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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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Lian ME, Yee WG, Yu KL, Wu GY, Yang SM, Tsai HY. Radiation exposure in augmented fluoroscopic bronchoscopy procedures: a comprehensive analysis for patients and physicians. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:011502. [PMID: 38194908 DOI: 10.1088/1361-6498/ad1cd3] [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: 08/31/2023] [Accepted: 01/09/2024] [Indexed: 01/11/2024]
Abstract
Cancer is a major health challenge and causes millions of deaths worldwide each year, and the incidence of lung cancer has increased. Augmented fluoroscopic bronchoscopy (AFB) procedures, which combine bronchoscopy and fluoroscopy, are crucial for diagnosing and treating lung cancer. However, fluoroscopy exposes patients and physicians to radiation, and therefore, the procedure requires careful monitoring. The National Council on Radiation Protection and Measurement and the International Commission on Radiological Protection have emphasised the importance of monitoring patient doses and ensuring occupational radiation safety. The present study evaluated radiation doses during AFB procedures, focusing on patient skin doses, the effective dose, and the personal dose equivalent to the eye lens for physicians. Skin doses were measured using thermoluminescent dosimeters. Peak skin doses were observed on the sides of the patients' arms, particularly on the side closest to the x-ray tube. Differences in the procedures and experience of physicians between the two hospitals involved in this study were investigated. AFB procedures were conducted more efficiently at Hospital A than at Hospital B, resulting in lower effective doses. Cone-beam computed tomography (CT) contributes significantly to patient effective doses because it has higher radiographic parameters. Despite their higher radiographic parameters, AFB procedures resulted in smaller skin doses than did image-guided interventional and CT fluoroscopy procedures. The effective doses differed between the two hospitals of this study due to workflow differences, with cone-beam CT playing a dominant role. No significant differences in left and right eyeHp(3) values were observed between the hospitals. For both hospitals, theHp(3) values were below the recommended limits, indicating that radiation monitoring may not be required for AFB procedures. This study provides insights into radiation exposure during AFB procedures, concerning radiation dosimetry, and safety for patients and physicians.
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Affiliation(s)
- Meng-En Lian
- Institute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Wong Guang Yee
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Kai-Lun Yu
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Guan-Yi Wu
- Scientific Research Division, National Synchrotron Radiation Research Center, Hsinchu, Taiwan
| | - Shun-Mao Yang
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Hui-Yu Tsai
- Institute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu, Taiwan
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Ehrengut C, Vogt J, Leonhardi J, Carabenciov E, Teske F, van Boemmel F, Berg T, Seehofer D, Lincke T, Sabri O, Gößmann H, Denecke T, Ebel S. Analysis of Periprocedural X-ray Exposure in Transarterial Radioembolization with Glass or Resin Microspheres. Diagnostics (Basel) 2023; 13:3609. [PMID: 38132193 PMCID: PMC10742723 DOI: 10.3390/diagnostics13243609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
Background: Transarterial Radioembolization (TARE) is an effective treatment option for both primary and secondary liver malignancies. However, challenging anatomical conditions can lead to prolonged fluoroscopy times (FT), elevated doses of periprocedural X-radiation (DAP), and increased use of contrast agents (CAs). In this study, we examined the influence of our radiologists' experience and the choice of microspheres on X-ray exposure and CA doses in TARE. Material and Methods: Datasets comprising 161 TARE and 164 preprocedural evaluation angiographies (TARE-EVA) were analyzed. Our study focused on assessing DAP, FT, and CA concerning both microsphere types, the radiologist's experience, and whether the same radiologist performed both the TARE-EVA and the actual TARE. Results: In TARE, the use of resin microspheres resulted in significantly higher FT and CA compared to glass microspheres (14.3 ± 1.6 min vs. 10.6 ± 1.1 min and 43 ± 2.2 mL vs. 33.6 ± 2.1 mL, p < 0.05), with no notable differences in DAP (p = 0.13). Experienced radiologists demonstrated reduced FT/DAP, with a 19% decrease in DAP and 53% in FT during the evaluation angiography (p < 0.05) and a 49% reduction in DAP during the actual TARE (p < 0.05), with no statistical differences in FT. Performing TARE and TARE-EVA under the same radiologist led to a 43% reduction in DAP and a 25% decrease in FT (p < 0.05, respectively). Conclusions: To mitigate X-radiation exposure, it is advisable for radiologists to undergo thorough training, and, ideally, the same radiologist should conduct both the TARE and the TARE-EVA. While the use of glass spheres may decrease intraarterial CA, it does not significantly impact periprocedural X-ray exposure.
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Affiliation(s)
- Constantin Ehrengut
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Johanna Vogt
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Jakob Leonhardi
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Emma Carabenciov
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Felix Teske
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Florian van Boemmel
- Division of Hepatology, Department of Medicine II, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Thomas Lincke
- Department of Nuclear Medicine, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Holger Gößmann
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (J.V.); (S.E.)
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Lee WJ, Jang EJ, Kim KS, Bang YJ. Underestimation of Radiation Doses by Compliance of Wearing Dosimeters among Fluoroscopically-Guided Interventional Medical Workers in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148393. [PMID: 35886244 PMCID: PMC9318991 DOI: 10.3390/ijerph19148393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 02/05/2023]
Abstract
This study aimed to estimate the level of underestimation of National Dose Registry (NDR) doses based on the workers’ dosimeter wearing compliance. In 2021, a nationwide survey of Korean medical radiation workers was conducted. A total of 989 medical workers who performed fluoroscopically-guided interventional procedures participated, and their NDR was compared with the adjusted doses by multiplying the correction factors based on the individual level of dosimeter compliance from the questionnaire. Ordinal logistic regression analysis was performed to identify the factors for low dosimeter wearing. Based on the data from the NDR, the average annual effective radiation dose was 0.95 mSv, while the compliance-adjusted dose was 1.79 mSv, yielding an 89% increase. The risks for low compliance with wearing a badge were significantly higher among doctors, professionals other than radiologists or cardiologists, workers not frequently involved in performing fluoroscopically-guided interventional procedures, and workers who did not frequently wear protective devices. This study provided quantitative information demonstrating that the NDR data may have underestimated the actual occupational radiation exposure. The underestimation of NDR doses may lead to biased risk estimates in epidemiological studies for radiation workers, and considerable attention on dosimetry wearing compliance is required to interpret and utilize NDR data.
