1
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Hamada N. Noncancer Effects of Ionizing Radiation Exposure on the Eye, the Circulatory System and beyond: Developments made since the 2011 ICRP Statement on Tissue Reactions. Radiat Res 2023; 200:188-216. [PMID: 37410098 DOI: 10.1667/rade-23-00030.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/07/2023]
Abstract
For radiation protection purposes, noncancer effects with a threshold-type dose-response relationship have been classified as tissue reactions (formerly called nonstochastic or deterministic effects), and equivalent dose limits aim to prevent occurrence of such tissue reactions. Accumulating evidence demonstrates increased risks for several late occurring noncancer effects at doses and dose rates much lower than previously considered. In 2011, the International Commission on Radiological Protection (ICRP) issued a statement on tissue reactions to recommend a threshold of 0.5 Gy to the lens of the eye for cataracts and to the heart and brain for diseases of the circulatory system (DCS), independent of dose rate. Literature published thereafter continues to provide updated knowledge. Increased risks for cataracts below 0.5 Gy have been reported in several cohorts (e.g., including in those receiving protracted or chronic exposures). A dose threshold for cataracts is less evident with longer follow-up, with limited evidence available for risk of cataract removal surgery. There is emerging evidence for risk of normal-tension glaucoma and diabetic retinopathy, but the long-held tenet that the lens represents among the most radiosensitive tissues in the eye and in the body seems to remain unchanged. For DCS, increased risks have been reported in various cohorts, but the existence or otherwise of a dose threshold is unclear. The level of risk is less uncertain at lower dose and lower dose rate, with the possibility that risk per unit dose is greater at lower doses and dose rates. Target organs and tissues for DCS are also unknown, but may include heart, large blood vessels and kidneys. Identification of potential factors (e.g., sex, age, lifestyle factors, coexposures, comorbidities, genetics and epigenetics) that may modify radiation risk of cataracts and DCS would be important. Other noncancer effects on the radar include neurological effects (e.g., Parkinson's disease, Alzheimer's disease and dementia) of which elevated risk has increasingly been reported. These late occurring noncancer effects tend to deviate from the definition of tissue reactions, necessitating more scientific developments to reconsider the radiation effect classification system and risk management. This paper gives an overview of historical developments made in ICRP prior to the 2011 statement and an update on relevant developments made since the 2011 ICRP statement.
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Affiliation(s)
- Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Chiba, Japan
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2
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Askounis P, Torras Gonzalez A, Ginjaume M, Carinou E. Practical guidelines for personal monitoring and estimation of effective dose and dose to the lens of the eye in interventional procedures. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:031514. [PMID: 35940135 DOI: 10.1088/1361-6498/ac87b8] [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: 06/01/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Estimation of effective dose and dose to the lens of the eye for workers involved in interventional procedures is challenging. The interventional procedures in question involve high doses and, due to this, workers need to wear protective garments. As a result, various methodologies have been developed to assess the effective dose and dose to the lens of the eye. In the present study, measurements from four European dosimetry services, over and under protective garments, have been collected and analysed in order to provide practical guidelines based on the routine use of personal dosemeters from staff in interventional workplaces. The advantages and limitations of using one or two dosemeters are discussed.
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Affiliation(s)
| | | | - Merce Ginjaume
- Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
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3
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Miyaji N, Miwa K, Iimori T, Wagatsuma K, Tsushima H, Yokotsuka N, Murata T, Kasahara T, Terauchi T. Determination of a reliable assessment for occupational eye lens dose in nuclear medicine. J Appl Clin Med Phys 2022; 23:e13713. [PMID: 35775691 PMCID: PMC9359038 DOI: 10.1002/acm2.13713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
The most recent statement published by the International Commission on Radiological Protection describes a reduction in the maximum allowable occupational eye lens dose from 150 to 20 mSv/year (averaged over 5‐year periods). Exposing the eye lens to radiation is a concern for nuclear medicine staff who handle radionuclide tracers with various levels of photon energy. This study aimed to define the optimal dosimeter and means of measuring the amount of exposure to which the eye lens is exposed during a routine nuclear medicine practice. A RANDO human phantom attached to Glass Badge and Luminess Badge for body or neck, DOSIRIS and VISION for eyes, and nanoDot for body, neck, and eyes was exposed to 99mTc, 123I, and 18F radionuclides. Sealed syringe sources of each radionuclide were positioned 30 cm from the abdomen of the phantom. Estimated exposure based on measurement conditions (i.e., air kerma rate constants, conversion coefficient, distance, activity, and exposure time) was compared measured dose equivalent of each dosimeter. Differences in body, neck, and eye lens dosimeters were statistically analyzed. The 10‐mm dose equivalent significantly differed between the Glass Badge and Luminess Badge for the neck, but these were almost equivalent at the body. The 0.07‐mm dose equivalent for the nanoDot dosimeters was greatly overestimated compared to the estimated exposure of 99mTc and 123I radionuclides. Measured dose equivalents of exposure significantly differed between the body and eye lens dosimeters with respect to 18F. Although accurately measuring radiation exposure to the eye lenses of nuclear medicine staff is conventionally monitored using dosimeters worn on the chest or abdomen, eye lens dosimeters that provide a 3‐mm dose equivalent near the eye would be a more reliable means of assessing radiation doses in the mixed radiation environment of nuclear medicine.
