Eye lens dose in interventional cardiology

Medical staff dose estimation during pediatric cardiac interventional procedures

The purpose of this study is to evaluate the occupational doses (eye lens, extremities and whole body) in paediatric cardiac interventional and diagnostic catheterization procedures performed in a paediatric reference hospital located in Recife, Pernambuco. For eye lens dosimetry, the results show that the left eye receives a higher dose than the right eye, and there is a small difference between the doses received during diagnostic (D) and therapeutic (T) procedures. The extrapolated annual values for the most exposed eye are close to the annual limit. For doses to the hands, it was observed that in a significant number of procedures (37 out of 45 therapeutic procedures, or 82%) at least one hand of the physician was exposed to the primary beam. During diagnostic procedures, the physician's hand was in the radiation field in 11 of the 17 catheterization procedures (65%). This resulted in a 10-fold increase in dose to the hands. The results underscore the need for optimization of radiation safety and continued efforts to engage staff in a radiation safety culture.

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

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

Radiation exposure in augmented fluoroscopic bronchoscopy procedures: a comprehensive analysis for patients and physicians

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.

A practical method for routine eye lens dosimetry of staff in interventional radiology

Hospital staff doing fluoroscopy-guided interventions receive the highest doses and are at risk of exceeding the new occupational eye lens dose limit of 20 mSv. Since the introduction of the new limit in the International Commission on Radiological Protection recommendations different eye lens dose monitoring techniques have been tested on phantoms. This study uses real-life dose data to assess the need for routine eye lens dose monitoring. The correlation of eye lens dose and Hp (10) measured with a whole-body dosemeter above the lead apron was investigated as an alternative to dedicated eye lens dosimetry. A survey taken among the medical personnel allowed to determine the preferred method for measuring eye lens doses in daily practice.

Eye Lens Radiation Dose to Nurses during Cardiac Interventional Radiology: An Initial Study

Although interventional radiology (IVR) is preferred over surgical procedures because it is less invasive, it results in increased radiation exposure due to long fluoroscopy times and the need for frequent imaging. Nurses engaged in cardiac IVR receive the highest lens radiation doses among medical workers, after physicians. Hence, it is important to measure the lens exposure of IVR nurses accurately. Very few studies have evaluated IVR nurse lens doses using direct dosimeters. This study was conducted using direct eye dosimeters to determine the occupational eye dose of nurses engaged in cardiac IVR, and to identify simple and accurate methods to evaluate the lens dose received by nurses. Over 6 months, in a catheterization laboratory, we measured the occupational dose to the eyes (3 mm dose equivalent) and neck (0.07 mm dose equivalent) of nurses on the right and left sides. We investigated the relationship between lens and neck doses, and found a significant correlation. Hence, it may be possible to estimate the lens dose from the neck badge dose. We also evaluated the appropriate position (left or right) of eye dosimeters for IVR nurses. Although there was little difference between the mean doses to the right and left eyes, that to the right eye was slightly higher. In addition, we investigated whether it is possible to estimate doses received by IVR nurses from patient dose parameters. There were significant correlations between the measured doses to the neck and lens, and the patient dose parameters (fluoroscopy time and air kerma), implying that these parameters could be used to estimate the lens dose. However, it may be difficult to determine the lens dose of IVR nurses accurately from neck badges or patient dose parameters because of variation in the behaviors of nurses and the procedure type. Therefore, neck doses and patient dose parameters do not correlate well with the radiation eye doses of individual IVR nurses measured by personal eye dosimeters. For IVR nurses with higher eye doses, more accurate measurement of the radiation doses is required. We recommend that a lens dosimeter be worn near the eyes to measure the lens dose to IVR nurses accurately, especially those exposed to relatively high doses.