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Behr-Meenen C, von Boetticher H, Kersten JF, Nienhaus A. Radiation Protection in Interventional Radiology/Cardiology-Is State-of-the-Art Equipment Used? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13131. [PMID: 34948742 PMCID: PMC8700859 DOI: 10.3390/ijerph182413131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022]
Abstract
Interventional radiology/cardiology is one of the fields with the highest radiation doses for workers. For this reason, the International Commission on Radiological Protection (ICRP) published new recommendations in 2018 to shield staff from radiation. This study sets out to establish the extent to which these recommendations are observed in Germany. For the study, areas were selected which are known to have relatively high radiation exposure along with good conditions for radiological protection-interventional cardiology, radiology and vascular surgery. The study was advertised with the aid of an information flyer which was distributed via organisations including the German Cardiac Society (Deutsche Gesellschaft für Kardiologie- Herz- und Kreislaufforschung e. V.). Everyone who participated in our study received a questionnaire to record their occupational medical history, dosimetry, working practices, existing interventional installations and personal protective equipment. The results were compared with international recommendations, especially those of the ICRP, based on state-of-the-art equipment. A total of 104 respondents from eight German clinics took part in the survey. Four participants had been medically diagnosed with cataracts. None of the participants had previously worn an additional dosimeter over their apron to determine partial-body doses. The interventional installations recommended by the ICRP have not been fitted in all examination rooms and, where they have been put in place, they are not always used consistently. Just 31 participants (36.6%) stated that they "always" wore protective lead glasses or a visor. This study revealed considerable deficits in radiological protection-especially in connection with shielding measures and dosimetric practices pertaining to the head and neck-during a range of interventions. Examination rooms without the recommended interventional installations should be upgraded in the future. According to the principle of dose minimization, there is considerable potential for improving radiation protection. Temporary measurements should be taken over the apron to determine the organ-specific equivalent dose to the lens of the eye and the head.
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Affiliation(s)
- Christiane Behr-Meenen
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (J.F.K.); (A.N.)
| | - Heiner von Boetticher
- Division for Medical Radiation Physics, Faculty VI: Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26121 Oldenburg, Germany;
| | - Jan Felix Kersten
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (J.F.K.); (A.N.)
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (J.F.K.); (A.N.)
- Department of Occupational Medicine, Toxic Substances, Health Service Research, German Statuary Institution for Accident Insurance and Prevention for Health and Welfare Services (BGW), 22089 Hamburg, Germany
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Borrego D, Yoder C, Balter S, Kitahara CM. Collar badge lens dose equivalent values among U.S. physicians performing fluoroscopically-guided interventional procedures. J Vasc Interv Radiol 2021; 33:219-224.e2. [PMID: 34748952 PMCID: PMC10388339 DOI: 10.1016/j.jvir.2021.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe the range of occupational badge dose readings and annualized dose records among physicians performing fluoroscopically guided interventional (FGI) procedures using job title information provided by the same three major medical institutions in 2009, 2012, and 2015. METHODS The Radiation Safety Office of selected hospitals was contacted to request assistance with identifying physicians in a large commercial dosimetry database. All entries judged to be uninformative of occupational doses to FGI procedures staff were excluded. Monthly and annualized doses were described with univariate statistics and box-and-whisker plots. RESULTS The dosimetry dataset of interventional radiology staff contains 169 annual dose records from 77 different physicians and 698 annual dose records from 455 non-physicians. The median annualized lens dose equivalent values among physicians (11.9 mSv; IQR=6.9-20.0) was nearly threefold higher than non-physician medical staff assisting with FGI procedures (4.0 mSv; IQR=1.8-6.7) (P<0.001). During the study period, without eye protection, 25% (23 of 93) of the physician annualized lens dose equivalent values may have exceeded 20 mSv; for non-physician medical staff, this value was may have been exceeded 3.5% (6 of 173) of the time. However, these values do not account for eye protection. CONCLUSION The findings from this study highlight the importance of mitigating occupational dose to the eyes of medical staff, particularly physicians, performing or assisting with FGI procedures. Training on radiation protection principles, the use of personal protective equipment, and patient radiation dose management can all help ensure occupational radiation dose is adequately controlled.
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Affiliation(s)
- David Borrego
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Craig Yoder
- Independent consultant, Weddington, North Carolina
| | - Stephen Balter
- Departments of Radiology and Medicine, Columbia University Medical Center, New York, New York
| | - Cari M Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Alnaaimi M, Alduaij M, Shenawy F, Algaily M, Mohammedzein T, Shaaban M, Rehani MM. Assessment of eye doses to staff involved in interventional cardiology procedures in Kuwait. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:639-645. [PMID: 34351496 PMCID: PMC8339394 DOI: 10.1007/s00411-021-00929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/24/2021] [Indexed: 06/13/2023]
Abstract
In this study, which is the first of its kind in the gulf region, eye doses of interventional cardiologists and nurses were measured using active dosimeters for left and right eyes, in 60 percutaneous coronary interventions in three main hospitals in Kuwait. The dose given in terms of Hp(0.07) per procedure when ceiling suspended screens were used by main operators ranged from 18.5 to 30.3 µSv for the left eye and from 12.6 to 23.6 µSv for the right eye. Taking into account typical staff workload, the results show that the dose limit of 20 mSv/year to the eyes can be exceeded for interventional cardiologists in some situations, which demonstrates the need of using additional effective radiation protection tools, e.g. protective eye spectacles, in addition to the regular and proper use of ceiling suspended screens. With indications of increase in workload, the need for availability of a dedicated active dosimeter for the regular monitoring of eye doses is emphasized.