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Affiliation(s)
- Noriaki Miyaji
- Department of Nuclear Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kenta Miwa
- Department of Radiological Sciences, School of Health Sciences, Fukushima Medical University, Fukushima, Japan
| | - Takashi Iimori
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Kei Wagatsuma
- School of Allied Health Science, Kitasato University, Kanagawa, Japan
| | - Hiroyuki Tsushima
- Department of Radiological Technology, Faculty of Health Sciences, Kobe Tokiwa University, Hyogo, Japan
| | - Noriyo Yokotsuka
- Department of Radiological Technology, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Taisuke Murata
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | | | - Takashi Terauchi
- Department of Nuclear Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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4
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Staff eye lens dose in interventional radiology and cardiology in Finland. Phys Med 2022; 98:1-7. [DOI: 10.1016/j.ejmp.2022.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/29/2022] [Accepted: 04/09/2022] [Indexed: 11/20/2022] Open
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5
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Dubeau J, Sun J, Djeffal S, Leroux N, Golovko V, Dodkin C, Mistry R. Current status of eye-lens dosimetry in Canada. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:011520. [PMID: 34715681 DOI: 10.1088/1361-6498/ac34a1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
For occupational exposures in planned exposure situations International Commission on Radiological Protection (ICRP) publication 118 recommends an equivalent dose limit for the lens of the eye of 20 mSv yr-1averaged over five years with no single year exceeding 50 mSv. This constitutes a reduction from the previous limit of 150 mSv yr-1. The Canadian nuclear regulator, the Canadian Nuclear Safety Commission, responded to the ICRP recommendation by initiating amendments to theRadiation Protection Regulationsthrough a discussion paper which was published for comment by interested stakeholders in 2013. The revised equivalent dose limit of 50 mSv in a one-year dosimetry period for nuclear energy workers came into effect in January 2021. This paper presents the outcome of discussions with Canadian stakeholders in diverse fields of radiological work which focused on the implementation of the reduced occupational equivalent dose limit for the lens of the eye in their respective workplaces. These exchanges highlighted the existing practices for monitoring doses to the lens of the eye and identified current technological gaps. The exchanges also identified that, in many cases, the lens of the eye dose is anticipated to be well within the new dose limit despite some of the gaps in technology. The paper also presents the monitoring and eye-lens dose assessment solutions that are available based on different methods for eye-lens monitoring; presented together with criteria for their use.
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Affiliation(s)
| | - Jiansheng Sun
- Dosimetry Services, Canadian Nuclear Laboratories, Chalk River, ON, Canada
| | - Salah Djeffal
- Radiation Protection Division, Canadian Nuclear Safety Commission, Ottawa, ON, Canada
| | - Neil Leroux
- Dosimetry Services, Canadian Nuclear Laboratories, Chalk River, ON, Canada
| | - Victor Golovko
- Dosimetry Services, Canadian Nuclear Laboratories, Chalk River, ON, Canada
| | - Christina Dodkin
- Radiation Protection Division, Canadian Nuclear Safety Commission, Ottawa, ON, Canada
| | - Rajesh Mistry
- Radiation Protection Division, Canadian Nuclear Safety Commission, Ottawa, ON, Canada
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6
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Bohra F, Atanackovic J, Byun SH, Hanu AR, Laranjeiro A. Quantification of pure beta spectra in mixed beta gamma fields as part of eye lens dosimetry at CANDU power plants. Appl Radiat Isot 2021; 174:109746. [PMID: 33930726 DOI: 10.1016/j.apradiso.2021.109746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/26/2022]
Abstract
To address the issue of eye lens dosimetry in nuclear industry, we initiated the project to quantify the beta and gamma-ray source term in CANDU power plants and to convert this source term into dosimetric quantities of interest, such as eye lens dose and personal dose equivalents Hp(10), Hp(0.07). This way, the eye lens dose can be compared with dosimetric operational quantities to evaluate whether independent dosimetry is required for eye lens protection, or present dosimetry is adequate.