Fluoroscopically guided vascular and cardiac transcatheter procedures: a comparison of occupational and patient dose by anatomical region

X-ray guided procedures are being performed by an increasing variety of medical specialties. Due to improvements in vascular transcatheter therapies, there is an increasing overlap of imaged anatomy between medical specialties. There is concern that non-radiology fluoroscopic operators may not have sufficient training to be well informed of the potential implications of radiation exposure and mitigation strategies to reduce dose. This was a prospective, observational, single center study to compare occupational and patient dose levels when imaging different anatomical regions during fluoroscopically guided cardiac and endovascular procedures. Occupational radiation dose was measured at the level of the temple of 24 cardiologists and 3 vascular surgeons (n = 1369), 32 scrub nurses (n = 1307) and 35 circulating nurses (n = 885). The patient dose was recorded for procedures (n = 1792) performed in three angiography suites. Abdominal imaging during endovascular aneurysm repair (EVAR) procedures was associated with a comparatively high average patient, operator and scrub nurse dose despite additional table-mounted lead shields. Air kerma was relatively high for procedures performed in the chest, and chest + pelvis. Higher dose area product and staff eye dose were recorded during procedures of the chest + pelvis due to the use of digital subtraction angiography to evaluate access route prior to/during transaortic valve implantation. Scrub nurses were exposed to higher average radiation levels than the operator during some procedures. Staff should be cognizant of the potentially higher radiation burden to patients and exposed personnel during EVAR procedures and cardiac procedures using digital subtraction angiography.

Surgeon eye lens dose monitoring in interventional neuroradiology, cardiovascular and radiology procedures

PURPOSE

This study investigated the radiation dose to surgeon eye lens for single procedure and normalised to exposure parameters for eight selected neuroradiology, cardiovascular and radiology interventional procedures.

METHODS

The procedures investigated were diagnostic study, Arteriovenous Malformations treatment (AVM) and aneurysm embolization for neuroradiology procedures, Coronary Angiography and Percutaneous Transluminal Coronary Angioplasty (CA-PTCA), Pacemaker and Implantable Cardioverter-Defibrillator implantation (PM-ICD), Endovascular Aortic Repair (EVAR) and Fenestrated Endovascular Aortic Repair (FEVAR) for cardiovascular and electrophysiology procedures. CT-guided lung biopsy was also monitored. All procedures were performed with table-mounted and ceiling-suspended shields (0.5 mm lead equivalent thickness), except for FEVAR and PM-ICD where only a table mounted shield was present, and CT-guided lung biopsy where no shield was used. Dose assessment was performed using a dosemeter positioned close to the most exposed eye of the surgeon, outside the protective eyewear.

RESULTS

The surgeon most exposed eye lens median H_p(3) equivalent dose for a single procedure, without protective eyewear contribution, was 18 μSv for neuroradiology diagnostic study, 62 μSv for AVM, 38 μSv for aneurysm embolization, 33 μSv for CA-PTCA, 39 μSv for PM-ICD, 49 μSv for EVAR, 2500 μSv for FEVAR, 153 μSv for CT-guided lung biopsy.

CONCLUSIONS

In interventional procedures, the 20 mSv/year dose limit for surgeon eye lens exposure might be exceeded if shields or protective eyewear are not used. Surgeon eye lens doses, normalised to single procedures and to exposure parameters, are a valuable tool for determining appropriate radiation protection measures and dedicated eye lens dosemeter assignment.

Assessment of Occupational Exposure to Eye Lens Dosimetry for Interventional Radiology Workers in China during 2017-2019

ABSTRACT

The eye lens is a sensitive tissue to ionizing radiation and recently has been recognized as more radiosensitive than previously considered. The International Commission on Radiological Protection (ICRP) has recommended a considerable reduction in the equivalent dose limit of eye lens from 150 mSv y -1 to 20 mSv y -1 , averaged over a defined period of 5 y. In this paper, the eye lens dose of interventional radiology workers in China during 2017-2019 is analyzed to understand the current status of eye lens occupational exposure and to provide decision-making suggestions for health supervision departments using data obtained from the National Radiological Health Information Platform in China. A total of 3,026 eye lens dose records of interventional radiology workers were collected. The average annual eye lens dose (AAELD) for interventional radiology workers ranged from 1.07 to 1.51 mSv during 2017-2019 and was 1.44 mSv for all monitored interventional radiology workers, with 2,973 records (98.2%) lower than the public limit of 15 mSv and 33 records (1.1%) exceeding the newly revised occupational eye lens dose limit of 20 mSv y -1 . During the period of 2017-2019, the AAELDs of interventional radiologists (1.61 mSv) and of interventional cardiologists (1.59 mSv) were significantly higher than that of other interventional workers (0.62 mSv); the AAELD of doctors (1.50 mSv) was significantly higher than that of nurses (1.01 mSv); the AAELD of western China (2.00 mSv) was significantly higher than that of eastern (1.11 mSv) and central China (1.27 mSv); and the AAELD of males (1.59 mSv) was significantly higher than that of females (0.84 mSv). The eye lens dose of interventional radiology workers meets the Chinese standard limit of 150 mSv y -1 , while some cases exceed the one recommended by ICRP. The study shows that the interventional radiology workers' eye lens dosimetry data complied with the existing Chinese eye lens dose limits. However, education, training, and supervision of radiation protection also should be strengthened continuously for interventional radiology workers, especially for the interventional radiologists and interventional cardiologists. Significant attention should be paid to the radiation protection of underdeveloped regions in China in future works.

