Observations of tissue reactions following neuroradiology interventional procedures

Background Factors Affecting the Radiation Exposure of the Lens of the Eye among Nurses in Interventional Radiology: A Quantitative Observational Study

With the International Commission on Radiological Protection's (ICRP) reduction in the radiation dose threshold for cataracts, evaluating and preventing radiation exposure to the lens of the eye among interventional radiology (IR) staff have become urgent tasks. In this study, we focused on differences in lens-equivalent dose (HT Lens) to which IR nurses in three hospitals were exposed and aimed to identify factors underlying these differences. According to analyses of time-, distance-, and shielding-related factors, the magnitude of the HT Lens dose to which IR nurses were exposed could be explained not by time or shielding but by the distance between the X-ray exposure field and the location of the IR nurse. This distance tended to be shorter in hospitals with fewer staff. The most effective means of reducing the exposure of the lenses of IR nurses' eyes to radiation is to position them at least two meters from the radiation source during angiography procedures. However, some hospitals must provide IR departments with comparatively few staff. In work environments where it is infeasible to reduce exposure by increasing distance, interventions to reduce time by managing working practices and investment in shielding equipment are also important. This study was not registered.

Patients' Radiation Shielding in Interventional Radiology Settings: A Systematic Review

As a result of the increasing risk of developing radiation-related complications, many approaches aimed at reducing this risk and enhancing the outcomes of the patient, doctor or device operator have been developed. In this systematic review, we aim to discuss previous investigations that studied patient shielding or protection within the context of selected interventional radiology procedures. We included original studies that used K_a,r, and P_KA for the assessment of the outcomes of two procedures: transjugular intrahepatic portosystemic shunt creation (TIPS) and hepatic arterial chemoembolization (HAE). A thorough search strategy was conducted on relevant databases to identify all relevant studies. We included 13 investigations, including 12 cross-sectional studies and one randomized controlled trial. Significant diversity was found among all these studies in terms of the used modalities, which made them hard to compare. However, almost all studies agreed that using novel imaging and interventional modalities is useful when obtaining better outcomes and reducing patient radiation exposure. The use of ultrasound-guided procedures and providing adequate lead curtains has also been recommended by the identified studies in order to minimize the frequency of radiation exposure. The reported K_a,r, and P_KA were also variable between studies and were discussed within this study. Our findings indicate that unified guidelines for patient radiation shielding should be urgently investigated.

Old enemy, new threat: you can't solve today's problems with yesterday's solution

The radiation protection principles of justification, optimization, and dose limitation as enumerated by the International Commission on Radiological Protection have been guiding light for the profession for over three decades. The dose limitation does not apply to medical exposure but keeping patients' doses low is achieved through optimization, particularly by developing and using diagnostic reference levels (DRLs). There are new findings that demonstrate that despite using the best possible approaches to justification and optimization including as well use of DRLs, a very large number of patients are receiving doses in excess of 100 mSv of effective dose or organ doses exceeding 100 mGy. A non-ignorable fraction of patients is receiving such high doses in a single day. The magnitude of such patients creates the need for a relook into the principles with the intent to understand what can be done to attend to today's problems. A look at other areas such as approaches, and principles used in the pharmaceutical industry and in traffic management throws some light into what can be learnt from these examples. It appears that the system needs to be enriched to deal with the protection of the individual patient. The currently available approaches and even the principles are largely based on the protection of the population or group of patients. The third level of justification for individual needs further refinement to take into account series of imaging many patients are needing, and cumulative radiation doses involved, many of which happen in a short duration of 1 to 5 years. There is every likelihood of patient radiation doses continuing to increase further that underscores the need for timely attention. This paper provides several suggestions to deal with the situation.

Optimization of the Maximum Skin Dose Measurement Technique Using Digital Imaging and Communication in Medicine-Radiation Dose Structured Report Data for Patients Undergoing Cerebral Angiography

Understanding the maximum skin dose is important for avoiding tissue reactions in cerebral angiography. In this study, we devised a method for using digital imaging and communication in medicine-radiation dose structured report (DICOM-RDSR) data to accurately estimate the maximum skin dose from the total air kerma at the patient entrance reference point (Total Ka,r). Using a test data set (n = 50), we defined the mean ratio of the maximum skin dose obtained from measurements with radio-photoluminescence glass dosimeters (RPLGDs) to the Total Ka,r as the conversion factor, CFKa,constant, and compared the accuracy of the estimated maximum skin dose obtained from multiplying Total Ka,r by CFKa,constant (Estimation Model 1) with that of the estimated maximum skin dose obtained from multiplying Total Ka,r by the functional conversion factor CFKa,function (Estimation Model 2). Estimation Model 2, which uses the quadratic function for the ratio of the fluoroscopy Ka,r to the Total Ka,r (Ka,r ratio), provided an estimated maximum skin dose closer to that obtained from direct measurements with RPLGDs than compared with that determined using Estimation Model 1. The same results were obtained for the validation data set (n = 50). It was suggested the quadratic function for the Ka,r ratio provides a more accurate estimate of the maximum skin dose in real time.

Unintended and Accidental Exposures, Significant Dose Events and Trigger Levels in Interventional Radiology

Over recent years, an increasing number of fluoroscopically guided interventions (FGIs) have been performed by radiologists and non-radiologists. Also, the number of complex interventional procedures has increased. In the late nineties, first reports of skin injuries appeared in the literature. The medical community responded through increased awareness for radiation protection and public authorities by recommendations and legislation, for example, the European Basic Safety Standards (EU-BSS) which were published in 2014, or the international Basic Safety Standards (BSS). Implementation of the EU-BSS requires concerted action from interventionalists, radiographers, medical physics experts and competent national authorities. Interventionalists should play an important role in this project since implementation of the EU-BSS will affect their daily practice. This paper discusses some important issues of the EU-BSS such as unintended and accidental radiation exposures of patients, the meaning of significant dose events and how to deal with patients who were exposed to a substantial radiation dose with the risk of tissue injuries. In addition, this paper provides practical advice on how to implement alert and trigger levels in daily practice of FGIs in order to increase patient safety.