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Affiliation(s)
- F Bohra
- McMaster University, Department of Physics and Astronomy, Hamilton, ON, L8S 4L8, Canada
| | - J Atanackovic
- McMaster University, Department of Physics and Astronomy, Hamilton, ON, L8S 4L8, Canada; Ontario Power Generation, Whitby, ON, L1N 9E3, Canada.
| | - S H Byun
- McMaster University, Department of Physics and Astronomy, Hamilton, ON, L8S 4L8, Canada
| | - A R Hanu
- McMaster University, Department of Physics and Astronomy, Hamilton, ON, L8S 4L8, Canada; Bruce Power, Tiverton, ON, N0G 2T0, Canada
| | - A Laranjeiro
- McMaster University, Department of Physics and Astronomy, Hamilton, ON, L8S 4L8, Canada
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Morcillo AB, Alejo L, Huerga C, Bayón J, Marín A, Corredoira E, Novo JR, Hernández T, Ponce MD, Garzón G, Vañó E, Guibelalde E. Occupational doses to the eye lens in pediatric and adult noncardiac interventional radiology procedures. Med Phys 2021; 48:1956-1966. [PMID: 33544901 DOI: 10.1002/mp.14753] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/04/2020] [Accepted: 01/21/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To assess occupational lens exposure in a mixed interventional radiology department, comparing pediatric and adult procedures. To analyze the correlation between the lens dose and the doses measured at the chest and collar level and the kerma-area product (PKA ). METHODS For 17 months, three radiologists performing both pediatric and adult interventions were monitored by means of 14 dosimeters per worker: 12 single-point optically stimulated luminescent (OSL) dosimeters calibrated in terms of Hp (0.07) were placed on the inside and outside of two pairs of lead glasses, one for pediatric procedures and one for adult interventions; another whole-body OSL dosimeter calibrated in terms of Hp (10) was placed over the thyroid shield; finally, an additional active solid-state dosimeter, also calibrated for Hp (10), was worn on the chest, over the apron. Furthermore, a database was created to register the demographic and dosimetric data of the procedures, as well as the name of the radiologist acting as first operator. RESULTS For the three radiologists, who performed 276-338 procedures/year (20% pediatric), cumulative annual doses to the left bare eye exceeded 20 mSv (21-61 mSv). Considering the glasses' protection, annual doses exceeded 6 mSv (13-48 mSv) for both eyes. No important differences were observed in lens dose per procedure between pediatric and adult interventions (0.16 vs 0.18, 0.12 vs 0.09, and 0.07 vs 0.07 mSv), although lens dose per PKA was 4.1-4.5 times higher in pediatrics (5.8 vs 1.3, 3.3 vs 0.8, and 2.6 vs 0.6 µSv/Gy·cm2 ) despite a similar use of the ceiling-suspended screen. Lens doses were highly correlated with collar readings (with Pearson coefficients [r] ranging from 0.86 to 0.98) and with chest readings (with r ranging from 0.75 to 0.93). However, slopes of the linear regressions varied greatly among radiologists. CONCLUSIONS There is real risk of exceeding the occupational dose limit to the eye lens in mixed interventional radiology rooms if radiation protection tools are not used properly. Regular monitoring of the lens dose is recommended, given lens exposure might easily exceed 6 mSv/yr. Using a collar dosimeter for this purpose might be suitable if it is preceded by an individualized regression analysis. The same radiation protection measures should be applied to interventional radiologists regardless of whether they are treating pediatric or adult patients.
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Affiliation(s)
- Ana Belén Morcillo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Luis Alejo
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Carlos Huerga
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - José Bayón
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Alberto Marín
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Eva Corredoira
- Medical Physics Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Joan Ricardo Novo
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Teresa Hernández
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - María Dolores Ponce
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Gonzalo Garzón
- Vascular and Interventional Radiology Department, La Paz University Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
| | - Eliseo Vañó
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, Madrid, 28040, Spain
| | - Eduardo Guibelalde
- Radiology Department, Complutense University, Plaza de Ramón y Cajal, Madrid, 28040, Spain
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8
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Ng KH, Brady Z, Ng AH, Soh HS, Chou YH, Varma D. The status of radiation protection in medicine in the Asia-Pacific region. J Med Imaging Radiat Oncol 2021; 65:464-470. [PMID: 33606359 DOI: 10.1111/1754-9485.13165] [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: 11/09/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 12/29/2022]
Abstract
More than half of the world's population live in Asia-Pacific. This region is culturally diverse, with significant disparities in terms of socio-economic status, provision of health care and access to advanced technology. The medical use of ionising radiation is increasing worldwide and similarly within the Asia-Pacific region. In this paper, we highlight the current status in usage of ionising radiation in medicine in the region, and review the legal framework, implementation and activities in radiation protection. Asia-Pacific countries are active in strengthening radiation protection by promoting education and training. Various projects and activities initiated by international organisations such as the IAEA, WHO and ICRP have provided stimulation in the region, but more work is needed to continue to improve protection practices.