Assessment of Occupational Exposure in Medical Practice in the Region of Hohhot, China, for the Period 2004-2020

ABSTRACT

Individual monitoring is of great significance in efforts to protect the health of radiation workers and improve the level of radiation protection and management. This paper presents a retrospective analysis of occupational exposure to ionizing radiation from medical practice in the region of Hohhot, China, from 2004 to 2020. Results show that the average annual effective dose of occupationally exposed workers in medical practice significantly declined from 1.44 mSv in 2005 to 0.29 mSv in 2020 (Z = -5.23, P < 0.05). The number of medical radiation workers increased by 181%, the composition of radiation workers whose average annual effective dose exceeded 1 mSv decreased, and the number of radiation workers whose average annual effective dose was less than or equal to the minimum detection level (MDL) increased yearly over the 17-y study period. It was found that the dose of 1.106 mSv received by workers in interventional radiology is significantly higher than the doses of 0.52 mSv in dental radiology, 0.47 mSv in radiotherapy, and 0.33 mSv in all other medical uses (Z = 3.71, 9.13, 5.93, respectively; P < 0.05). The distribution ratios of workers in nuclear medicine and interventional radiology whose annual individual effective dose exceeded 5 mSv were 0.040 and 0.043, respectively, which are significantly higher than those in other occupational categories (χ2 = 307.11, P < 0.05). It was also shown that the average annual effective dose of 0.67 mSv in interventional radiology is significantly higher than that of 0.17 mSv in radiotherapy (Z = 3.39, P < 0.05) in 2020. According to these observations, the exposure of radiation workers in medical practice in Hohhot meets the requirements of the China standard. This study shows that the status of radiation workers in medical practice has obviously improved during the period 2004-2020. However, it is still necessary to focus on the protection of groups with high occupational exposure risk, and the continuous improvement of protection measures, monitoring means, and radiation workers' training, especially for the workers in the fields of interventional radiology and nuclear medicine.

Radiation dose to nurses, cardiologists, and patients during coronary angiography: a comparison of femoral and radial access

BACKGROUND

Exposure to radiation during fluoroscopically guided cardiac procedures is a cause for concern for both the patient and staff.

AIMS

This study sought to compare the occupational and patient radiation dose during femoral and radially accessed invasive coronary angiography (CA).

METHODS AND RESULTS

Occupational dose (µSv) was measured at the left temple of the cardiologist (n = 17), scrub (n = 27), and circulator nurse (n = 27) during 761 femoral and 671 radially accessed diagnostic coronary angiograms and percutaneous coronary intervention (PCI) procedures. Patient dose parameters of dose area product (DAP) (Gy.cm2) and air kerma (AK) (Gy) were also measured. Coronary angiography performed via the radial artery is associated with greater mean dose to the cardiologist, with the exception of procedures including only PCI. Results demonstrated that scrub nurses are exposed to higher mean doses than the cardiologist when using femoral access and similar doses during radial cases. Both AK and DAP were associated with a higher average dose for femoral PCI than radial, with DAP being significantly higher.

CONCLUSIONS

Awareness of factors that increase the dose to staff and patients is vital to inform and improve practice. This study has demonstrated that access route during diagnostic CA and PCI influences both patient and staff dose. Radiation dose to in-room staff other than the fluoroscopic operator should be a focus of future research. In addition, all staff present during X-ray guided procedures should be provided with radiation education and adopt dose minimization strategies to reduce occupational exposures.