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Affiliation(s)
- Meshari Alnaaimi
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait.
| | - Mousa Alduaij
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Faisal Shenawy
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Musab Algaily
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Talal Mohammedzein
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Mohamed Shaaban
- Radiation Protection Department, Shuwaikh, Kuwait City, Kuwait
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Mourtada F, Clement CH, Dauer LT, Baureus Koch C, Cosset JM, Doruff M, Damato A, Guedea F, Scalliet P, Thomadsen B, Pinillos-Ashton L, Small W. Occupational Radiological Protection in Brachytherapy. Ann ICRP 2021; 50:5-75. [PMID: 34503342 DOI: 10.1177/01466453211013514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Firas Mourtada
- Chief of Clinical Physics, ChristianaCare, Newark, Delaware.,President, American Brachytherapy Society
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Lee Y, Lee WJ, Jin YW, Jang S. Interventional radiologists have a higher rate of chromosomal damage due to occupational radiation exposure: a dicentric chromosome assay. Eur Radiol 2021; 31:8256-8263. [PMID: 33876297 DOI: 10.1007/s00330-021-07883-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/14/2021] [Accepted: 03/15/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES There are growing concerns regarding radiation exposure in medical workers who perform interventional fluoroscopy procedures. Owing to the nature of certain interventional procedures, workers may be subjected to partial-body radiation exposure that is high enough to cause local damage. We aimed to investigate the level of radiation exposure in interventional radiologists in South Korea by performing cytogenetic biodosimetry, particularly focusing on partial-body exposure. METHODS Interventional radiologists (n = 52) completed a questionnaire, providing information about their work history and practices. Blood samples were collected and processed for a dicentric chromosome assay. We determined Papworth's U-value to assess the conformity of dicentrics with the Poisson distribution to estimate the partial-body exposures of the radiologists. RESULTS Radiologists had a higher number of dicentrics than the normal population and industrial radiographers. Indeed, subjects with a U-value of > 1.96, an indicator of heterogeneous exposure, were observed more frequently; 4.67 ± 0.81% of their body was irradiated at an average dose of 4.64 ± 0.67 Gy. Logistic regression analysis revealed that the total duration of all interventional procedures per week was associated with partial-body exposure levels. CONCLUSIONS Our findings suggest that interventional radiologists had greater chromosomal damages than those in other occupational groups, and their partial-body exposure levels might be high enough to cause local damage. Use of special dosimeters to monitor partial-body exposure, as well as restricting the time and frequency of interventional procedures, could help reduce occupational radiation exposure. KEY POINTS • Interventional radiologists had a higher number of dicentrics than the normal population and industrial radiographers. • The level of partial-body exposure of interventional radiologists might be high enough to cause occupational local damage such as a skin cancer in fingers. • Restricting the duration and frequency of interventional procedures might be helpful in reducing occupational radiation exposure.
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Affiliation(s)
- Younghyun Lee
- Laboratory of Biological Dosimetry, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Woo Jin
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Seongjae Jang
- Laboratory of Biological Dosimetry, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.
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Ko S, Kim KP, Cho SB, Bang YJ, Ha YW, Lee WJ. Occupational Radiation Exposure and Validity of National Dosimetry Registry among Korean Interventional Radiologists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084195. [PMID: 33921003 PMCID: PMC8071388 DOI: 10.3390/ijerph18084195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023]
Abstract
The national dose registry (NDR) contains essential information to help protect radiation workers from radiation-related health risks and to facilitate epidemiological studies. However, direct validation of the reported doses has not been considered. We investigated the validity of the NDR with a personal dosimeter monitoring conducted among Korean interventional radiologists. Among the 56 interventional radiologists, NDR quarterly doses were compared with actively monitored personal thermoluminescent dosimeter (TLD) doses as standard measures of validation. We conducted analyses with participants categorized according to compliance with TLD badge-wearing policies. A correlation between actively monitored doses and NDR doses was low (Spearman ρ = 0.06), and the mean actively monitored dose was significantly higher than the mean NDR dose (mean difference 0.98 mSv) in all participants. However, interventional radiologists who wore badges irregularly showed a large difference between actively monitored doses and NDR doses (mean difference 2.39 mSv), and participants who wore badges regularly showed no apparent difference between actively monitored doses and NDR doses (mean difference 0.26 mSv). This study indicated that NDR data underestimate the actual occupational radiation exposure, and the validity of these data varies according to compliance with badge-wearing policies. Considerable attention is required to interpret and utilize NDR data based on radiation workers’ compliance with badge-wearing policies.
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Affiliation(s)
- Seulki Ko
- Department of Preventive Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.K.); (Y.J.B.); (Y.W.H.)
- Graduate School of Public Health, Korea University, Seoul 02841, Korea
| | - Kwang Pyo Kim
- Department of Nuclear Engineering, Kyung Hee University, Gyeonggi-do 02447, Korea;
| | - Sung Bum Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea;
| | - Ye Jin Bang
- Department of Preventive Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.K.); (Y.J.B.); (Y.W.H.)
- Graduate School of Public Health, Korea University, Seoul 02841, Korea
| | - Yae Won Ha
- Department of Preventive Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.K.); (Y.J.B.); (Y.W.H.)
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.K.); (Y.J.B.); (Y.W.H.)