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Affiliation(s)
- Kwan Hoong Ng
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zoe Brady
- Radiology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Aik Hao Ng
- Department of Radiotherapy and Oncology, National Cancer Institute, Putrajaya, Malaysia
| | - Hwee Shin Soh
- Medical Radiation Surveillance Division, Ministry of Health, Putrajaya, Malaysia
| | - Yi Hong Chou
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan.,Department of Radiology, Taipei Veterans General Hospital and School of Medicine, and National Yang Ming University, Taipei, Taiwan.,Department of Radiology, Yee Zen General Hospital, Taoyuan, Taiwan
| | - Dinesh Varma
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
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9
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Laranjeiro AS, Bohra F, Byun SH, Atanackovic J, Hanu AR. CHARACTERIZATION OF A LANTHANUM BROMIDE DETECTOR FOR EYE LENS DOSIMETRY AT THE CANDU NUCLEAR POWER PLANTS BASED ON DIRECT MEASUREMENTS OF THE GAMMA-RAY SPECTRA. RADIATION PROTECTION DOSIMETRY 2020; 192:309-320. [PMID: 33320200 DOI: 10.1093/rpd/ncaa186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/27/2020] [Accepted: 10/18/2020] [Indexed: 06/12/2023]
Abstract
Gamma-ray spectra were measured using a LaBr$_{3}$(Ce) spectrometer during the outage periods, aiming at quantifying the gamma source term of radiation workers' exposure, at the CANDU nuclear power reactors, for the purposes of eye lens dosimetry. The spectra were measured inside the boiler rooms, of the Bruce Power and Ontario Power Generation (OPG) CANDU nuclear power plants, where workers are exposed to relatively high dose rates radiation fields during the maintenance work. Prior to measurements at the CANDU reactors, the pulse shaping parameters of the gamma spectrometer were optimised for high rates gamma fields, up to an input rates of 120 kcps, in order to accomplish a high output rate with a reasonable energy resolution. In parallel, the response of the LaBr$_{3}$(Ce) detector was characterized by experiments and Monte Carlo simulations. The gamma spectra measured at the CANDU reactors were reported in terms of the gamma-ray fluence rate spectrum. In all measured data, $^{60}$Co and $^{95}$Nb were main contributors of the gamma fields. The measured spectra have been used to calculate the dosimetric quantities of interest: personal dose equivalents H$_{p}$(10) and H$_{p}$(0.07) and eye lens absorbed dose.
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Affiliation(s)
- A S Laranjeiro
- Department of Physics and Astronomy, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - F Bohra
- Department of Physics and Astronomy, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - S H Byun
- Department of Physics and Astronomy, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - J Atanackovic
- Department of Physics and Astronomy, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- Ontario Power Generation, 1549 Victoria St E, Whitby, ON, L1N 9E3, Canada
| | - A R Hanu
- Department of Physics and Astronomy, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- Bruce Power, 177 Tie Rd, Tiverton, ON, N0G 2T0, Canada
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10
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Jamshidi AM, Massel DH, Liounakos JI, Silman Z, Good CR, Schroerlucke SR, Cannestra A, Hsu V, Lim J, Zahrawi F, Ramirez PM, Sweeney TM, Wang MY. Fluoroscopy time analysis of a prospective, multi-centre study comparing robotic- and fluoroscopic-guided placement of percutaneous pedicle screw instrumentation for short segment minimally invasive lumbar fusion surgery. Int J Med Robot 2020; 17:e2188. [PMID: 33217131 DOI: 10.1002/rcs.2188] [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] [Received: 06/07/2020] [Revised: 09/20/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND As minimally invasive spine surgery becomes more widespread, concerns regarding radiation exposure to surgeons and patients alike have become a growing concern. Robotic guidance has been developed as a way to increase the accuracy of instrumentation while decreasing radiation burden. METHODS A retrospective analysis of a large, multi-centre, prospective study comparing robotic-guided (RG) to fluoroscopic-guided (FG) (Multi-centre, Partially Randomized, Controlled Trial of MIS Robotic vs. Freehand in Short Adult Degenerative Spinal Fusion Surgeries) was performed to evaluate for differences in radiation exposure between study groups. RESULTS RG was associated with 78.3% (p < 0.001) and 79.8% (p < 0.001) reduction in total and per screw fluoroscopy times, respectively, as compared to FG. RG was also associated with a 50.8% (p < 0.001) reduction in total operative fluoroscopy time. CONCLUSIONS RG was associated with significantly lower fluoroscopy times compared to FG. This suggests that utilization of robotic navigation systems may result in decreased operative radiation exposure, which is a growing concern for surgeons performing minimally invasive spine surgery.