ASSESSMENT OF WHOLE BODY, SKIN AND EYE LENS DOSES OF THE INTERVENTIONAL RADIOLOGISTS AT SELECTED HOSPITALS IN IRAN

High radiation doses to the body may lead to the stochastic/deterministic effects of ionizing radiation on the critical organs as well as causing the cataract in eye lens of the clinical staff in interventional radiology. In this study, the received doses of the eyes, skin and whole body of 38 clinical staff including physicians, residents, nurses and radiotechnologists in cardiac angiography departments in three selected hospitals were assessed using personal dosemeters during two bimonthly dosimetry periods. Moreover, the correlation coefficients among the measured dose components including eye lens dose, skin dose and whole body dose equivalent in both area of under and over their lead-apron were calculated for all these occupational groups. The results show that the occupational annual dose values of the clinical staff are below the annual dose limits recommended by International Commission on Radiation Protection. Furthermore, among the measured dose components, the highest correlation coefficient value was obtained between the eye lens dose and personal dose equivalent measured over the lead apron for all the occupational groups.

Occupational doses to the eye lens in pediatric and adult noncardiac interventional radiology procedures

PURPOSE

To assess occupational lens exposure in a mixed interventional radiology department, comparing pediatric and adult procedures. To analyze the correlation between the lens dose and the doses measured at the chest and collar level and the kerma-area product (P_KA ).

METHODS

For 17 months, three radiologists performing both pediatric and adult interventions were monitored by means of 14 dosimeters per worker: 12 single-point optically stimulated luminescent (OSL) dosimeters calibrated in terms of H_p (0.07) were placed on the inside and outside of two pairs of lead glasses, one for pediatric procedures and one for adult interventions; another whole-body OSL dosimeter calibrated in terms of H_p (10) was placed over the thyroid shield; finally, an additional active solid-state dosimeter, also calibrated for H_p (10), was worn on the chest, over the apron. Furthermore, a database was created to register the demographic and dosimetric data of the procedures, as well as the name of the radiologist acting as first operator.

RESULTS

For the three radiologists, who performed 276-338 procedures/year (20% pediatric), cumulative annual doses to the left bare eye exceeded 20 mSv (21-61 mSv). Considering the glasses' protection, annual doses exceeded 6 mSv (13-48 mSv) for both eyes. No important differences were observed in lens dose per procedure between pediatric and adult interventions (0.16 vs 0.18, 0.12 vs 0.09, and 0.07 vs 0.07 mSv), although lens dose per P_KA was 4.1-4.5 times higher in pediatrics (5.8 vs 1.3, 3.3 vs 0.8, and 2.6 vs 0.6 µSv/Gy·cm² ) despite a similar use of the ceiling-suspended screen. Lens doses were highly correlated with collar readings (with Pearson coefficients [r] ranging from 0.86 to 0.98) and with chest readings (with r ranging from 0.75 to 0.93). However, slopes of the linear regressions varied greatly among radiologists.

CONCLUSIONS

There is real risk of exceeding the occupational dose limit to the eye lens in mixed interventional radiology rooms if radiation protection tools are not used properly. Regular monitoring of the lens dose is recommended, given lens exposure might easily exceed 6 mSv/yr. Using a collar dosimeter for this purpose might be suitable if it is preceded by an individualized regression analysis. The same radiation protection measures should be applied to interventional radiologists regardless of whether they are treating pediatric or adult patients.

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

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.

CORRELATION OF EYE LENS DOSES AND PERSONAL DOSE EQUIVALENT MEASURED ON THE ARM OF INTERVENTIONAL CARDIOLOGISTS FOR A RETROSPECTIVE ASSESSMENT OF DOSES TO OPERATORS' EYE LENS

Coefficients converting the readings of the whole body dosemeter worn on the left arm to eye lens doses were determined by analysing the correlations between Hp(10) and Hp(3) values. Doses were measured on a phantom for specific C-arm projections typically used during CA/PCI procedures. In order to estimate the cumulative eye lens doses, conversion coefficients were then applied to the dose records of interventional cardiologists collected in the database of dosimetry service between the years 1995 and 2009. The Hp(10) to Hp(3) conversion coefficients are 0.29 (CV = 34%) and 0.17 (CV = 42%) for left and right eye lens, respectively. However, they can vary from one laboratory to another depending on working technique. From among 61 interventional cardiologists, none exceeded the threshold dose of 0.5 Gy for eye lens opacities. However, 44% of interventional cardiologists were likely to exceed the annual limit of 20 mSv for the most exposed eye at least once in the analysed time period.

Occupational eye dose to medical staff in various interventional cardiologic procedures: is the need for lead goggles the same in all groups of radiation workers?