- Graduate School of Public Health, Korea University, Seoul 02841, Korea
- Correspondence:
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Žauhar G, Dresto-Alač B. Trends in Professional Radiation Exposures of Medical Staff Covered by Personal Dose Monitoring at a Rijeka Clinical Hospital Centre (2000 to 2015). HEALTH PHYSICS 2021; 120:308-315. [PMID: 33086264 DOI: 10.1097/hp.0000000000001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
ABSTRACT The increase in the number of radiological procedures observed in recent years also means greater exposure to ionizing radiation for the medical staff performing these procedures. This is most pronounced in the teams that perform interventional and invasive radiological procedures. The aim of this study was to examine the impact of increasing numbers of radiological procedures on the effective dose received by medical staff and to determine which professions received the highest exposure to ionizing radiation. Data for effective doses of 326 employees of Rijeka Clinical Hospital Centre covered by personal dosimetry in the period from 2000 to 2015 have been analyzed. Employees were divided by sex, by departments in which they were employed, and according to their professions. The analysis has shown that the exposure level of workers working in the ionizing radiation zone is typically well below the dose limits. During 2015, most employees (over 96.3%) received an annual effective dose of less than 0.1 mSv. Only three persons received an annual dose higher than 0.5 mSv, and one person received an annual dose of 6.9 mSv. Comparison of the radiation exposure doses of medical workers of different professions has shown that the highest dose of radiation is received by cardiologists involved in interventional cardiology procedures. Therefore, the additional need is to take care of their protection, check the manner of their work, and ensure more even workload of cardiologists participating in procedures that involve higher exposure to ionizing radiation.
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Affiliation(s)
- Gordana Žauhar
- University of Rijeka, Faculty of Medicine, Department of Medical Physics and Biophysics, Braće Branchetta 20, 51 000 Rijeka, Croatia and University of Rijeka, Department of Physics, Radmile Matejčić 2, 51 000 Rijeka, Croatia
| | - Branka Dresto-Alač
- University of Rijeka, Faculty of Health Studies, Viktora Cara Emina 5, 51 000 Rijeka, Croatia
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Patient dosimetry in neurointerventional procedures. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2020.108962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Elshami W, Abuzaid M, Pekkarinen A, Kortesniemi M. ESTIMATION OF OCCUPATIONAL RADIATION EXPOSURE FOR MEDICAL WORKERS IN RADIOLOGY AND CARDIOLOGY IN THE UNITED ARAB EMIRATES: NINE HOSPITALS EXPERIENCE. RADIATION PROTECTION DOSIMETRY 2020; 189:466-474. [PMID: 32424394 DOI: 10.1093/rpd/ncaa060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/17/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Occupational radiation exposure for medical workers in radiology and cardiology was analyzed in nine hospitals in the UAE between 2002 and 2016. The purpose of the study was to determine the time trend and the differences in occupational radiation exposure among worker groups and hospitals in the country. METHODS Readings of 5700 thermoluminescence dosimeters (TLDs) were obtained from 1011 medical workers and grouped into 5 worker groups (radiographers, diagnostic radiologists, nurses, cardiologists and physicians). RESULTS The mean annual effective dose was from 0.38 to 0.62 mSv per worker. Even though an increase in the collective effective dose has been noticed during the study period, no significant time trend was observed in the mean effective dose. Furthermore, cardiologists received higher mean and maximum effective doses than the other worker groups. CONCLUSION The annual effective doses were below the limits set by national legislation and international standards, and for the average worker, the likelihood of high exposure is small. However, improvements in radiation protection practices could be implemented to reduce occupational radiation dose to cardiologists, who were the most exposed worker group in this study.
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Affiliation(s)
- Wiam Elshami
- Medical Diagnostic Imaging Department, College of Health Science, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohamed Abuzaid
- Medical Diagnostic Imaging Department, College of Health Science, University of Sharjah, Sharjah, United Arab Emirates
| | - Antti Pekkarinen
- Kymsote Radiotherapy and Oncology, Kymenlaakso Central Hospital, Kotka, Finland
- Department of Physics, University of Helsinki, Helsinki, Finland
- HUS Medical Imaging Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Mika Kortesniemi
- HUS Medical Imaging Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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Borrego D, Kitahara CM, Balter S, Yoder C. Occupational Doses to Medical Staff Performing or Assisting with Fluoroscopically Guided Interventional Procedures. Radiology 2020; 294:353-359. [PMID: 31769743 PMCID: PMC6996708 DOI: 10.1148/radiol.2019190018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022]
Abstract
Background Staff who perform fluoroscopically guided interventional (FGI) procedures are among the most highly radiation-exposed groups in medicine. However, there are limited data on monthly or annual doses (or dose trends over time) for these workers. Purpose To summarize occupational badge doses (lens dose equivalent and effective dose equivalent values) for medical staff performing or assisting with FGI procedures in 3 recent years after accounting for uninformative values and one- versus two-badge monitoring protocol. Materials and Methods Badge dose entries of medical workers believed to have performed or assisted with FGI procedures were retrospectively collected from the largest dosimetry provider in the United States for 49 991, 81 561, and 125 669 medical staff corresponding to years 2009, 2012, and 2015, respectively. Entries judged to be uninformative of occupational doses to FGI procedures staff were excluded. Monthly and annual occupational doses were described using summary statistics. Results After exclusions, 22.2% (153 033 of 687 912) of the two- and 32.9% (450 173 of 1 366 736) of the one-badge entries were judged to be informative. There were 335 225 and 916 563 of the two- and one-badge entries excluded, respectively, with minimal readings in the above-apron badge. Among the two-badge entries, 123 595 were incomplete and 76 059 had readings indicating incorrect wear of the badges. From 2009 to 2015 there was no change in lens dose equivalent values among workers who wore one badge (P = .96) or those who wore two badges (P = .23). Annual lens dose equivalents for workers wearing one badge (median, 6.9 mSv; interquartile range, 3.8213.8 mSv; n = 6218) were similar to those of staff wearing two badges (median, 7.1 mSv; interquartile range, 4.6-11.2 mSv; n = 1449) (P = .18), suggesting a similar radiation environment. Conclusion These workers are among the highest exposed to elevated levels of ionizing radiation, although their occupational doses are within U.S. regulatory limits. This is a population that requires consistent and accurate dose monitoring; however, failure to return one or both badges, reversal of badges, and improper badge placement are a major hindrance to this goal. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Karellas in this issue.