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Affiliation(s)
- Aria M Jamshidi
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Dustin H Massel
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA.,Department of Orthopedic Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Jason I Liounakos
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Zmira Silman
- Israel Academic College, Tel Aviv University, Ramat Gan, Israel
| | | | | | | | - Victor Hsu
- Rothman Institute, Willow Grove, Pennsylvania, USA
| | - Jae Lim
- Atlantic Brain & Spine, Reston, Viginia, USA
| | - Faissal Zahrawi
- AdventHealth Neuroscience Institute, Celebration, Florida, USA
| | | | | | - Michael Y Wang
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
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11
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Cantone MC, Ginjaume M, Martin CJ, Hamada N, Yokoyama S, Bordy JM, Dauer L, Durán A, Jeffries C, Harris W, Kashirina O, Koteng AO, Michelin S, Sudchai W. Report of IRPA task group on issues and actions taken in response to the change in eye lens dose limit. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:1508-1533. [PMID: 33226005 DOI: 10.1088/1361-6498/abb5ec] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
In 2018, the International Radiation Protection Association (IRPA) established its third task group (TG) on the implementation of the eye lens dose limit. To contribute to sharing experience and raising awareness within the radiation protection community about protection of workers in exposure of the lens of the eye, the TG conducted a questionnaire survey and analysed the responses. This paper provides an overview of the results of the questionnaire.
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Affiliation(s)
| | - Merce Ginjaume
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Colin J Martin
- University of Glasgow, Gartnavel Royal Hospital, Glasgow, United Kingdom
| | - Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan
| | | | - Jean-Marc Bordy
- CEA, LIST, Laboratoire National Henri Becquerel, F-91191, Gif-sur-Yvette, France
| | - Lawrence Dauer
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States of America
| | - Ariel Durán
- University Hospital, Montevideo School of Medicine, Montevideo, Uruguay
| | - Cameron Jeffries
- Flinders Medical Centre, Flinders Drive, South Australia, Australia
| | - Willie Harris
- Exelon Nuclear, 200 Exelon Way, United States of America
| | - Olga Kashirina
- Burnazyan Federal Medical Biophysical Centre, Federal Medical Biological Agency, Moscow, Russia
| | - Arthur Omondi Koteng
- Kenia Radiation Protection Board, RPB, Eastern Africa Association for Radiation Protection, EAARP, Nairobi, Kenya
| | | | - Waraporn Sudchai
- TINT, Thailand Institute of Nuclear Technology, Bangkok, Thailand
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12
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Affiliation(s)
- Andrew Karellas
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067
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13
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Kim JI, Cho JD, Son J, Choi CH, Wu HG, Park JM. Contact lens-type ocular in vivo dosimeter for radiotherapy. Med Phys 2019; 47:722-735. [PMID: 31743441 DOI: 10.1002/mp.13932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/26/2019] [Accepted: 11/13/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This study aimed to (a) develop a contact lens-type ocular in vivo dosimeter (CLOD) that can be worn directly on the eye and (b) assess its dosimetric characteristics and biological stability for radiation therapy. METHODS The molder of a soft contact lens was directly used to create the dosimeter, which included a radiation-sensitive component - an active layer similar to a radiochromic film - to measure the delivered dose. A flatbed scanner with a reflection mode was used to measure the change in optical density due to irradiation. The sensitivity, energy, dose rate, and angular dependence were tested, and the uncertainty in determining the dose was calculated using error propagation analysis. Sequential biological stability tests, specifically, cytotoxicity and ocular irritation tests, were conducted to ensure the safe application of the CLOD to patients. RESULTS The dosimeter demonstrated high sensitivity in the low dose region, and the sensitivity linearly decreased with the dose. The responses obtained for the 10 and 15 MV photon beams were 1.7% and 1.9% higher compared to the 6 MV photon beam. A strong dose rate dependence was not obtained for the CLOD. Angular dependence was observed from 90° to 180° with a difference in response from 1% to 2%. The total uncertainty in error propagation analysis decreased as a function of the dose in the red channel. For a dose range of 0 to 50 cGy, the total uncertainties for 5, 10, and 50 cGy were 14.2%, 8.9%, and 5%, respectively. Quantitative evaluation using the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) method presented no cytotoxicity. Further, no corneal opacity, iris reaction, or conjunctival inflammation was observed. CONCLUSIONS The CLOD is the first dosimeter that can be worn close to the eye. The results of cytotoxicity and irritation tests indicate that it is a stable medical device. The evaluation of dose characteristics in open field conditions shows that the CLOD can be applied to an in vivo dosimeter in radiotherapy.