Considering the increased use of interventional cardiologic procedures and concern about irradiation to the eyes, it is necessary to measure eye dose in radiation workers. The assessment of eye dose using collar dose is a routine but inaccurate method. Therefore this study was designed to measure eye dose in the radiation workers of various interventional cardiologic procedures. In this study eye dose was measured for left and right eyes in three groups of radiation workers in angiography ward of Afshar hospital in various procedures using TLD. Measurements were done separately for cardiologists, nurses and radio-technologists in 100 procedures. The nurses functioned as surgical assistants and were usually close to the table. The correlation of staff dose to exposure parameters was also investigated. Eye dose in physicians were higher than other staff in all procedures. Also the left eye dose was considerably higher than right one, especially for physicians. The median equivalent dose per procedure of left eye for physicians, nurses and radio-technologists were 7.4, 3.6, 1.4 µSv (PCI) and 3.2, 3.1, 1.3 µSv (Adhoc) and 3.2, 1.7, 1.1 µSv (CA), respectively. The annual left eye equivalent dose with (without) using lead goggles were 2.4 (15.3), 1.4 (2.2), 1.0 (1.1) mSv for physicians, nurses and radio-technologists, respectively. There were also a positive correlation between eye dose and KAP for procedures without lead goggles. The lead goggles showed lower protection effects for radio-technologists than other staff. Only 30% of physicians received a dose higher than 1/3 of the ICRP annual dose limit, therefor only physician eye dose should be monitored in catheterization labs.

A study of the underestimation of eye lens dose with current eye dosemeters for interventional clinicians wearing lead glasses

The reduction in the occupational dose limit of the eye lens has created the need for optimising eye protection and dose assessment, in particular for interventional clinicians. Lead glasses are one of the protection tools for shielding the eyes, but assessing the eye lens dose when these are in place remains challenging. In this study, we evaluated the impact of the position of H _p (3) dosemeters on the estimated eye lens dose when lead glasses are used in interventional settings. Using the Monte Carlo method (MCNPX), an interventional cardiology setup was simulated for two models of lead glasses, five beam projections and two patient access routes. H _p (3) dosemeters were placed at several positions on the operator and the obtained dose was compared to the dose to the sensitive part of the eye lens (H _lens). Furthermore, to reproduce an experimental setup, a reference dosemeter, H _p (3)_ref, was placed on the surface of the eye. The dose measured by H _p (3)_ref was, on average, only 60% of H _lens. Dosemeters placed on the glasses, under their shielding, underestimated H _lens for all parameters considered, by from 10% up to 90%. Conversely, dosemeters placed on the head or on the glasses, over their shielding, overestimated H _lens, on average, up to 60%. The presence or lack of side shielding in lead glasses affected mostly dosemeters placed on the forehead, at the left side. Results suggest that both use of a correction factor of 0.5 to account for the presence of lead glasses in doses measured outside their shielding and placing an eye lens dosemeter immediately beneath the lenses of lead glasses may lead to the underestimation of the eye lens dose. Most suitable positions for eye lens dose assessment were on the skin, unshielded by the glasses or close to the eye, with no correction to the dose measured.

Angular dependence of shielding effect of radiation protective eyewear for radiation protection of crystalline lens

Radiation protective (RP) eyewear effectively protects crystalline lenses from radiation exposure. A drawback of RP eyewear is the angular dependence of the shielding effect, which results from the design of the eyewear. In this study, 21 models of RP eyewear with different designs and lead equivalences were assessed. Each piece of RP eyewear was hung on a Styrofoam phantom that imitated the head, and a 0.125-cc ionization chamber dosimeter was placed at the position of the crystalline lens. The differences in angular dependence of the shielding effect were evaluated by changing the irradiation angle, and parameters that improved the angular dependence of the shielding effect-sufficient lead equivalence, large coverage design, and minimum gap between the crystalline lens and the RP eyewear-were identified. Thus, the findings highlight the importance of selecting RP eyewear according to the angular distribution and the nature of radiation exposure in the workplace for radiation workers.

Occupational radiation exposure to the head is higher for scrub nurses than cardiologists during cardiac angiography

AIMS

This study aimed to compare the head dose of a cardiologist to scrub and scout nurses during cardiac angiography.

DESIGN

A correlational longitudinal quantitative design was used to examine the relationship between the variable of occupational dose to the medical operator when compared with the dose to the scrub and scout nurses.