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Affiliation(s)
- David Borrego
- From the Radiation Epidemiology Branch, Division of Cancer
Epidemiology and Genetics, National Cancer Institute, National Institutes of
Health, 9609 Medical Center Dr, Bethesda, MD 20892-9778 (D.B., C.M.K.);
Departments of Radiology and Medicine, Columbia University Medical Center, New
York, NY (S.B.); and Independent consultant, Weddington, NC (C.Y.)
| | - Cari M. Kitahara
- From the Radiation Epidemiology Branch, Division of Cancer
Epidemiology and Genetics, National Cancer Institute, National Institutes of
Health, 9609 Medical Center Dr, Bethesda, MD 20892-9778 (D.B., C.M.K.);
Departments of Radiology and Medicine, Columbia University Medical Center, New
York, NY (S.B.); and Independent consultant, Weddington, NC (C.Y.)
| | - Stephen Balter
- From the Radiation Epidemiology Branch, Division of Cancer
Epidemiology and Genetics, National Cancer Institute, National Institutes of
Health, 9609 Medical Center Dr, Bethesda, MD 20892-9778 (D.B., C.M.K.);
Departments of Radiology and Medicine, Columbia University Medical Center, New
York, NY (S.B.); and Independent consultant, Weddington, NC (C.Y.)
| | - Craig Yoder
- From the Radiation Epidemiology Branch, Division of Cancer
Epidemiology and Genetics, National Cancer Institute, National Institutes of
Health, 9609 Medical Center Dr, Bethesda, MD 20892-9778 (D.B., C.M.K.);
Departments of Radiology and Medicine, Columbia University Medical Center, New
York, NY (S.B.); and Independent consultant, Weddington, NC (C.Y.)
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Badel AE, Rico-Mesa JS, Gaviria MC, Arango-Isaza D, Hernández Chica CA. Radiación ionizante: revisión de tema y recomendaciones para la práctica. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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16
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Linet MS, Kitahara CM, Ntowe E, Kleinerman RA, Gilbert ES, Naito N, Lipner RS, Miller DL, Berrington de Gonzalez A. Mortality in U.S. Physicians Likely to Perform Fluoroscopy-guided Interventional Procedures Compared with Psychiatrists, 1979 to 2008. Radiology 2017; 284:482-494. [PMID: 28234559 DOI: 10.1148/radiol.2017161306] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose To compare total and cause-specific mortality rates between physicians likely to have performed fluoroscopy-guided interventional (FGI) procedures (referred to as FGI MDs) and psychiatrists to determine if any differences are consistent with known radiation risks. Materials and Methods Mortality risks were compared in nationwide cohorts of 45 634 FGI MDs and 64 401 psychiatrists. Cause of death was ascertained from the National Death Index. Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for FGI MDs versus psychiatrists, with adjustment (via stratification) for year of birth and attained age. Results During follow-up (1979-2008), 3506 FGI MDs (86 women) and 7814 psychiatrists (507 women) died. Compared with psychiatrists, FGI MDs had lower total (men: RR, 0.80 [95% CI: 0.77, 0.83]; women: RR, 0.80 [95% CI: 0.63, 1.00]) and cancer (men: RR, 0.92 [95% CI: 0.85, 0.99]; women: RR, 0.83 [95% CI: 0.58, 1.18]) mortality. Mortality because of specific types of cancer, total and specific types of circulatory diseases, and other causes were not elevated in FGI MDs compared with psychiatrists. On the basis of small numbers, leukemia mortality was elevated among male FGI MDs who graduated from medical school before 1940 (RR, 3.86; 95% CI: 1.21, 12.3). Conclusion Overall, total deaths and deaths from specific causes were not elevated in FGI MDs compared with psychiatrists. These findings require confirmation in large cohort studies with individual doses, detailed work histories, and extended follow-up of the subjects to substantially older median age at exit. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Martha S Linet
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, NCI Shady Grove, 9609 Medical Center Dr, Room 7E452, Bethesda, MD 20892-9778 (M.S.L., C.M.K., E.N., R.A.K., E.S.G., A.B.d.G.); Retired, U.S. Navy, Washington, DC (N.N.); American Board of Internal Medicine, Philadelphia, Pa (R.S.L.); and Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M.). Members of the Multi-Specialty Occupational Health Group are listed at the end
| | - Cari M Kitahara
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, NCI Shady Grove, 9609 Medical Center Dr, Room 7E452, Bethesda, MD 20892-9778 (M.S.L., C.M.K., E.N., R.A.K., E.S.G., A.B.d.G.); Retired, U.S. Navy, Washington, DC (N.N.); American Board of Internal Medicine, Philadelphia, Pa (R.S.L.); and Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M.). Members of the Multi-Specialty Occupational Health Group are listed at the end
| | - Estelle Ntowe
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, NCI Shady Grove, 9609 Medical Center Dr, Room 7E452, Bethesda, MD 20892-9778 (M.S.L., C.M.K., E.N., R.A.K., E.S.G., A.B.d.G.); Retired, U.S. Navy, Washington, DC (N.N.); American Board of Internal Medicine, Philadelphia, Pa (R.S.L.); and Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M.). Members of the Multi-Specialty Occupational Health Group are listed at the end
| | - Ruth A Kleinerman
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, NCI Shady Grove, 9609 Medical Center Dr, Room 7E452, Bethesda, MD 20892-9778 (M.S.L., C.M.K., E.N., R.A.K., E.S.G., A.B.d.G.); Retired, U.S. Navy, Washington, DC (N.N.); American Board of Internal Medicine, Philadelphia, Pa (R.S.L.); and Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M.). Members of the Multi-Specialty Occupational Health Group are listed at the end
| | - Ethel S Gilbert
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, NCI Shady Grove, 9609 Medical Center Dr, Room 7E452, Bethesda, MD 20892-9778 (M.S.L., C.M.K., E.N., R.A.K., E.S.G., A.B.d.G.); Retired, U.S. Navy, Washington, DC (N.N.); American Board of Internal Medicine, Philadelphia, Pa (R.S.L.); and Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M.). Members of the Multi-Specialty Occupational Health Group are listed at the end
| | - Neal Naito
