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Ferrari P, Venturi G, Campani L, Mariotti F, Becker F, Jansen J, Jovanović Z, Krstić D, Teles P. Medical staff monitoring in interventional cardiology: over apron dosemeter placement based on measurements and simulations. RADIATION PROTECTION DOSIMETRY 2024; 200:802-807. [PMID: 38773775 DOI: 10.1093/rpd/ncae125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 04/18/2024] [Accepted: 05/09/2024] [Indexed: 05/24/2024]
Abstract
Interventional cardiology is characterized by high radiation exposure for both the patient and the operator. Adequate shielding and monitoring of the operator are fundamental to comply with radiation protection principles. In a previous work, the effect on the dose of the dosemeter position on the chest was studied. In this paper, the investigation has been completed, employing an anthropomorphic thorax phantom, equipped with arms. Although there are differences between the Monte Carlo simulations and the measurements, similar trends are observed, showing that the reduction in dose, due to the arms, is between 20 and 60%, compared with the situation without arms. For that reason, considering a dosemeter placed on the chest, the upper position, which is the least affected by the arms, should be preferred while the extreme lateral position, near the armpit, should be avoided.
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Affiliation(s)
- Paolo Ferrari
- ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development, IRP-Radiation Protection Institute, Bologna 40129, Italy
| | | | - Lorenzo Campani
- ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development, IRP-Radiation Protection Institute, Bologna 40129, Italy
| | - Francesca Mariotti
- ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development, IRP-Radiation Protection Institute, Bologna 40129, Italy
| | - Frank Becker
- KIT-Karlsruhe Institute of Technology, Institute for Nuclear Waste Disposal, Eggenstein-Leopoldshafen 76344, Germany
| | - Jan Jansen
- UK Health Security Agency, Oxon OX11 0RQ, United Kingdom
| | - Zoran Jovanović
- Faculty of Science, University of Kragujevac, Kragujevac 34000, Serbia
| | - Dragana Krstić
- Faculty of Science, University of Kragujevac, Kragujevac 34000, Serbia
| | - Pedro Teles
- Faculty of Science, University of Porto and CI-IPOP (Porto Cancer Institute Research Centre), Porto 4169-007, Portugal
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Wickramasinghe SU, Ramanathan V, Sarasanandarajah S, De Zoyza M, Paranamana R. Occupational dose measurement in interventional cardiology practice. RADIATION PROTECTION DOSIMETRY 2024; 200:629-639. [PMID: 38555495 DOI: 10.1093/rpd/ncae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
Ensuring the safety of healthcare workers in interventional cardiology necessitates effective monitoring of occupational radiation exposure. This study aims to assess the accuracy of the over-apron single dosimetric approach compared with double dosimetric methods and explore the relationship between under-apron and over-apron doses. This investigation showed that the prescribed annual dose constraint of 20 mSv year-1 was not exceeded by the maximum annual occupational doses determined by dosimetric algorithms, which were 0.13 ± 0.02, 0.15 ± 0.02 and 0.27 ± 0.04 mSv, respectively. The study demonstrated excellent statistically significant correlations among single and double dosimetric algorithms and between direct under-apron and over-apron doses. Consequently, single dosimetric algorithms could effectively estimate doses for double dosimetric algorithms, highlighting the limited added value of under-apron measurements. These findings significantly impact the practice of interventional cardiology in Sri Lanka, playing a crucial role in enhancing radiation protection measures.
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Affiliation(s)
| | - Vijitha Ramanathan
- Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Sivananthan Sarasanandarajah
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
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3
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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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Tsai WC, Chu WH, Sheu RJ. Ratios of Eye Lens and Hand Equivalent Doses with Whole-Body Effective Doses for Operators Performing Interventional Radiological Procedures. HEALTH PHYSICS 2022; 123:257-264. [PMID: 35613375 DOI: 10.1097/hp.0000000000001586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
ABSTRACT Estimating radiation doses for operators performing interventional radiological procedures is crucial in the occupational radiation protection of medical staff. In this study, Monte Carlo simulations coupled with an anthropomorphic phantom were used to model various exposure scenarios during the procedures. Conversion coefficients of the dose-area product of x rays for the eye lens equivalent dose, hand equivalent dose, and whole-body effective dose of the operator were calculated. Accordingly, the relationships between these dose quantities in typical interventional configurations were established, considering various source locations, tube voltages, and use of protective equipment or not. The results are presented in a systematic way for easy comparison and use. Tables and figures of the data can be helpful to provide estimates of eye lens and hand equivalent doses when records of specific dosimeters are absent, such as in the retrospective assessment of operators' eye lens and hand equivalent doses in past practices.
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Affiliation(s)
- Wan-Chih Tsai
- Institute of Nuclear Engineering and Science, National Tsing-Hua University, 101, Sec. 2, Kuang-Fu Road, Hsinchu, Taiwan
| | - Wei-Han Chu
- Institute of Nuclear Energy Research, 1000, Wen-Hua Road, Longtan, Taoyuan, Taiwan
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Smeulders J, da Silva EH, Struelens L, Vanhavere F, De Mey J, Martin CJ, Buls N. CORRELATION BETWEEN ROUTINE PERSONAL DOSIMETRY READING AND THE DOSE TO THE BRAIN OF INTERVENTIONAL STAFF. RADIATION PROTECTION DOSIMETRY 2022; 198:349-357. [PMID: 35482286 DOI: 10.1093/rpd/ncac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
This study aimed to evaluate the relationship between the brain absorbed dose and personal dosimetry readings in interventional cardiologists. Interventional procedures were replicated using Monte Carlo simulations (MCNP 6) with anthropomorphic phantoms representing both operator and patient. Absorbed doses were evaluated for 10 predefined regions of the operator's brain as well as for dosemeters at chest and neck level. One beam quality (HVL = 6.2 mm Al) and nine beam projections were considered. A significant bias in the laterality of brain dose was found with doses at the left side of the brain being up to 2.8 times higher compared with the right. The correlation between brain dose and dosemeter reading was found to be dependent on beam projection. Yet, a generalized conversion factor (brain dose normalized by Hp(10)), averaged over all considered beam projections, could be proposed for (retrospective) brain dose estimation from routinely measured dosimetry data.