METHODS

A quantitative analysis was performed on data collected during coronary angiograms (N = 612) for one cardiologist and 22 nurses performing either the scrub or scout role between May 2015 and February 2017. Analysis was based on log-transformed dose levels and reported as geometric means and associated 95% confidence intervals.

RESULTS

It was found that scrub nurses received on average 41% more head dose than the cardiologist during diagnostic procedures and 52% higher doses during interventional cases.

CONCLUSION

Nurses working in fluoroscopic cardiovascular procedures should be provided with appropriate training and protective equipment, notably lead skull caps, to minimize their occupational radiation exposure.

IMPACT

There is a notable lack of research evaluating the occupational head and eye exposure to nurses involved in fluoroscopic procedures. This study found that during diagnostic coronary angiograms, the scrub nurses received 41% more occupational head dose than the cardiologist and 52% higher head doses during interventional cases. Radial access resulted in higher doses to scrub nurses than femoral artery access. It is advisable that staff wear protective lead glasses and skull caps and use appropriately positioned ceiling mounted lead shields to minimize the risk of adverse effects of occupational exposure to ionizing radiation.

The new lens dose limit: implication for occupational radiation protection

AIM AND OBJECTIVES

The aim of this article was to explore the implications of the new Euratom dose limit for occupational radiation protection in the context of medical occupational radiation exposures. The European Directive 2013/59/Euratom takes into account the new recommendations on reduction in the dose limit for the lens of the eye for planned occupational exposures released in 2012 by the International Commission on Radiological Protection (ICRP 118).

MATERIALS AND METHODS

Different dose-monitoring procedures and devices were considered. Occupational eye lens doses reported by previous studies were analyzed, mainly considering workers involved in interventional procedures with X-rays. The current status of eye lens radiation protection and the main methods for dose reduction were investigated.

RESULTS

The analysis showed that the workers, potentially exceeding the new limit, are clinical staff performing interventional procedures with a relatively high X-ray dose. Regarding radiological protection issues, the considered literature reports that the proper use of personal protective equipment may reduce the eye lens absorbed dose.

CONCLUSION

The evaluation of the occupational eye lens dose is essential to establish which method of personal dose monitoring should be preferred. Furthermore, education and training about the right use of personal protective equipment are important for medical staff working with ionizing radiation.

OCCUPATIONAL DOSES FOR THE FIRST AND SECOND OPERATORS IN LEBANESE INTERVENTIONAL CARDIOLOGY SUITES

The study monitored occupational dose for 12 interventional cardiologists (first operators) and 10 technicians (second operators), from 10 different Lebanese hospitals performing coronary angiography and precutaneous coronary interventions exclusively on adult patients. Each individual wore dosemeters under and over the lead apron at chest and collar level, respectively, on the wrist and next to the left eye. The total follow-up period for each first/second operator varied between two to six bimonthly monitoring periods. For the first operator, the mean (range) effective, hand and eye lens doses were of 6 (1-41), 112 (10-356) and 15 (5-47) μSv/procedure, respectively. These were of 2.3 (0.1-8), 16 (2-109) and 7 (2-14) μSv/procedure for the second operator. Extrapolated annual eye lens doses revealed that both first and second operators may exceed 3/10th of the annual eye lens dose permissible limit thus supporting the need for dedicated eye lens monitoring.

OPTIMIZATION OF A RADIOPHOTOLUMINESCENT GLASS DOSEMETER FOR OCCUPATIONAL EYE LENS DOSIMETRY IN INTERVENTIONAL RADIOLOGY/CARDIOLOGY

Hospital based workers that perform interventional radiology are at risk of reaching the eye lens dose limit of 20 mSv/y. These workers are exposed to the radiation scattered by the patient, which creates a complex field, with low radiation energy reaching the eyes of the medical staff from wide angles. Therefore, the dosemeter used in the assessment of the eye lens dose of interventional radiologists needs to respond accurately in such conditions. In this study, the angular response of a commercially available radiophotoluminescent glass dosemeter, GD-352M, was optimized via Monte Carlo simulations, aiming at its use as eye lens dosemeter in interventional radiology. The improved dosemeter was manufactured and then characterized in terms of Hp(3), the quantity recommended for eye lens dosimetry. Its response was compared to the IEC 62387:2012 requirements for Hp(3) and to requirements proposed specifically for eye lens dosemeters used in interventional radiology. The improved dosemeter meets the IEC 62387:2012 requirements for energy and angular response for Hp(3) and also shows good agreement with the more strict requisites proposed for eye lens dosemeters to be used in interventional radiology.