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Affiliation(s)
- Jung-In Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Jin-Dong Cho
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, Republic of Korea.,Department of Radiation Oncology, College of Medicine, Yonsei University, Seoul, 03722, Republic of Korea
| | - Jaeman Son
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Robotics Research Laboratory for Extreme Environments, Advanced Institute of Convergence Technology, Suwon, 16229, Republic of Korea
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14
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Khan MUA, Yi BJ. Reduction of radiation exposure to operating physician and assistant using a real-time auditory feedback dosimeter during femoral artery puncturing: a study on swine model. Eur Radiol Exp 2019; 3:38. [PMID: 31549259 PMCID: PMC6757085 DOI: 10.1186/s41747-019-0116-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/24/2019] [Indexed: 12/05/2022] Open
Abstract
Background Real-time dosimeters may create a relatively safer environment not only for the patient but also for the physician and the assistant as well. We propose the use of a real-time radiation measurement dosimeter having auditory feedback to reduce radiation exposure. Methods Radiation dose rates were measured for 30 fluoroscopy-guided puncturing procedures of femoral arteries in swine. Fifteen puncturing procedures were performed with real-time radiation measurement dosimeter having auditory feedback and other 15 were performed without auditory feedback dosimeter by an interventional cardiologist with 10 years of experience. Results The left body side of the operating physician (38%, p < 0.001) and assistant (25%, p < 0.001) was more exposed as compared to the right body side. Radiation dose rate to the left hand, left arm and left leg were reduced from 0.96 ± 0.10 to 0.79 ± 0.12 mSv/h (17% reduction, p < 0.001), from 0.11 ± 0.02 to 0.07 ± 0.01 mSv/h (36% reduction, p < 0.001) and from 0.22 ± 0.06 to 0.15 ± 0.02 mSv/h (31% reduction, p < 0.001) with the use of auditory feedback dosimeter, respectively. The mean fluoroscopic time was reduced from 4.8 ± 0.43 min to 4.2 ± 0.53 min (p < 0.001). The success rate of performing arterial puncturing was 100%. Conclusions The use of auditory feedback dosimeter resulted in reduction in effective dose. The sound beep alerted the physician from the danger of exposure, and this approach induced awareness and protective mindset to the operating physician and assistant.
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Affiliation(s)
| | - Byung-Ju Yi
- Department of Electronic Systems Engineering, Hanyang University, 55 Hanyangdeahak-ro, Sangnok-gu, Ansan, Gyeonggi-do, 15588, South Korea.
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15
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Ishii H, Haga Y, Sota M, Inaba Y, Chida K. Performance of the DOSIRIS™ eye lens dosimeter. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2019; 39:N19-N26. [PMID: 31167175 DOI: 10.1088/1361-6498/ab2729] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Monitoring and protecting of occupational eye doses in interventional radiology (IR) are very important matters. DOSIRIS™ is the useful solution to estimate the 3 mm dose-equivalent (Hp(3)), and it can be worn behind lead glasses. And DOSIRIS™, adjustable according to 3 axes, it is ideally placed as close to the eye and in contact with the skin. So, DOSIRIS™ will be suitable eye lens dosimeter. However, the fundamental characteristics of the DOSIRIS™ in the diagnostic x-ray energy domain (including that of IR x-ray systems) remain unclear. Here, we evaluated the performance of the dosimeter in that energy range. As a result, the DOSIRIS™ has good fundamental characteristics (batch uniformity, dose linearity, energy dependence, and angular dependence) in the diagnostic x-ray energy domain. We conclude that the DOSIRIS™ has satisfactory basic performance for occupational eye dosimetry in diagnostic x-ray energy settings (including IR x-ray systems).