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Affiliation(s)
| | | | | | | | - Johan De Mey
- Department of Radiology, UZ Brussel, Brussels, Belgium
| | - Colin J Martin
- Department of Clinical Physics and Bio-Engineering, University of Glasgow, Glasgow, Scotland
| | - Nico Buls
- Department of Radiology, UZ Brussel, Brussels, Belgium
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What Is Worth Knowing in Interventional Practices about Medical Staff Radiation Exposure Monitoring: A Review of Recent Outcomes of EURADOS Working Group 12. ENVIRONMENTS 2022. [DOI: 10.3390/environments9040053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
EURADOS (European Radiation Dosimetry Group) Working Group 12 (WG12) SG1 activities are aimed at occupational radiation protection and individual monitoring in X-ray and nuclear medicine practices. In recent years, many studies have been carried out in these fields, especially for interventional radiology and cardiology workplaces (IC/IR). The complexity of the exposure conditions of the medical staff during interventional practices makes the radiation protection and monitoring of the exposed workers a challenging task. The scope of the present work is to review some of the main results obtained within WG12 activities about scattered field characterization and personal dosimetry that could be very useful in increasing the quality of radiation protection of the personnel, safety, and awareness of radiation risk. Two papers on Monte Carlo modelling of interventional theater and three papers on active personal dosimeters (APDs) for personnel monitoring were considered in the review. More specifically, Monte Carlo simulation was used as the main tool to characterize the levels of exposure of the medical staff, allowing to determine how beam energy and direction can have an impact on the doses received by the operators. Indeed, the simulations provided information about the exposure of the operator’s head, and the study concluded with the determination of an eye-lens protection factor when protection goggles and a ceiling shielding are used. Moreover, the review included the results of studies on active personal dosimeters, their use in IC/IR workplaces, and how they respond to calibration fields, with X-ray standard and pulsed beams. It was shown that APDs are insensitive to backscatter radiation, but some of them could not respond correctly to the very intense pulsed fields (as those next to the patient in interventional practices). The measurements during interventional procedures showed the potential capability of the employment of APDs in hospitals.
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López-Ángeles D, Gamboa-deBuen I, Martínez-de Los Santos C, Alaniz-Sida K, Vega-Montesinos S, Lopez-Rendon X. Estimation of occupational radiation doses in neuroendovascular procedures. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:1304-1316. [PMID: 34348239 DOI: 10.1088/1361-6498/ac1a83] [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: 12/09/2020] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
To estimate the mean effective dose per procedure with multiple dosimetry, to calculate the annual effective dose to personnel working in neuroendovascular procedures and compared with methods reported in the literature and with national and international limits. The radiation dose to personnel was monitored in 20 procedures classified as diagnostic or therapeutic. During each procedure, the equivalent dose to eyes, thyroid, under and over the lead apron at chest level, hands, gonads and knees was measured with lithium fluoride thermoluminescent dosimeter chips (TLD-100). Estimations of the annual effective dose from different methods found in literature that use one or two dosimeters and from this work were compared. Also, a comparison was made with the safety limits recommended in national and international regulations. Radiation exposure to eyes, thyroid, gonads and knees is relevant to the effective dose, and therefore to the annual effective dose estimations. Personnel position is important, as the performing physician, who is closer to the patient, received the highest dose measured. In particular, this was observed in the equivalent dose received over the apron. However, the equivalent dose to the right eye was higher for neuroanaesthesiologists than for performing physicians due to their position relative to the patient. In general, effective doses estimated using one- and two-dosimeter methods found in the literature were, respectively, lower and higher than those obtained with the ten-dosimeter method in this work. The annual effective doses to personnel estimated with the multiple dosimetry algorithm ranged from 1.3 to 1.5 mSv y-1and are within the national and international limits.
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Affiliation(s)
- D López-Ángeles
- Facultad de Ciencias, Universidad Nacional Autónoma de México, A.P. 70-543, 04510 CDMX, Mexico
| | - I Gamboa-deBuen
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, A.P. 70-543, 04510 CDMX, Mexico
| | | | - K Alaniz-Sida
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, CDMX 14269, Mexico
| | - S Vega-Montesinos
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, CDMX 14269, Mexico
| | - X Lopez-Rendon
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, CDMX 14269, Mexico
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Hatami A, Bagheri M, Falahati F, Banaei A, Abedi-Firouzjah R, Zamani H, Kiapour M, Momeni F. Estimating the whole-body effective dose and health risks as well as introducing a new easy method for eye lens dosimetry in interventional cardiology procedures. MethodsX 2020; 7:101097. [PMID: 33134097 PMCID: PMC7586141 DOI: 10.1016/j.mex.2020.101097] [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: 08/02/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022] Open
Abstract
This study aimed to introduce a new method for eye lens thermo-luminescent dosimetry and also estimate the dose associated with induced cancer risk due to the ionizing radiation exposure received by physicians and other staff cooperating in interventional cardiology (IC) procedures. The measurements were performed with six TLDs (thermoluminescent dosimeters): four TLDs for eye lens dosimetry (2 positioned on respiratory/surgical mask under the eye region as the new method; and 2 near the outside border of the eye as the common method) and two TLDs for whole-body dosimetry. Whole-body doses were used to calculate the cancer risks induced by IC procedures. The results of the new proposed method for eye lens dosimetry were similar to common TLD positioning (mean differences <5%) and mask displacement had no significant effect on eye dose measurement in our new method. Our proposed method for eye lens dosimetry is simpler and more comfortable compared to the common method and it can be used as an alternative method without using TLD holders to monitor lens dose for IC workers wearing masks during the procedure. The estimated excess cancer incidence risk induced by IC procedures was 29.58 ± 5.71 and 46.68 ± 7.77 (per 100000 individuals) for men and women, respectively.
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Affiliation(s)
- Alireza Hatami
- Department of Medical Physics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahmoud Bagheri
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Sina Campus, Tehran, Iran
| | - Farzaneh Falahati
- Department of Medical Physics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amin Banaei
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Hamed Zamani
- Department of Medical Physics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Kiapour
- Department of Medical Physics Radiobiology and Radiation Protection, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Farideh Momeni
- Medical Physics and Medical Engineering Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Gerasia R, Cannataci C, Maruzzelli L, Caruso C, Liotta F, Cucchiara A, Cortis K, Miraglia R. OCCUPATIONAL RADIATION DOSE PERFORMING HEPATOBILIARY MINIMALLY INVASIVE PROCEDURES IN CHILDREN WEIGHING LESS THAN 20 kg. RADIATION PROTECTION DOSIMETRY 2020; 188:56-64. [PMID: 31735959 DOI: 10.1093/rpd/ncz260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/26/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
Our objective is to retrospectively evaluate the effective dose (E) of operators performing pediatric Hepatobiliary Minimally Invasive Procedures (HMIP). Between October 2015 and December 2017, 58 consecutive HMIP were performed on 26 children weighing less than 20 kg (mean 12.3 kg, median 13 kg, range 2.4-20 kg). About 31 vascular procedures (n = 9 hepatic venograms with/without stenting; n = 9 retrograde wedge portography; n = 8 transhepatic portography with angioplasty and/or stenting and n = 5 hepatic arteriography/embolization) and 27 non-vascular procedures (n = 6 percutaneous transhepatic biliary drainage (PTBD); n = 3 bilioplasty; n = 15 biliary catheter change and n = 3 cholangiogram) were performed. Electronic personal dosimeters were used to measure radiation doses to the interventional radiologist, radiographer and anesthesia nurse. The results shows the highest mean effective dose: interventional radiologist's in PTBD (1.18 μSv); radiographer's in hepatic veins phlebography with/without stenting (0.25 μSv) and nurse's in hepatic arteriography/embolization (0.26 μSv). Operators' E can vary depending on the complexity of procedure performed and the position of the operators within the angiosuite.