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, NCI Shady Grove, 9609 Medical Center Dr, Room 7E452, Bethesda, MD 20892-9778 (M.S.L., C.M.K., E.N., R.A.K., E.S.G., A.B.d.G.); Retired, U.S. Navy, Washington, DC (N.N.); American Board of Internal Medicine, Philadelphia, Pa (R.S.L.); and Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M.). Members of the Multi-Specialty Occupational Health Group are listed at the end
| | - Rebecca S Lipner
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, NCI Shady Grove, 9609 Medical Center Dr, Room 7E452, Bethesda, MD 20892-9778 (M.S.L., C.M.K., E.N., R.A.K., E.S.G., A.B.d.G.); Retired, U.S. Navy, Washington, DC (N.N.); American Board of Internal Medicine, Philadelphia, Pa (R.S.L.); and Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M.). Members of the Multi-Specialty Occupational Health Group are listed at the end
| | - Donald L Miller
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, NCI Shady Grove, 9609 Medical Center Dr, Room 7E452, Bethesda, MD 20892-9778 (M.S.L., C.M.K., E.N., R.A.K., E.S.G., A.B.d.G.); Retired, U.S. Navy, Washington, DC (N.N.); American Board of Internal Medicine, Philadelphia, Pa (R.S.L.); and Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M.). Members of the Multi-Specialty Occupational Health Group are listed at the end
| | - Amy Berrington de Gonzalez
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, NCI Shady Grove, 9609 Medical Center Dr, Room 7E452, Bethesda, MD 20892-9778 (M.S.L., C.M.K., E.N., R.A.K., E.S.G., A.B.d.G.); Retired, U.S. Navy, Washington, DC (N.N.); American Board of Internal Medicine, Philadelphia, Pa (R.S.L.); and Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M.). Members of the Multi-Specialty Occupational Health Group are listed at the end
| | -
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, NCI Shady Grove, 9609 Medical Center Dr, Room 7E452, Bethesda, MD 20892-9778 (M.S.L., C.M.K., E.N., R.A.K., E.S.G., A.B.d.G.); Retired, U.S. Navy, Washington, DC (N.N.); American Board of Internal Medicine, Philadelphia, Pa (R.S.L.); and Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M.). Members of the Multi-Specialty Occupational Health Group are listed at the end
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Sánchez RM, Vano E, Fernández JM, Pifarré X, Ordiales JM, Rovira JJ, Carrera F, Goicolea J, Fernández-Ortiz A. Occupational eye lens doses in interventional cardiology. A multicentric study. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:133-143. [PMID: 26861214 DOI: 10.1088/0952-4746/36/1/133] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
New European regulation regarding radiological protection of workers and more specifically the new occupational dose limit for the eye lens recently reduced to 20 mSv yr(-1) may affect interventional cardiologists. This paper presents a set of measurements of occupational doses performed in five interventional cardiology centres and then compared with the new dose limit. The measurement of occupational doses was performed over the apron at chest level using electronic dosemeters recording H p(10). In one of the centres, scatter dose at goggles was also measured with optically stimulated luminescence dosemeters calibrated in terms of H p(0.07). An average H p(10) over the apron of 46 μSv/procedure was measured for cardiologists. Lower doses were noted in other professionals like second cardiologists, nurses or anaesthetists. Procedures for valvular and other structural heart diseases involved the highest occupational doses, averaging over 100 μSv/procedure. Important differences in occupational doses among centres may be indicative of different radiation protection habits. The new occupational dose limit for the eye lens is likely to be exceeded by those among the interventionalists who do not use protection tools (ceiling suspended screen and/or goggles) even with standard workloads.
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Affiliation(s)
- R M Sánchez
- Medical Physics, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
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19
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Rehani MM, Gupta R, Bartling S, Sharp GC, Pauwels R, Berris T, Boone JM. Radiological Protection in Cone Beam Computed Tomography (CBCT). ICRP Publication 129. Ann ICRP 2015; 44:9-127. [PMID: 26116562 DOI: 10.1177/0146645315575485] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of this publication is to provide guidance on radiological protection in the new technology of cone beam computed tomography (CBCT). Publications 87 and 102 dealt with patient dose management in computed tomography (CT) and multi-detector CT. The new applications of CBCT and the associated radiological protection issues are substantially different from those of conventional CT. The perception that CBCT involves lower doses was only true in initial applications. CBCT is now used widely by specialists who have little or no training in radiological protection. This publication provides recommendations on radiation dose management directed at different stakeholders, and covers principles of radiological protection, training, and quality assurance aspects. Advice on appropriate use of CBCT needs to be made widely available. Advice on optimisation of protection when using CBCT equipment needs to be strengthened, particularly with respect to the use of newer features of the equipment. Manufacturers should standardise radiation dose displays on CBCT equipment to assist users in optimisation of protection and comparisons of performance. Additional challenges to radiological protection are introduced when CBCT-capable equipment is used for both fluoroscopy and tomography during the same procedure. Standardised methods need to be established for tracking and reporting of patient radiation doses from these procedures. The recommendations provided in this publication may evolve in the future as CBCT equipment and applications evolve. As with previous ICRP publications, the Commission hopes that imaging professionals, medical physicists, and manufacturers will use the guidelines and recommendations provided in this publication for implementation of the Commission's principle of optimisation of protection of patients and medical workers, with the objective of keeping exposures as low as reasonably achievable, taking into account economic and societal factors, and consistent with achieving the necessary medical outcomes.