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Affiliation(s)
- Hiroki Ishii
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan
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16
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Betti M, Mazzoni LN, Belli G, Bernardi L, Bicchi S, Busoni S, Fedele D, Fedeli L, Gasperi C, Gori C, Quattrocchi M, Taddeucci A, Vigliotti M, Vaiano A, Rossi F. Surgeon eye lens dose monitoring in catheterization lab: A multi-center survey: Invited for ECMP 2018 Focus Issue. Phys Med 2019; 60:127-131. [PMID: 31000072 DOI: 10.1016/j.ejmp.2019.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To perform a multi-centre survey on the eye lens equivalent dose absorbed by primary interventionalist during catheterization procedures, using a personal dosimeter placed close to the eye lens. METHODS 15 different cardiologists working in 3 different centers, for a total of 5 operating rooms were enrolled. All of them were provided with a single thermoluminescent dosimeter positioned on the inner side of the temples of eyeglasses. The dose monitoring, performed on a two-months basis, started in 2016 and is still running. All dose measurements were performed by a ISO 17025 standard accredited dosimetry service thus providing certified uncertainties as well. Correlation of eye lens and wrist dose with KAP was also investigated. RESULTS A total number of 101 eye lens measurements were performed. Annual eye lens dose estimation was obtained for all 15 surgeons (mean, mode, range, standard deviation: 10.8, 8, 4.9-27.3, 5.6 mSv, respectively). Uncertainties on annual eye lens dose estimations ranged between 10% and 20%. No significant correlation was found between eye lens dose and KAP. CONCLUSIONS Cardiologists involved in catheterization procedures may receive annual eye lens doses close to the ICRP 118 dose limit and thus individual monitoring with a dedicated dosimeter should be carried out. Uncertainty assessment play a relevant role in eye lens equivalent dose estimation to ensure not to exceed dose limit.
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Affiliation(s)
- Margherita Betti
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | | | - Giacomo Belli
- Azienda Ospedaliero-Universitaria Careggi, Medical Physics Unit, Firenze, Italy
| | - Luca Bernardi
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | - Sara Bicchi
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | - Simone Busoni
- Azienda Ospedaliero-Universitaria Careggi, Medical Physics Unit, Firenze, Italy
| | - David Fedele
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | - Luca Fedeli
- Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Sesto Fiorentino, Firenze, Italy
| | - Chiara Gasperi
- Azienda Usl Toscana Sud-Est, Medical Physics Unit, Arezzo, Italy
| | - Cesare Gori
- Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Sesto Fiorentino, Firenze, Italy; INFN, Sezione di Firenze, Sesto Fiorentino, Italy
| | | | - Adriana Taddeucci
- Azienda Ospedaliero-Universitaria Careggi, Medical Physics Unit, Firenze, Italy
| | | | - Angela Vaiano
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | - Francesco Rossi
- Azienda Ospedaliero-Universitaria Careggi, Medical Physics Unit, Firenze, Italy
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17
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Carinou E, Kollaard R, Stankovic Petrovic J, Ginjaume M. A European survey on the regulatory status for the estimation of the effective dose and the equivalent dose to the lens of the eye when radiation protection garments are used. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2019; 39:126-135. [PMID: 30523929 DOI: 10.1088/1361-6498/aaf456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Following the proposal of the ICRP for the reduction of the dose limit for the lens of the eye, which has been adopted by the International Atomic Energy Agency and the European Council, concerns have been raised about the implementation of proper dose monitoring methods as defined in national regulations, and about the harmonisation between European countries. The European Radiation Dosimetry Group organised a survey at the end of 2017, through a web questionnaire, regarding national dose monitoring regulations. The questions were related to: double dosimetry, algorithms for the estimation of the effective dose, methodology for the determination of the equivalent dose to the lens of the eye and structure of the national dose registry. The results showed that more than 50% of the countries that responded to the survey have legal requirements about the number and the position of dosemeters used for estimation of the effective dose when radiation protection garments are used. However, in only five out of 26 countries are there nationally approved algorithms for the estimation of the effective dose. In 14 out of 26 countries there is a legal requirement to estimate the dose to the lens of the eye. All of the responding countries use some kind of national database for storing individual monitoring data but in only 12 out of 26 countries are the estimated effective dose values stored. The personal dose equivalent at depth 3 mm is stored in the registry of only seven out of 26 countries. From the survey, performed just before the implementation of the European Basic Safety Standards Directive, it is concluded that national occupational exposure frameworks require intensive and immediate work under the coordination of the competent authorities to bring them into line with the latest basic safety standards and achieve harmonisation between European countries.