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Affiliation(s)
- Roberta Gerasia
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy
| | - Christine Cannataci
- Medical Imaging Department, Mater Dei Hospital, Triq Dun Karm, MSD9032 Msida, Malta
| | - Luigi Maruzzelli
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy
| | - Calogero Caruso
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy
| | - Ferdinanda Liotta
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy
| | - Antonino Cucchiara
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy
| | - Kelvin Cortis
- Medical Imaging Department, Mater Dei Hospital, Triq Dun Karm, MSD9032 Msida, Malta
| | - Roberto Miraglia
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy
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Negri P, Campi F, De Crescenzo S, Garlati L, Tambussi O. EXPERIMENTAL VALIDATION OF ALGORITHMS USED TO ESTIMATE EFFECTIVE DOSE DURING INTERVENTIONAL RADIOLOGY PROCEDURES. RADIATION PROTECTION DOSIMETRY 2019; 187:42-49. [PMID: 31111940 DOI: 10.1093/rpd/ncz136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 04/16/2019] [Accepted: 04/29/2019] [Indexed: 06/09/2023]
Abstract
In IR procedures, in order to evaluate the effective dose, the importance of the double dosemeter has been recognised, one worn above and one under the apron. Over the last few decades several algorithms have been developed to combine the readings of the dosemeters, however currently there is no international consensus on which is the best one. In this work, eight irradiations, corresponding to typical interventional radiology procedures, were carried out in order to experimentally verify the accuracy of the algorithms. The patient was substituted by solid water-equivalent (RW3) layers, while effective dose to personnel was calculated by TLDs inside the Alderson Rando phantom. The results show that most of the algorithms, with a few exceptions, are too conservative, however there are many factors which can affect their accuracy, so it is impossible to achieve a high level of precision in the evaluation of the effective dose.
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Affiliation(s)
- P Negri
- CERAP SA, Cherbourg Octeville, France
| | - F Campi
- Politecnico di Milano, CeSNEF-Nuclear Engineering, Milano, Italy
| | | | - L Garlati
- Politecnico di Milano, CeSNEF-Nuclear Engineering, Milano, Italy
| | - O Tambussi
- Politecnico di Milano, CeSNEF-Nuclear Engineering, Milano, Italy
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Ginjaume M, Carinou E, Brodecki M, Clairand I, Domienik-Andrzejewska J, Exner L, Ferrari P, Jovanović Z, Krstic D, Principi S, Van Hoey O, Vanhavere F. Effect of the radiation protective apron on the response of active and passive personal dosemeters used in interventional radiology and cardiology. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2019; 39:97-112. [PMID: 30523896 DOI: 10.1088/1361-6498/aaf2c0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In fluoroscopy guided interventional procedures, workers use protective garments and often two personal dosemeters, the readings of which are used for the estimation of the effective dose; whereas the dosemeter above the protection can be used for the estimation of the equivalent dose of the lens of the eye. When a protective apron is worn the scattered field that reaches the dosemeter is different from the case where no protection is used; this study analyses the changes in the response of seven passive and eight active personal dosemeters (APDs) when they are placed above a lead or lead equivalent garment for S-Cs and x-ray diagnostic qualities. Monte Carlo simulations are used to support the experimental results. It is found that for passive dosemeters, the influence on the dosemeter's response to the lead or lead equivalent was within the range 15%-38% for the x-ray qualities. This effect is smaller, of the order of 10%, when lead-free garments are used, and much smaller, within 1%-10%, for most of the APDs used in the study. From these results it is concluded that when comparing passive and active dosemeter measurements worn above the protection, a difference of 20%-40% is expected. The effect is small when deriving the effective dose from double dosimetry algorithms, but it can be of major importance when eye lens monitoring is based on the use of the dosemeter worn above the protection.
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Affiliation(s)
- Mercè Ginjaume
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya (UPC), Diagonal 647, Barcelona 08028, Spain
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12
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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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Quintero-Quintero A, Patiño-Camargo G, Soriano Á, Palma JD, Vilar-Palop J, Pujades MC, Llorca-Domaica N, Ballester F, Vijande J, Candela-Juan C. Calibration of a thermoluminescent dosimeter worn over lead aprons in fluoroscopy guided procedures. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:549-564. [PMID: 29498356 DOI: 10.1088/1361-6498/aab38f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Fluoroscopy guided interventional procedures provide remarkable benefits to patients. However, medical staff working near the scattered radiation field may be exposed to high cumulative equivalent doses, thus requiring shielding devices such as lead aprons and thyroid collars. In this situation, it remains an acceptable practice to derive equivalent doses to the eye lenses or other unprotected soft tissues with a dosimeter placed above these protective devices. Nevertheless, the radiation backscattered by the lead shield differs from that generated during dosimeter calibration with a water phantom. In this study, a passive personal thermoluminescent dosimeter (TLD) was modelled by means of the Monte Carlo (MC) code Penelope. The results obtained were validated against measurements performed in reference conditions in a secondary standard dosimetry laboratory. Next, the MC model was used to evaluate the backscatter correction factor needed for the case where the dosimeter is worn over a lead shield to estimate the personal equivalent dose H p (0.07) to unprotected soft tissues. For this purpose, the TLD was irradiated over a water slab phantom with a photon beam representative of the result of a fluoroscopy beam scattered by a patient. Incident beam angles of 0° and 60°, and lead thicknesses between the TLD and phantom of 0.25 and 0.5 mm Pb were considered. A backscatter correction factor of 1.23 (independent of lead thickness) was calculated comparing the results with those faced in reference conditions (i.e., without lead shield and with an angular incidence of 0°). The corrected dose algorithm was validated in laboratory conditions with dosimeters irradiated over a thyroid collar and angular incidences of 0°, 40° and 60°, as well as with dosimeters worn by interventional radiologists and cardiologists. The corrected dose algorithm provides a better approach to estimate the equivalent dose to unprotected soft tissues such as eye lenses. Dosimeters that are not shielded from backscatter radiation might underestimate personal equivalent doses when worn over a lead apron and, therefore, should be specifically characterized for this purpose.