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20
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Vano E. Occupational radiation protection of health workers in imaging. RADIATION PROTECTION DOSIMETRY 2015; 164:126-129. [PMID: 25480840 DOI: 10.1093/rpd/ncu354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Occupational radiological protection (RP) is still a challenge in several clinical practices. ICRP has included specific recommendations and advice for occupational protection in most of the documents published in recent years and its current programme of work includes the preparation of documents with specific contents on Occupational Protection. Different professional groups and different medical specialists need dedicated training, supervision and advice to optimise their practices. Many medical specialties outside the imaging departments are still using fluoroscopically guided procedures in surgical theatres without the appropriate RP tools. In addition to the stochastic radiation risks, the new thresholds for tissue reactions proposed by ICRP, and especially the ones for the lens of the eyes and the cerebrovascular system, are a matter of concern for some groups of health workers. More support from medical physics and radiation protection experts regarding occupational issues in the medical field will be needed in the coming years.
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Affiliation(s)
- E Vano
- Radiology Department, Medicine Faculty, Complutense University and IdISSC San Carlos Hospital, Madrid 28040, Spain
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21
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Occupational Radiation Protection of Pregnant or Potentially Pregnant Workers in IR: A Joint Guideline of the Society of Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2015; 26:171-81. [DOI: 10.1016/j.jvir.2014.11.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/20/2014] [Indexed: 12/17/2022] Open
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23
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Ubeda C, Vano E, Gonzalez L, Miranda P, Valenzuela E, Vergara F, Guarda E. Evaluation of patient doses and lens radiation doses to interventional cardiologists in a nationwide survey in Chile. RADIATION PROTECTION DOSIMETRY 2013; 157:36-43. [PMID: 23740814 DOI: 10.1093/rpd/nct118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objective of this study was to perform a nationwide survey in Chile to determine dose levels to patients and staff in four risk scenarios during cardiac catheterisation procedures. Different phantom thicknesses of polymethyl methacrylate (PMMA) were used to simulate adult patients. Scenario 1: 10-min fluoroscopy and 800 cine frames for 20 cm of PMMA; Scenario 2: 10-min fluoroscopy and 800 cine frames for 28 cm of PMMA; Scenario 3: 30-min fluoroscopy and 2400 cine frames for 20 cm of PMMA; Scenario 4: 30-min fluoroscopy and 2400 cine frames for 28 cm of PMMA. The average values regarding dose-area product and scattered doses at the cardiologist eye lens achieved for the four scenarios were 94, 249, 281, 747 Gy cm(2) and 0.3, 0.8, 0.9 and 2.5 mSv, respectively. Large variations in radiation doses received by both patients and staff for the same type of procedure suggest that optimising procedure protocols and using the most effective types of protective devices may substantially reduce the dose values found here.
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Affiliation(s)
- Carlos Ubeda
- Medical Technology Department, Study Center in Radiological Sciences (CECRAD), Health Sciences Faculty and CHIDE, Tarapaca University, Arica, Chile
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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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Vañó E, Fernández JM, Sánchez RM, Dauer LT. Realistic approach to estimate lens doses and cataract radiation risk in cardiology when personal dosimeters have not been regularly used. HEALTH PHYSICS 2013; 105:330-339. [PMID: 23982609 DOI: 10.1097/hp.0b013e318299b5d9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Interventional fluoroscopic guided cardiac procedures lead to radiation exposure to the lenses of the eyes of cardiologists, which over time may be associated with an increased risk of cataracts. This study derives radiation doses to the lens of the eye in cardiac catheterization laboratories from measurements of individual procedures to allow for estimates of such doses for those cases when personal dosimeters have not been used regularly. Using active electronic dosimeters at the C-arm (at 95 cm from the isocenter), scatter radiation doses have been measured for cardiac procedures and estimated radiation doses to the lenses of the cardiologists for different groups of procedures (diagnostic, PTCAs, and valvular). Correlation factors with kerma area product included in the patient dose reports have been derived. The mean, median, and third quartile scatter dose values per procedure at the C-arm for 1,969 procedures were 0.99, 0.78 and 1.25 mSv, respectively; for coronary angiography, 0.51, 0.45, and 0.61 mSv, respectively; for PTCAs, 1.29, 1.07, and 1.56 mSv; and for valvular procedures, 1.64, 1.45, and 2.66 mSv, respectively. For all the procedures, the ratio between the scatter dose at the C-arm and the kerma area product resulted in between 10.3-11.3 μSv Gy cm. The experimental results of this study allow for realistic estimations of the dose to the lenses of the eyes from the workload of the cardiologists and from the level of use of radiation protection tools when personal dosimeters have not been regularly used.
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Affiliation(s)
- Eliseo Vañó
- Medical Physics Service, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.
