a wide range of clinical situations, and can be used as a first indication of the risk of exceeding the annual eye lens dose limit for staff at other medical centres.
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Affiliation(s)
- Artur Omar
- Department of Medical Physics, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
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Thorne MC. Innovation: technical and social. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2017; 37:E1-E6. [PMID: 28247851 DOI: 10.1088/1361-6498/aa6048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- M C Thorne
- Quarry Cottage, Hamsterley, Bishop Auckland, DL13 3NJ, United Kingdom
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Simulator training to minimize ionizing radiation exposure in the catheterization laboratory. Int J Cardiovasc Imaging 2016; 33:303-310. [DOI: 10.1007/s10554-016-1009-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 10/24/2016] [Indexed: 10/24/2022]
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