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Affiliation(s)
- A Quintero-Quintero
- Department of Atomic, Molecular and Nuclear Physics, Universitat de València (UV), Burjassot (València) 46100, Spain. Grupo de Física Nuclear Aplicada y Simulación, Universidad Pedagógica y Tecnológica de Colombia (UPTC), Tunja (Boyacá), 150003, Colombia
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Vargas CS, Struelens L, Vanhavere F. Abstract ID: 73 Design of a personal dosimeter for estimating the effective dose of medical staff when wearing radioprotective garments using Monte Carlo simulations. Phys Med 2017. [DOI: 10.1016/j.ejmp.2017.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Yoder RC, Salasky MR. A REVIEW OF TWO METHODS USED IN THE USA TO ASSESS HE DURING FLUOROSCOPIC-BASED RADIOLOGY. RADIATION PROTECTION DOSIMETRY 2016; 170:307-310. [PMID: 26891788 DOI: 10.1093/rpd/ncw006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Dosemeter results for ∼81 500 people performing fluoroscopic and interventional radiology procedures were examined to identify differences between groups monitored either by using two dosemeters, one placed at the collar above the apron and a second placed under the apron on the torso (EDE1) or by using one single dosemeter placed at the collar above the apron (EDE2). The median annual HE was 0.17 mSv for those monitored using the EDE1 protocol and 0.26 mSv for the group using the EDE2 protocol. The EDE2 method was used most frequently with the EDE1 method preferred for those more highly exposed. Approximately, 22 % of dosemeter results for EDE1 were inconsistent with expected norms based on over and under apron dosemeter relationships.
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Affiliation(s)
- R Craig Yoder
- Landauer, Inc., 2 Science Road, Glenwood, IL 60425, USA
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16
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VRAL ANNE, DECORTE VEERLE, DEPUYDT JULIE, WAMBERSIE ANDRÉ, THIERENS HUBERT. A semi‑automated FISH‑based micronucleus‑centromere assay for biomonitoring of hospital workers exposed to low doses of ionizing radiation. Mol Med Rep 2016; 14:103-10. [PMID: 27176451 PMCID: PMC4918626 DOI: 10.3892/mmr.2016.5265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/10/2016] [Indexed: 12/02/2022] Open
Abstract
The aim of the present study was to perform cytogenetic analysis by means of a semi‑automated micronucleus‑centromere assay in lymphocytes from medical radiation workers. Two groups of workers receiving the highest occupational doses were selected: 10 nuclear medicine technicians and 10 interventional radiologists/cardiologists. Centromere‑negative micronucleus (MNCM‑) data, obtained from these two groups of medical radiation workers were compared with those obtained in matched controls. The blood samples of the matched controls were additionally used to construct a 'low‑dose' (0‑100 mGy) MNCM‑ dose‑response curve to evaluate the sensitivity and suitability of the micronucleus‑centromere assay as an 'effect' biomarker in medical surveillance programs. The physical dosimetry data of the 3 years preceding the blood sampling, based on single or double dosimetry practices, were collected for the interpretation of the micronucleus data. The in vitro radiation results showed that for small sized groups, semi‑automated scoring of MNCM‑ enables the detection of a dose of 50 mGy. The comparison of MNCM‑ yields in medical radiation workers and control individuals showed enhanced MNCM‑ scores in the medical radiation workers group (P=0.15). The highest MNCM‑ scores were obtained in the interventional radiologists/cardiologists group, and these scores were significantly higher compared with those obtained from the matched control group (P=0.05). The higher MNCM‑ scores observed in interventional radiologists/cardiologists compared with nuclear medicine technicians were not in agreement with the personal dosimetry records in both groups, which may point to the limitation of 'double dosimetry' procedures used in interventional radiology/cardiology. In conclusion, the data obtained in the present study supports the importance of cytogenetic analysis, in addition to physical dosimetry, as a routine biomonitoring method in medical radiation workers receiving the highest occupational radiation burdens.
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Affiliation(s)
- ANNE VRAL
- Department of Basic Medical Sciences, Ghent University, B-9000 Ghent, Belgium
| | - VEERLE DECORTE
- Scientific Committee Centre de Services Interentreprises, External Service For Prevention and Protection at Work, Catholic University of Louvain, St-Luc Clinical University, B-1200 Brussels, Belgium
| | - JULIE DEPUYDT
- Department of Basic Medical Sciences, Ghent University, B-9000 Ghent, Belgium
| | - ANDRÉ WAMBERSIE
- Institute of Experimental and Clinical Research, Molecular Imaging, Radiotherapy and Oncology Unit, Catholic University of Louvain, St-Luc Clinical University, B-1200 Brussels, Belgium
| | - HUBERT THIERENS
- Department of Basic Medical Sciences, Ghent University, B-9000 Ghent, Belgium
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17
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Huda A, Garzón WJ, Filho GCL, Vieira B, Kramer R, Xu XG, Gao Y, Khoury HJ. Evaluation of staff, patient and foetal radiation doses due to endoscopic retrograde cholangiopancreatography (ERCP) procedures in a pregnant patient. RADIATION PROTECTION DOSIMETRY 2016; 168:401-407. [PMID: 26084305 DOI: 10.1093/rpd/ncv354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 05/14/2015] [Indexed: 06/04/2023]
Abstract
The use of endoscopic retrograde cholangiopancreatography (ERCP) in pregnant patients is not rare. Most studies on the safety and efficacy of these procedures report short- and long-term pregnancy outcomes and but not foetal absorbed doses. This investigation reports on an ERCP procedure for a 40-y-old woman who was 32-34 weeks pregnant. Thermoluminescent dosemeters (TLD 100) were used to measure doses received by the patient and the staff. Additionally, Monte Carlo calculations were performed using a 3D computational phantom representing a 9-month pregnant patient to estimate the foetal absorbed dose. The results show that the spleen of the mother received the largest absorbed dose of 12.18 mGy since it was closer to the source than other internal organs. For the foetus and uterus, the lowest absorbed dose was found to be 0.01 mGy to the foetal brain, while the largest absorbed dose was estimated to be 0.13 mGy to the placenta.
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Affiliation(s)
- A Huda
- Department of Nuclear Energy, Federal University of Pernambuco, Recife, Brazil Department of Physics, California State University, Fresno, CA, USA
| | - W J Garzón
- Department of Nuclear Energy, Federal University of Pernambuco, Recife, Brazil
| | - G C L Filho
- The Professor Fernando Figueira Integral Medicine Institute, Recife, Brazil
| | - B Vieira
- The Professor Fernando Figueira Integral Medicine Institute, Recife, Brazil
| | - R Kramer
- Department of Nuclear Energy, Federal University of Pernambuco, Recife, Brazil
| | - X G Xu
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, New York, USA
| | - Y Gao
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, New York, USA
| | - H J Khoury
- Department of Nuclear Energy, Federal University of Pernambuco, Recife, Brazil
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18
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Andreoli S, Moretti R, Lorini FL, Lagrotta M. Radiation exposure of an anaesthesiologist in catheterisation and electrophysiological cardiac procedures. RADIATION PROTECTION DOSIMETRY 2016; 168:76-82. [PMID: 25752757 DOI: 10.1093/rpd/ncv009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/23/2015] [Indexed: 06/04/2023]
Abstract
Sometimes, cardiac catheterisation and electrophysiological procedures, diagnostic and interventional, require an anaesthesiological support. The anaesthesiologist receives radiation doses depending on various factors, such as type of procedure and exposure modality, anaesthesiological technique, individual protective devices and operator experience. The aim of this study was to investigate the dose per procedure, the exposure inhomogeneity and the effective dose, E, of a senior anaesthesiologist in the haemodynamic laboratory of Ospedali Riuniti, Bergamo. The dose monitoring was routinely performed with sets of several thermoluminescent dosemeters and an electronic personal dosemeter. The study covered 300 consecutive procedures over 1 y. The anaesthesiologist wore a protective apron, a thyroid collar and glasses (0.5 mm lead-equivalent).