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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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Cousins C, Miller DL, Bernardi G, Rehani MM, Schofield P, Vañó E, Einstein AJ, Geiger B, Heintz P, Padovani R, Sim KH. ICRP PUBLICATION 120: Radiological protection in cardiology. Ann ICRP 2013; 42:1-125. [PMID: 23141687 DOI: 10.1016/j.icrp.2012.09.001] [Citation(s) in RCA: 234] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiac nuclear medicine, cardiac computed tomography (CT), interventional cardiology procedures, and electrophysiology procedures are increasing in number and account for an important share of patient radiation exposure in medicine. Complex percutaneous coronary interventions and cardiac electrophysiology procedures are associated with high radiation doses. These procedures can result in patient skin doses that are high enough to cause radiation injury and an increased risk of cancer. Treatment of congenital heart disease in children is of particular concern. Additionally, staff(1) in cardiac catheterisation laboratories may receive high doses of radiation if radiological protection tools are not used properly. The Commission provided recommendations for radiological protection during fluoroscopically guided interventions in Publication 85, for radiological protection in CT in Publications 87 and 102, and for training in radiological protection in Publication 113 (ICRP, 2000b,c, 2007a, 2009). This report is focused specifically on cardiology, and brings together information relevant to cardiology from the Commission's published documents. There is emphasis on those imaging procedures and interventions specific to cardiology. The material and recommendations in the current document have been updated to reflect the most recent recommendations of the Commission. This report provides guidance to assist the cardiologist with justification procedures and optimisation of protection in cardiac CT studies, cardiac nuclear medicine studies, and fluoroscopically guided cardiac interventions. It includes discussions of the biological effects of radiation, principles of radiological protection, protection of staff during fluoroscopically guided interventions, radiological protection training, and establishment of a quality assurance programme for cardiac imaging and intervention. As tissue injury, principally skin injury, is a risk for fluoroscopically guided interventions, particular attention is devoted to clinical examples of radiation-related skin injuries from cardiac interventions, methods to reduce patient radiation dose, training recommendations, and quality assurance programmes for interventional fluoroscopy.
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Reduction of Exposure of Patients and Staff to Radiation During Fluoroscopically Guided Interventional Procedures. CURRENT RADIOLOGY REPORTS 2012. [DOI: 10.1007/s40134-012-0001-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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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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Picano E, Vano E. The radiation issue in cardiology: the time for action is now. Cardiovasc Ultrasound 2011; 9:35. [PMID: 22104562 PMCID: PMC3256101 DOI: 10.1186/1476-7120-9-35] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 11/21/2011] [Indexed: 02/07/2023] Open
Abstract
The "radiation issue" is the need to consider possible deterministic effects (e.g., skin injuries) and long-term cancer risks due to ionizing radiation in the risk-benefit assessment of diagnostic or therapeutic testing. Although there are currently no data showing that high-dose medical studies have actually increased the incidence of cancer, the "linear-no threshold" model in radioprotection assumes that no safe dose exists; all doses add up in determining cancer risks; and the risk increases linearly with increasing radiation dose. The possibility of deterministic effects should also be considered when skin or lens doses may be over the threshold. Cardiologists have a special mission to avoid unjustified or non-optimized use of radiation, since they are responsible for 45% of the entire cumulative effective dose of 3.0 mSv (similar to the radiological risk of 150 chest x-rays) per head per year to the US population from all medical sources except radiotherapy. In addition, interventional cardiologists have an exposure per head per year two to three times higher than that of radiologists. The most active and experienced interventional cardiologists in high volume cath labs have an annual exposure equivalent to around 5 mSv per head and a professional lifetime attributable to excess cancer risk on the order of magnitude of 1 in 100. Cardiologists are the contemporary radiologists but sometimes imperfectly aware of the radiological dose of the examination they prescribe or practice, which can range from the equivalent of 1-60 mSv around a reference dose average of 10-15 mSv for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multi-detector coronary angiography, or a myocardial perfusion imaging scintigraphy. A good cardiologist cannot be afraid of life-saving radiation, but must be afraid of radiation unawareness and negligence.
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Affiliation(s)
| | - Eliseo Vano
- Institute of Clinical Physiology, CNR, Pisa, Italy
- San Carlos University Hospital, Complutense University of Madrid, Madrid, Spain
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Ciraj-Bjelac O, Rehani MM, Sim KH, Liew HB, Vano E, Kleiman NJ. Risk for radiation-induced cataract for staff in interventional cardiology: is there reason for concern? Catheter Cardiovasc Interv 2011; 76:826-34. [PMID: 20549683 DOI: 10.1002/ccd.22670] [Citation(s) in RCA: 233] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To examine the prevalence of radiation-associated lens opacities among interventional cardiologists and nurses and correlate with occupational radiation exposure. BACKGROUND Interventional cardiology personnel are exposed to relatively high levels of X-rays and based on recent findings of radiation-associated lens opacities in other cohorts, they may be at risk for cataract without use of ocular radiation protection. METHODS Eyes of interventional cardiologists, nurses, and age- and sex-matched unexposed controls were screened by dilated slit lamp examination and posterior lens changes graded using a modified Merriam-Focht technique. Individual cumulative lens X-ray exposure was calculated from responses to a questionnaire and personal interview. RESULTS The prevalence of radiation-associated posterior lens opacities was 52% (29/56, 95% CI: 35-73) for interventional cardiologists, 45% (5/11, 95% CI: 15-100) for nurses, and 9% (2/22, 95% CI: 1-33) for controls. Relative risks of lens opacity was 5.7 (95% CI: 1.5-22) for interventional cardiologists and 5.0 (95% CI: 1.2-21) for nurses. Estimated cumulative ocular doses ranged from 0.01 to 43 Gy with mean and median values of 3.4 and 1.0 Gy, respectively. A strong dose-response relationship was found between occupational exposure and the prevalence of radiation-associated posterior lens changes. CONCLUSIONS These findings demonstrate a dose dependent increased risk of posterior lens opacities for interventional cardiologists and nurses when radiation protection tools are not used. While study of a larger cohort is needed to confirm these findings, the results suggest ocular radio-protection should be utilized.
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