Occupational radiation exposure to nursing staff during cardiovascular fluoroscopic procedures: A review of the literature

Fluoroscopy is a method used to provide real time x-ray imaging of the body during medical procedures to assist with medical diagnosis and treatment. Recent technological advances have seen an increase in the number of fluoroscopic examinations being performed. Nurses are an integral part of the team conducting fluoroscopic investigations and are often located close to the patient resulting in an occupational exposure to radiation. The purpose of this review was to examine recent literature which investigates occupational exposure received by nursing staff during cardiovascular fluoroscopic procedures. Articles published between 2011 and 2017 have been searched and comprehensively reviewed on the referenced medical search engines. Twenty-four relevant studies were identified among which seventeen investigated nursing dose comparative to operator dose. Seven researched the effectiveness of interventions in reducing occupational exposure to nursing staff. While doctors remain at the highest risk of exposure during procedures, evidence suggests that nursing staff may be at risk of exceeding recommended dose limits in some circumstances. There is also evidence of inconsistent use of personal protection such as lead glasses and skull caps by nursing staff to minimize radiation exposure. Conclusions: The review has highlighted a lack of published literature focussing on dose to nurses. There is a need for future research in this area to inform nursing staff of factors which may contribute to high occupational doses and of methods for minimizing the risk of exposure, particularly regarding the importance of utilizing radiation protective equipment.

EYE LENS DOSIMETRY WITHIN THE CARDIAC CATHETERISATION LABORATORY-ARE ANCILLARY STAFF BEING FORGOTTEN?

Eye lens doses have been widely explored for interventional clinicians, however, data for ancillary staff is limited. Eye doses have been measured using a headband technique for clinicians, specialist registrars, nurses and radiographers working in a cardiac catheterisation laboratory in a UK hospital. Workload was found to be significantly higher for ancillary staff, and consequently, despite the absolute monthly collar doses and other indicators such as eye dose/KAP and eye dose/procedure being highest for clinicians, our study found there was no significant difference in the monthly eye dose readings between the clinicians and nurses (p = 0.82), and clinicians and radiographers (p = 0.72). The average eye dose/collar dose ratios were 0.71 and 0.61 for cardiologists and SPRs, but ratios above one were found for nurses and radiographers. This work expands on the eye dose data available for ancillary staff and demonstrates that eye dosimetry for these workers should not be overlooked.

Eye lens dose correlations with personal dose equivalent and patient exposure in paediatric interventional cardiology performed with a fluoroscopic biplane system

PURPOSE

To analyse the correlations between the eye lens dose estimates performed with dosimeters placed next to the eyes of paediatric interventional cardiologists working with a biplane system, the personal dose equivalent measured on the thorax and the patient dose.

METHODS

The eye lens dose was estimated in terms of H_p(0.07) on a monthly basis, placing optically stimulated luminescence dosimeters (OSLDs) on goggles. The H_p(0.07) personal dose equivalent was measured over aprons with whole-body OSLDs. Data on patient dose as recorded by the kerma-area product (P_KA) were collected using an automatic dose management system. The 2 paediatric cardiologists working in the facility were involved in the study, and 222 interventions in a 1-year period were evaluated. The ceiling-suspended screen was often disregarded during interventions.

RESULTS

The annual eye lens doses estimated on goggles were 4.13±0.93 and 4.98±1.28mSv. Over the aprons, the doses obtained were 10.83±0.99 and 11.97±1.44mSv. The correlation between the goggles and the apron dose was R²=0.89, with a ratio of 0.38. The correlation with the patient dose was R²=0.40, with a ratio of 1.79μSvGy^-1cm^-2. The dose per procedure obtained over the aprons was 102±16μSv, and on goggles 40±9μSv. The eye lens dose normalized to P_KA was 2.21±0.58μSvGy^-1cm^-2.

CONCLUSIONS

Measurements of personal dose equivalent over the paediatric cardiologist's apron are useful to estimate eye lens dose levels if no radiation protection devices are typically used.