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Affiliation(s)
- Stefano Andreoli
- USC Fisica Sanitaria, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Renzo Moretti
- USC Fisica Sanitaria, Papa Giovanni XXIII Hospital, Bergamo, Italy
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19
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Khoury HJ, Garzon WJ, Andrade G, Lunelli N, Kramer R, de Barros VSM, Huda A. Radiation exposure to patients and medical staff in hepatic chemoembolisation interventional procedures in Recife, Brazil. RADIATION PROTECTION DOSIMETRY 2015; 165:263-267. [PMID: 25870436 DOI: 10.1093/rpd/ncv075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to evaluate patient and medical staff absorbed doses received from transarterial chemoembolisation of hepatocellular carcinoma, which is the most common primary liver tumour worldwide. The study was performed in three hospitals in Recife, capital of the state of Pernambuco, located in the Brazilian Northeastern region. Two are public hospitals (A and B), and one is private (C). For each procedure, the number of images, irradiation parameters (kV, mA and fluoroscopy time), the air kerma-area product (PKA) and the cumulative air kerma (Ka,r) at the reference point were registered. The maximum skin dose (MSD) of the patient was estimated using radiochromic film. For the medical staff dosimetry, thermoluminescence dosemeters (TLD-100) were attached next to the eyes, close to the thyroid (above the shielding), on the thorax under the apron, on the wrist and on the feet. The effective dose to the staff was estimated using the algorithm of von Boetticher. The results showed that the mean value of the total PKA was 267.49, 403.83 and 479.74 Gy cm(2) for Hospitals A, B and C, respectively. With regard to the physicians, the average effective dose per procedure was 17 µSv, and the minimum and maximum values recorded were 1 and 41 µSy, respectively. The results showed that the feet received the highest doses followed by the hands and lens of the eye, since the physicians did not use leaded glasses and the equipment had no lead curtain.
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Affiliation(s)
- H J Khoury
- Nuclear Energy Department, Federal University of Pernambuco, Recife, PE, Brazil
| | - W J Garzon
- Nuclear Energy Department, Federal University of Pernambuco, Recife, PE, Brazil
| | - G Andrade
- IMIP-Institute of Medicine Dr. Fernando Figueira, Recife, PE, Brazil
| | - N Lunelli
- Nuclear Energy Department, Federal University of Pernambuco, Recife, PE, Brazil
| | - R Kramer
- Nuclear Energy Department, Federal University of Pernambuco, Recife, PE, Brazil
| | - V S M de Barros
- Nuclear Energy Department, Federal University of Pernambuco, Recife, PE, Brazil
| | - A Huda
- California State University, Fresno, CA, USA
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20
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Kong Y, Struelens L, Vanhavere F, Vargas CS, Schoonjans W, Zhuo WH. Influence of standing positions and beam projections on effective dose and eye lens dose of anaesthetists in interventional procedures. RADIATION PROTECTION DOSIMETRY 2015; 163:181-187. [PMID: 24795393 DOI: 10.1093/rpd/ncu148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
More and more anaesthetists are getting involved in interventional radiology procedures and so it is important to know the radiation dose and to optimise protection for anaesthetists. In this study, based on Monte Carlo simulations and field measurements, both the whole-body doses and eye lens dose of anaesthetists were studied. The results showed that the radiation exposure to anaesthetists not only depends on their workload, but also largely varies with their standing positions and beam projections during interventional procedures. The simulation results showed that the effective dose to anaesthetists may vary with their standing positions and beam projections to more than a factor of 10, and the eye lens dose may vary with the standing positions and beam projections to more than a factor of 200. In general, a close position to the bed and the left lateral (LLAT) beam projection will bring a high exposure to anaesthetists. Good correlations between the eye lens dose and the doses at the neck, chest and waist over the apron were observed from the field measurements. The results indicate that adequate arrangements of anaesthesia device or other monitoring equipment in the fluoroscopy rooms are useful measures to reduce the radiation exposure to anaesthetists, and anaesthetists should be aware that they will receive the highest doses under left lateral beam projection.
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Affiliation(s)
- Y Kong
- Institute of Radiation Medicine, Fudan University, Xietu Road 2094, Shanghai 200032, China
| | - L Struelens
- Radiation Protection Dosimetry and Calibration, Belgian Nuclear Research Centre, SCK·CEN, Boeretang 200, Mol 2400, Belgium
| | - F Vanhavere
- Radiation Protection Dosimetry and Calibration, Belgian Nuclear Research Centre, SCK·CEN, Boeretang 200, Mol 2400, Belgium
| | - C S Vargas
- Radiation Protection Dosimetry and Calibration, Belgian Nuclear Research Centre, SCK·CEN, Boeretang 200, Mol 2400, Belgium
| | - W Schoonjans
- Radiation Protection Dosimetry and Calibration, Belgian Nuclear Research Centre, SCK·CEN, Boeretang 200, Mol 2400, Belgium
| | - W H Zhuo
- Institute of Radiation Medicine, Fudan University, Xietu Road 2094, Shanghai 200032, China
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21
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Test and optimization of two routine dosemeters for the dose quantity Hp(3). RADIAT MEAS 2014. [DOI: 10.1016/j.radmeas.2014.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Funao H, Ishii K, Momoshima S, Iwanami A, Hosogane N, Watanabe K, Nakamura M, Toyama Y, Matsumoto M. Surgeons' exposure to radiation in single- and multi-level minimally invasive transforaminal lumbar interbody fusion; a prospective study. PLoS One 2014; 9:e95233. [PMID: 24736321 PMCID: PMC3988176 DOI: 10.1371/journal.pone.0095233] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/24/2014] [Indexed: 11/18/2022] Open
Abstract
Although minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has widely been developed in patients with lumbar diseases, surgeons risk exposure to fluoroscopic radiation. However, to date, there is no studies quantifying the effective dose during MIS-TLIF procedure, and the radiation dose distribution is still unclear. In this study, the surgeons' radiation doses at 5 places on the bodies were measured and the effective doses were assessed during 31 consecutive 1- to 3-level MIS-TLIF surgeries. The operating surgeon, assisting surgeon, and radiological technologist wore thermoluminescent dosimeter on the unshielded thyroid, chest, genitals, right middle finger, and on the chest beneath a lead apron. The doses at the lens and the effective doses were also calculated. Mean fluoroscopy times were 38.7, 53.1, and 58.5 seconds for 1, 2, or 3 fusion levels, respectively. The operating surgeon's mean exposures at the lens, thyroid, chest, genitals, finger, and the chest beneath the shield, respectively, were 0.07, 0.07, 0.09, 0.14, 0.32, and 0.05 mSv in 1-level MIS-TLIF; 0.07, 0.08, 0.09, 0.18, 0.34, and 0.05 mSv in 2-level; 0.08, 0.09, 0.14, 0.15, 0.36, and 0.06 mSv in 3-level; and 0.07, 0.08, 0.10, 0.15, 0.33, and 0.05 mSv in all cases. Mean dose at the operating surgeon's right finger was significantly higher than other measurements parts (P<0.001). The operating surgeon's effective doses (0.06, 0.06, and 0.07 mSv for 1, 2, and 3 fusion levels) were low, and didn't differ significantly from those of the assisting surgeon or radiological technologist. Revision MIS-TLIF was not associated with higher surgeons' radiation doses compared to primary MIS-TLIF. There were significantly higher surgeons' radiation doses in over-weight than in normal-weight patients. The surgeons' radiation exposure during MIS-TLIF was within the safe level by the International Commission on Radiological Protection's guidelines. The accumulated radiation exposure, especially to surgeon's hands, should be carefully monitored.