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18
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Dauer LT. Seeing through a glass darkly and taking the next right steps. Eur J Epidemiol 2018; 33:1135-1137. [PMID: 30390232 DOI: 10.1007/s10654-018-0458-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/26/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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19
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McWhan A, Dobrzynska W. Eye lens dose monitoring in the UK nuclear industry using active personal dosemeters. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:1204-1216. [PMID: 29155416 DOI: 10.1088/1361-6498/aa9bc6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The reduction of the dose limit for eye lens from 150 to 20 mSv yr-1 must be implemented by EU member states by February 2018. Consequently, there is a requirement for all employers engaged with work with ionising radiation to have appropriate monitoring arrangements in place by this date to demonstrate that they can meet this new limit for all workers. Eye lens dose is conventionally monitored by specific dosemeters worn near the eye. However, it is usually impractical for these dosemeters to be worn at all times in the workplace which can lead to problems accounting for any periods of work when an eye lens dosemeter has not been worn. The Berkeley Approved Dosimetry Service provides a monitoring service for 22 nuclear sites in the UK using active personal dosemeters (APDs) for measuring H p(10) and H p(0.07). TLDs for extremity and eye are also issued as appropriate for the working conditions. An analysis of the data from 2007 to 2016 concludes that the values for H p(0.07) as monitored indirectly by APDs worn on the trunk are comparable to the values assessed by specific H p(3) eye TLDs. This paper sets out evidence that compliance with the 20 mSv dose limit for the eye lens can be demonstrated using routine issue APDs although specific eye TLDs may still be required to meet international guidance for non-uniform workplace fields. This evidence supports the recent statement from International Radiation Protection Association that 'for the nuclear industry and other non-medical sectors the use of a whole body dosimeter is considered likely to be sufficient for the majority of workers'.
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Affiliation(s)
- A McWhan
- Cavendish Nuclear Limited, Berkeley Approved Dosimetry Service, Berkeley, United Kingdom
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20
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Tsapaki V, Balter S, Cousins C, Holmberg O, Miller DL, Miranda P, Rehani M, Vano E. The International Atomic Energy Agency action plan on radiation protection of patients and staff in interventional procedures: Achieving change in practice. Phys Med 2018; 52:56-64. [PMID: 30139610 DOI: 10.1016/j.ejmp.2018.06.634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/22/2018] [Accepted: 06/15/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The International Atomic Energy Agency (IAEA) organized the 3rd international conference on radiation protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session. MATERIAL AND METHODS The IAEA conference was conducted as a series of plenary sessions followed by various thematic sessions. "Radiation protection of patients and staff in interventional procedures" session keynote speakers presented information on: 1) Risk management of skin injuries, 2) Occupational radiation risks and 3) RP for paediatric patients. Then, a summary of the session-related papers was presented by a rapporteur, followed by an open question-and-answer discussion. RESULTS Sixty-seven percent (67%) of papers came from Europe. Forty-four percent (44%) were patient studies, 44% were occupational and 12% were combined studies. Occupational studies were mostly on eye lens dosimetry. The rest were on scattered radiation measurements and dose tracking. The majority of patient studies related to patient exposure with only one study on paediatric patients. Automatic patient dose reporting is considered as a first step for dose optimization. Despite efforts, paediatric IP radiation dose data are still scarce. The keynote speakers outlined recent achievements but also challenges in the field. Forecasting technology, task-specific targeted education from educators familiar with the clinical situation, more accurate estimation of lens doses and improved identification of high-risk professional groups are some of the areas they focused on. CONCLUSIONS Manufacturers play an important role in making patients safer. Low dose technologies are still expensive and manufacturers should make these affordable in less resourced countries. Automatic patient dose reporting and real-time skin dose map are important for dose optimization. Clinical audit and better QA processes together with more studies on the impact of lens opacities in clinical practice and on paediatric patients are needed.
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Affiliation(s)
- V Tsapaki
- Konstantopoulio General Hospital, Agias Olgas 3-5, 14233 Nea Ionia, Greece.
| | - S Balter
- Department of Radiology and Medicine, Columbia University, New York, USA.
| | - C Cousins
- FRCP, FRCR, Chair ICRP, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada.
| | - O Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna International Center, Vienna, Austria.
| | - D L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA.
| | - P Miranda
- Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile.
| | - M Rehani
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - E Vano
- Radiology Department, Medical School, Complutense University, 28040 Madrid, Spain.
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