Operator Radiation and the Efficacy of Ceiling-Suspended Lead Screen Shielding during Coronary Angiography: An Anthropomorphic Phantom Study Using Real-Time Dosimeters

Operator radiation and the radiation protection efficacy of a ceiling-suspended lead screen were assessed during coronary angiography (CA) in a catheterization laboratory. An anthropomorphic phantom was placed under the X-ray beam to simulate patient attenuation in eight CA projections. Using real-time dosimeters, radiation dose rates were measured on models mimicking a primary operator (PO) and an assistant. Subsequently, a ceiling-suspended lead screen was placed in three commonly used positions to compare the radiation protection efficacy. The radiation exposure to the PO was 2.3 to 227.9 (mean: 67.2 ± 49.0) μSv/min, with the left anterior oblique (LAO) 45°/cranial 25° and cranial 25° projections causing the highest and the lowest dose rates, respectively. The assistant experienced significantly less radiation overall (mean: 20.1 ± 19.6 μSv/min, P < 0.003), with the right anterior oblique (RAO) 30° and cranial 25° projections resulting in the highest and lowest exposure levels, respectively. Combined with table-side shielding, the ceiling-suspended lead screen reduced the radiation to the PO by 76.8%, 81.9% and 93.5% when placed close to the patient phantom, at the left side and close to the PO, respectively, and reduced the radiation to the assistant by 70.3%, 76.7% and 90.0%, respectively. When placed close to the PO, a ceiling-suspended lead screen provides substantial radiation protection during CA.

The effectiveness of lead glasses in reducing the doses to eye lenses during cardiac implantation procedures performed using x-ray tubes above the patient table

The dose reduction factors (DRF) for different types of lead glasses and C-arm units with x-ray tubes placed above the patient table were calculated from the results of measurements by loose thermoluminescent dosimeters (TLDs) and EYE-D dosimeters using a Rando phantom. The DRF values were analysed for different positions of routine dosimeters worn outside lead eyewear and confronted with DRFs calculated as the ratio of the dose equivalent to the eye measured with and without the eyewear. Moreover, for eye lens dosimeters designed to be worn behind lead glasses, multiplicative factors for various positions of dosimeter were derived in order to account for the differences between the doses measured on the inner side of the glasses and the dose equivalent to the eye lens. The DRFs calculated for the position of a routine dosimeter worn outside lead glasses on the band near the left eye lens are 5.6 and 5.7 for goggles and metallic glasses, respectively, while the DRFs calculated as the ratio of doses to the eyes measured with and without the eyewear are 10.2 and 9.9, respectively. Therefore, for dosimeters routinely used outside lead eyewear, the DRF calculated for the position of the dosimeter should be used. Otherwise, we can anticipate an almost two-fold underestimation of the doses. When the dosimeter is worn behind lead glasses, up to two-fold differences between the dose equivalent to the eye lens and the dose measured at the inner side of the glasses were observed depending on the dosimeter position.

The impact of various protective tools on the dose reduction in the eye lens in an interventional cardiology-clinical study

The aim of the study was to check, in clinical practice, the potential for the dose reduction of lead eyewear and a ceiling-suspended shield used to protect the eye lens of physicians working in interventional cardiology. To this end, for the lead eyewear, the dose reduction factors were derived to correct the readings from a dosimeter used routinely outside the glasses. Four types of lead eyewear with attached loose thermoluminescent dosimeters and EYE-D dosimeters were worn by physicians in two clinical centres, for two-month periods, during coronary angiography (CA), percutaneous coronary intervention (PCI), and pacemaker procedures. In order to analyse, separately, how a ceiling-suspended lead screen absorbs the scattered radiation, a series of measurements was carried out during single CA/PCI procedures performed with and without the protection. The lead eyewear may reduce the doses to the eye closest to the x-ray tube by a factor between 1.1 and 3.4, depending on its model and the physician's position. The effectiveness of the eyewear may, however, vary-even for the same model and physician-almost twofold between different working periods. The ceiling-suspended shield decreases the doses in clinical practice by a factor of 2.3. The annual eye lens doses without the eyewear estimated from routine measurements are high-above or close to the new eye lens dose limit established by the recent EU Basic Safety Standards, even though the ceiling-suspended shield was used. Therefore, to comply with the new dose limit that is set in the Directive, protection of the eyes of physicians with high workloads might require the use of both the eyewear and the ceiling-suspended shield.