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Affiliation(s)
- Haruki Funao
- Department of Orthopaedic Surgery, Nerima General Hospital, Tokyo, Japan
- Society for Minimally invasive spine Stabilization (Clinical research group)
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
- Society for Minimally invasive spine Stabilization (Clinical research group)
- * E-mail:
| | - Suketaka Momoshima
- Department of Radiology, School of Medicine, Keio University, Tokyo, Japan
| | - Akio Iwanami
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
- Society for Minimally invasive spine Stabilization (Clinical research group)
| | - Naobumi Hosogane
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
- Society for Minimally invasive spine Stabilization (Clinical research group)
| | - Kota Watanabe
- Advanced Therapy for Spine and Spinal Cord Disorders, Keio University, Tokyo, Japan
- Society for Minimally invasive spine Stabilization (Clinical research group)
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Yoshiaki Toyama
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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23
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Lunelli NA, Khoury HJ, Andrade GHVD, Borrás C. Evaluation of occupational and patient dose in cerebral angiography procedures. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000600007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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24
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Miller DL. Efforts to optimize radiation protection in interventional fluoroscopy. HEALTH PHYSICS 2013; 105:435-444. [PMID: 24077043 DOI: 10.1097/hp.0b013e31829c355a] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
While it has been known for more than a century that radiation presents risks to both the physician and the patient, skin injuries from fluoroscopy became increasingly rare after the 1930s, and radiation risk from fluoroscopy appeared to be adequately controlled. However, beginning in approximately 1975, new technologies and materials for interventional devices were developed. These enabled new procedures, and as these were instituted, skin injuries again occurred in patients. Four central issues were identified: equipment, quality management, operator training, and occupational radiation protection. Recognition that these were areas for improvement provoked changes in technology and practice that continue today.
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Affiliation(s)
- Donald L Miller
- *Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring MD 20993
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25
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Martin CJ, Magee JS. Assessment of eye and body dose for interventional radiologists, cardiologists, and other interventional staff. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2013; 33:445-460. [PMID: 23649355 DOI: 10.1088/0952-4746/33/2/445] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A dose limit for the eye of 20 mSv, as proposed by the ICRP, could be exceeded by interventional clinicians. Data on eye dose levels for interventional radiologists and cardiologists provided by medical physicists from hospitals around the UK have been collated. The results indicate that most hospitals would require one or more interventional clinicians to be classified and several would have exceeded a 20 mSv limit. Dose data in the literature have been reviewed to derive factors that might be used to predict eye dose levels based on dose per procedure or kerma-area product workload. These could be used in prior risk assessments to establish monitoring practice. An alternative approach to personnel dose monitoring in radiology applications using a collar dosimeter worn outside the lead apron as the first dosimeter is proposed. The collar dosimeter would provide an assessment of eye dose in terms of Hp(3) and body dose in terms of Hp(10), which could be divided by ten to provide an assessment of effective dose. If Hp(3) exceeded 1 mSv per month, regular monitoring with a head dosimeter would be recommended, and if Hp(10) exceeded 2 mSv per month, then an under-apron dosimeter should also be worn.
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Affiliation(s)
- C J Martin
- Health Physics, Gartnavel Royal Hospital, Glasgow, UK.
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26
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Durán A, Hian SK, Miller DL, Le Heron J, Padovani R, Vano E. Recommendations for occupational radiation protection in interventional cardiology. Catheter Cardiovasc Interv 2013; 82:29-42. [PMID: 23475846 DOI: 10.1002/ccd.24694] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 10/06/2012] [Indexed: 11/08/2022]
Abstract
The radiation dose received by cardiologists during percutaneous coronary interventions, electrophysiology procedures and other interventional cardiology procedures can vary by more than an order of magnitude for the same type of procedure and for similar patient doses. There is particular concern regarding occupational dose to the lens of the eye. This document provides recommendations for occupational radiation protection for physicians and other staff in the interventional suite. Simple methods for reducing or minimizing occupational radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in radiation protection for all interventional cardiology personnel, and the availability of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of radiation protection in the interventional suite. These recommendations for occupational radiation protection in interventional cardiology and electrophysiology have been endorsed by the Asian Pacific Society of Interventional Cardiology, the European Association of Percutaneous Cardiovascular Interventions, the Latin American Society of Interventional Cardiology, and the Society for Cardiovascular Angiography and Interventions.
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Affiliation(s)
- Ariel Durán
- Cardiology Department, University Hospital, Montevideo, Uruguay
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27
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Abstract
OBJECTIVE Interventional radiology tends to involve long procedures (i.e., long fluoroscopic times). Therefore, radiation protection for interventional radiology staff is an important issue. This study describes the occupational radiation dose for interventional radiology staff, especially nurses, to clarify the present annual dose level for interventional radiology nurses. MATERIALS AND METHODS We compared the annual occupational dose (effective dose and dose equivalent) among interventional radiology staff in a hospital where 6606 catheterization procedures are performed annually. The annual occupational doses of 18 physicians, seven nurses, and eight radiologic technologists were recorded using two monitoring badges, one worn over and one under their lead aprons. RESULTS The annual mean ± SD effective dose (range) to the physicians, nurses, and radiologic technologists using two badges was 3.00 ± 1.50 (0.84-6.17), 1.34 ± 0.55 (0.70-2.20), and 0.60 ± 0.48 (0.02-1.43) mSv/y, respectively. Similarly, the annual mean ± SD dose equivalent range was 19.84 ± 12.45 (7.0-48.5), 4.73 ± 0.72 (3.9-6.2), and 1.30 ± 1.00 (0.2-2.7) mSv/y, respectively. The mean ± SD effective dose for the physicians was 1.02 ± 0.74 and 3.00 ± 1.50 mSv/y for the one- and two-badge methods, respectively (p < 0.001). Similarly, the mean ± SD effective dose for the nurses (p = 0.186) and radiologic technologists (p = 0.726) tended to be lower using the one-badge method. CONCLUSION The annual occupational dose for interventional radiology staff was in the order physicians > nurses > radiologic technologists. The occupational dose determined using one badge under the apron was far lower than the dose obtained with two badges in both physicians and nonphysicians. To evaluate the occupational dose correctly, we recommend use of two monitoring badges to evaluate interventional radiology nurses as well as physicians.
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28
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Sánchez RM, Vano E, Fernández JM, Rosales F, Sotil J, Carrera F, García MA, Soler MM, Hernández-Armas J, Martínez LC, Verdú JF. Staff Doses in Interventional Radiology: A National Survey. J Vasc Interv Radiol 2012; 23:1496-501. [DOI: 10.1016/j.jvir.2012.05.056] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 05/23/2012] [Accepted: 05/23/2012] [Indexed: 11/27/2022] Open
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29
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Pantos I, Koukorava C, Nirgianaki E, Carinou E, Tzanalaridou E, Efstathopoulos EP, Katritsis DG. Radiation exposure of the operator during cardiac catheter ablation procedures. RADIATION PROTECTION DOSIMETRY 2012; 150:306-311. [PMID: 22234422 DOI: 10.1093/rpd/ncr414] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Radiation exposure of the operator during cardiac catheter ablation procedures was assessed for an experienced cardiologist adopting various measures of radiation protection and utilised electroanatomic navigation. Chip thermoluminescent dosemeters were placed at the eyes, chest, wrists and legs of the operator. The ranges of fluoroscopy time and air kerma area product values associated with cardiac ablation procedures were wide (6.3-48.3 min and 1.7-80.3 Gy cm(2), respectively). The measured median radiation doses per procedure for each monitored position were 23.6 and 21.3 μSv to the left and right wrists, respectively, 25.3 and 30.4 μSv to the left and right legs, respectively. The doses to the eyes were below the minimum detectable dose of 9 μSv. The estimated median effective dose was 22.5 μSv. Considering the actual workload of the operator, the calculated annual doses to the hands, legs and eyes, as well as the annual effective dose, were all below the corresponding limits. The findings of this study indicate that cardiac ablation procedures performed at a modern laboratory do not impose a high radiation hazard to the operator when radiation protection measures are routinely adopted.
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Affiliation(s)
- I Pantos
- Department of Cardiology, Athens Euroclinic, Athens, Greece
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30
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Kim KP, Miller DL, Berrington de Gonzalez A, Balter S, Kleinerman RA, Ostroumova E, Simon SL, Linet MS. Occupational radiation doses to operators performing fluoroscopically-guided procedures. HEALTH PHYSICS 2012; 103:80-99. [PMID: 22647920 PMCID: PMC3951010 DOI: 10.1097/hp.0b013e31824dae76] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In the past 30 y, the numbers and types of fluoroscopically-guided (FG) procedures have increased dramatically. The objective of the present study is to provide estimated radiation doses to physician specialists, other than cardiologists, who perform FG procedures. The authors searched Medline to identify English-language journal articles reporting radiation exposures to these physicians. They then identified several primarily therapeutic FG procedures that met specific criteria: well-defined procedures for which there were at least five published reports of estimated radiation doses to the operator, procedures performed frequently in current medical practice, and inclusion of physicians from multiple medical specialties. These procedures were percutaneous nephrolithotomy (PCNL), vertebroplasty, orthopedic extremity nailing for treatment of fractures, biliary tract procedures, transjugular intrahepatic portosystemic shunt creation (TIPS), head/neck endovascular therapeutic procedures, and endoscopic retrograde cholangiopancreatography (ERCP). Radiation doses and other associated data were abstracted, and effective dose to operators was estimated. Operators received estimated doses per patient procedure equivalent to doses received by interventional cardiologists. The estimated effective dose per case ranged from 1.7-56 μSv for PCNL, 0.1-101 μSv for vertebroplasty, 2.5-88 μSv for orthopedic extremity nailing, 2.0-46 μSv for biliary tract procedures, 2.5-74 μSv for TIPS, 1.8-53 μSv for head/neck endovascular therapeutic procedures, and 0.2-49 μSv for ERCP. Overall, mean operator radiation dose per case measured over personal protective devices at different anatomic sites on the head and body ranged from 19-800 (median = 113) μSv at eye level, 6-1,180 (median = 75) μSv at the neck, and 2-1,600 (median = 302) μSv at the trunk. Operators' hands often received greater doses than the eyes, neck, or trunk. Large variations in operator doses suggest that optimizing procedure protocols and proper use of protective devices and shields might reduce occupational radiation dose substantially.
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Affiliation(s)
- Kwang Pyo Kim
- Department of Nuclear Engineering, Kyung Hee University, Gyeonggi-do, Republic of Korea.
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Individual monitoring of medical staff working in interventional radiology in Switzerland using double dosimetry. RADIAT MEAS 2011. [DOI: 10.1016/j.radmeas.2011.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Beganović A, Bašić B, Gazdić-Šantić M, Kulić M, Spužić M, Skopljak-Beganović A, Drljević A, Samek D. Occupational and patient exposure in interventional cardiology in Bosnia and Herzegovina. RADIATION PROTECTION DOSIMETRY 2011; 147:102-105. [PMID: 21764805 DOI: 10.1093/rpd/ncr279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Monitoring of professionally exposed workers in Bosnia and Herzegovina started in 1960s. Doses received by patients and professionals in interventional cardiology are high in comparison with other practices in medicine. The purpose of this study is to present personal and patient dosimetry data. Results show increase in doses of personnel in interventional cardiology. Total collective dose for four cardiology centres in Bosnia and Herzegovina increased from 15 person mSv in 2007 to 52 person mSv in 2010. This increase mainly corresponds to higher number of personnel and increase in the number of procedures. Average monthly dose has increased from 0.40 to 0.72 mSv in the same period. The results of occupational and patient doses in interventional cardiology are similar to results reported in the literature. It is of great importance for professionals working in this field to be educated in radiation protection and proper use of X-ray equipment.
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Affiliation(s)
- A Beganović
- Department of Medical Physics and Radiation Safety, Clinical Centre of Sarajevo University, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina.
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33
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Martin CJ. Personal dosimetry for interventional operators: when and how should monitoring be done? Br J Radiol 2011; 84:639-48. [PMID: 21159809 PMCID: PMC3473494 DOI: 10.1259/bjr/24828606] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 05/05/2010] [Accepted: 05/10/2010] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Assessment of the potential doses to the hands and eyes for interventional radiologists and cardiologists can be difficult. A review of studies of doses to interventional operators reported in the literature has been undertaken. METHODS Distributions for staff dose to relevant parts of the body per unit dose-area product and for doses per procedure in cardiology have been analysed and mean, median and quartile values derived. The possibility of using these data to provide guidance for estimation of likely dose levels is considered. RESULTS Dose indicator values that could be used to predict orders of magnitude of doses to the eye, thyroid and hands from interventional operator workloads have been derived, based on the third quartile values, from the distributions of dose results analysed. CONCLUSION Dose estimates made in this way could be employed in risk assessments when reviewing protection and monitoring requirements. Data on the protection provided by different shielding and technique factors have also been reviewed to provide information for risk assessments. Recommendations on the positions in which dosemeters are worn should also be included in risk assessments, as dose measurements from suboptimal dosemeter use can be misleading.
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Affiliation(s)
- C J Martin
- Health Physics, Gartnavel Royal Hospital, Glasgow, UK.
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von Boetticher H, Lachmund J, Hoffmann W. An analytic approach to double dosimetry algorithms in occupational dosimetry using energy dependent organ dose conversion coefficients. HEALTH PHYSICS 2010; 99:800-805. [PMID: 21068598 DOI: 10.1097/hp.0b013e3181e850da] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Personnel dose in diagnostic radiology is often underestimated. Typically the effective dose E is estimated based on dosimeters worn underneath the protective clothing measuring the personal dose equivalent Hp(10). This one-spot-measurement systematically neglects the exposure to the unshielded organs in the head and neck region. In this paper, energy dependent double dosimetry algorithms in the range of 30-80 keV are derived using organ dose conversion coefficients. The doses of shielded organs are assigned to a single dosimeter in the anterior thoracic region (chest) underneath the apron (Hp,c,u), and the doses of the organs not shielded are assigned to another dosimeter placed on the front area of the neck over the protective garment (Hp,n,o) with E = a1 Hp,c,u(10) + a2 Hp,n,o(10). Organs not completely shielded are categorized correspondingly. The coefficients a1 and a2 increase with higher energies up to 70 keV. The factors a2 are clearly higher according to ICRP 103 (rather than ICRP 60) because ICRP 103 considers additional organs in the head and neck region. According to ICRP 103, a conservative general algorithm with thyroid protection is E = 0.84 Hp,c,u(10) + 0.051 Hp,n,o(10) and without thyroid protection E = 0.79 Hp,c,u(10) + 0.100 Hp,n,o(10).
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Affiliation(s)
- Heiner von Boetticher
- Institute for Radiology and Academy of Radiation Protection, Klinikum Links der Weser, Bremen, Germany.
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35
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Martin CJ. A review of radiology staff doses and dose monitoring requirements. RADIATION PROTECTION DOSIMETRY 2009; 136:140-157. [PMID: 19759087 DOI: 10.1093/rpd/ncp168] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Studies of radiation doses received during X-ray procedures by radiology, cardiology and other clinical staff have been reviewed. Data for effective dose (E), and doses to the eyes, thyroid, hands and legs have been analysed. These data have been supplemented with local measurements to determine the most exposed part of the hand for monitoring purposes. There are ranges of 60-100 in doses to individual tissues reported in the literature for similar procedures at different centres. While ranges in the doses per unit dose-area product (DAP) are between 10 and 25, large variations in dose result from differences in the sensitivity of the X-ray equipment, the type of procedure and the operator technique, but protection factors are important in maintaining dose levels as low as possible. The influence of shielding devices is significant for determining the dose to the eyes and thyroid, and the position of the operator, which depends on the procedure, is the most significant factor determining doses to the hands. A second body dosemeter worn at the level of the collar is recommended for operators with high workloads for use in assessment of effective dose and the dose to the eye. It is proposed that the third quartile values from the distributions of dose per unit DAP identified in the review might be employed in predicting the orders of magnitude of doses to the eye, thyroid and hands, based on interventional operator workloads. Such dose estimates could be employed in risk assessments when reviewing protection and monitoring requirements. A dosemeter worn on the little finger of the hand nearest to the X-ray tube is recommended for monitoring the hand.
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Affiliation(s)
- C J Martin
- Health Physics, Gartnavel Royal Hospital, Glasgow G12 0XH, UK.
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36
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Kuipers G, Velders XL. Effective dose to staff from interventional procedures: estimations from single and double dosimetry. RADIATION PROTECTION DOSIMETRY 2009; 136:95-100. [PMID: 19689952 DOI: 10.1093/rpd/ncp155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The exposure of 11 physicians performing interventional procedures was measured by means of two personal dosemeters. One personal dosemeter was worn outside the lead apron and an additional under the lead apron. The study was set up in order to determine the added value of a dosemeter worn under the lead apron. With the doses measured, the effective doses of the physicians were estimated using an algorithm for single dosimetry and two algorithms for double dosimetry. The effective doses calculated with the single dosimetry algorithm ranged from 0.11 to 0.85 mSv in 4 weeks. With the double dosimetry algorithms, the effective doses ranged from 0.02 mSv to 0.47 mSv. The statistical analysis revealed no significant differences in the accuracy of the effective doses calculated with single or double dosimetry algorithms. It was concluded that the effective dose cannot be considered a more accurate estimate when two dosemeters are used instead of one.
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Järvinen H, Buls N, Clerinx P, Miljanic S, Nikodemová D, Ranogajec-Komor M, Struelens L, d'Errico F. Comparison of double dosimetry algorithms for estimating the effective dose in occupational dosimetry of interventional radiology staff. RADIATION PROTECTION DOSIMETRY 2008; 131:80-86. [PMID: 18757899 DOI: 10.1093/rpd/ncn239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
'Double dosimetry' i.e. measurement with two dosemeters, one located above the protective apron and one under has been recommended in interventional radiology (IR) to determine the effective dose to staff. Several algorithms have been developed to calculate the effective dose from the readings of the two dosemeters, but there is no international consensus on what is the best algorithm. In this work, a few of the most recently developed algorithms have been tested in typical IR conditions. The effective dose and personnel dosemeter readings were obtained experimentally by using thermoluminescent dosemeters in and on a Rando-Alderson phantom provided with a lead apron. In addition, the effective dose and personnel dosemeter readings were calculated by the Monte Carlo method for the same irradiation geometry. The results suggest that most of the algorithms overestimate effective dose in the selected IR conditions, but there is also a risk of underestimation by using the least conservative algorithms. Two of the algorithms seem to comply best with the chosen criteria of performance, i.e. no underestimation, minimum overestimation and close estimation of effective dose in typical IR conditions. However, it might not be justified to generalise the results. It is recommended that whenever personnel doses approach or exceed the dose limit, IR conditions should be further investigated and the possibility of over- or under-estimation of effective dose by the algorithm used should be considered.
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Affiliation(s)
- H Järvinen
- Radiation and Nuclear Safety Authority (STUK), Helsinki, Finland.
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