Radiation exposure to patients and medical staff in hepatic chemoembolisation interventional procedures in Recife, Brazil

Dosimetry of Occupational Eye Lens Dose Using a Novel Direct Eye Dosimeter, DOSIRIS, during Interventional Radiology Procedures

In response to the recommendation by the International Commission on Radiological Protection to lower the equivalent eye dose limit, the Japanese Government in April 2021 lowered the equivalent dose limit for the eye lens for occupational exposure. A considerable number of interventional radiology operators are exposed to levels above the new limit. For this reason, a need exists to more accurately evaluate eye lens dose in interventional radiology operators by using a novel direct eye dosimeter, the DOSIRIS™(IRSN, France), which is capable of measuring a 3-mm dose equivalent under protective glasses. The DOSIRIS is a thermoluminescent dosimeter that exhibits good energy dependence and better directional properties than other dosimeters. Dosimetry using DOSIRIS might be accurate and compatible with the latest regulations.

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

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

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

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

Report of IRPA task group on issues and actions taken in response to the change in eye lens dose limit

In 2018, the International Radiation Protection Association (IRPA) established its third task group (TG) on the implementation of the eye lens dose limit. To contribute to sharing experience and raising awareness within the radiation protection community about protection of workers in exposure of the lens of the eye, the TG conducted a questionnaire survey and analysed the responses. This paper provides an overview of the results of the questionnaire.

Estimating brain radiation dose to the main operator in interventional radiology

The aim of this study was to estimate brain radiation dose to the main operator during interventional radiology procedures. Occupational brain doses from 19 interventional procedures were measured using thermoluminiscent dosimeters and an anthropomorphic RANDO woman phantom simulating a main operator. Results show that, interventional radiologists may receive minimum and maximum brain doses per procedure of 0.01 mGy (left temporal cortex) and 0.08 mGy (temporal lobe cortex), respectively. A radiologist who works without movable shielding devices during procedures and has a typical workload (for example 500 procedures per year), might exceed the new dose threshold of 0.5 Gy for circulatory disease in the brain working 12.6 years of his career.

PERFORMANCE OF THE INSTADOSETM DOSEMETER FOR INTERVENTIONAL RADIOLOGY AND CARDIOLOGY APPLICATION

The aim of this article was to verify the performance of the Mirion InstadoseTM dosemeter under clinical conditions and to compare its response in typical X-ray fields used during interventional and cardiology procedures with the TLD-100, usually used for radiation dosimetry. It was also objective of this study to verify the feasibility of using the InstadoseTM dosemeter response at the chest level for estimation of occupational eye lens dose in cardiology and interventional radiology. Initially the response of the dosemeter was tested using continuous X-ray beams and the results showed that the Instadose dosemeter present a satisfactory behavior of the most important dosimetric properties based on the tests as described in the IEC 62387 standard. The measurements performed in clinical conditions showed that the InstadoseTM dosemeter response was comparable to that of TL dosemeters used in interventional radiology and cardiology procedures and there is a correlation between the eye lens doses and the chest doses measured with the InstadoseTM. Based on the results obtained, we recommend the use of the InstadoseTM dosemeter for purposes of occupational whole-body monitoring of medical staff in interventional radiology and cardiology procedures.

Patient Radiation Dose Reduction Considerations in a Contemporary Interventional Radiology Suite

PURPOSE

We sought to evaluate patient radiation exposure during complex liver interventional procedures performed with newer angiography equipment.

MATERIALS AND METHODS

We conducted a retrospective study of transjugular intrahepatic portosystemic shunt (TIPS) creations and liver tumor embolizations performed in our new angiography suite (Discovery IGS740, GE Healthcare). T tests were used to compare air kerma-area product (P_KA) and reference plane air kerma (K_a,r) in the new room versus data from historical rooms and previous studies (including the RAD IR study). Results were expressed as medians [interquartile ranges (Q1, Q3)].

RESULTS

From February 2015 to June 2016, 134 complex liver interventional procedures were performed in the new room, including 14 TIPS creations, 60 hepatic tumor arterial embolizations (HAEs), 26 Y90 mappings (Y90m), and 34 Y90 radioembolizations (Y90). K_a,r (Gy) values were as follows: TIPS, 0.65 (0.24, 1.15); HAE, 0.89 (0.49, 1.49); Y90m, 0.54 (0.38, 0.94); Y90, 0.46 (0.21, 1.06). P_KA (Gy·cm²) values were as follows: TIPS, 148.2 (66.7, 326.5); HAE, 142.6 (88, 217.8); Y90m, 148.3 (98.2, 247); Y90, 90.8 (43.9, 161.5). K_a,r and P_KA were lower in the new room than in historical rooms [K_a,r and P_KA reductions: TIPS, 58 and 49%; HAE, 31 and 39%; Y90m, 58 and 52%; Y90, 49 and 56% (p < 0.05)] and versus the RAD IR study [K_a,r and P_KA reductions: TIPS, 64 and 43%; HAE, 26 and 40% (p < 0.05)].

CONCLUSIONS

Using the latest technology and image processing tools enables significant reduction in radiation exposure during complex liver interventional procedures.

Radiation Exposure of Patients and Interventional Radiologists during Prostatic Artery Embolization: A Prospective Single-Operator Study

PURPOSE

To prospectively analyze the radiation exposure of patients and interventional radiologists during prostatic artery embolization (PAE).

MATERIALS AND METHODS

Twenty-five consecutive PAE procedures performed with an Artis zee system in a single center by an interventional radiologist were prospectively monitored. The mean age, weight, and prostate volume of the patients were 65.7 year (range, 43-85 y), 71.4 kg (range, 54-88 kg), and 79 cm³ (range, 36-157 cm³), respectively. In addition to Digital Imaging and Communications in Medicine radiation data, direct measures were also obtained. Radiochromic film was used to evaluate peak skin dose (PSD). The radiologist wore a protective apron and a thyroid collar, and a ceiling-suspended screen and a table curtain were used. To estimate the absorbed doses, nine pairs of dosimeters were attached to the operator's body.

RESULTS

The average fluoroscopy time was 30.9 minutes (range, 15.5-48.3 min). The mean total dose-area product (DAP) was 450.7 Gy·cm² (range, 248.3-791.73 Gy·cm²) per procedure. Digital subtraction angiography was responsible for 71.5% of the total DAP, followed by fluoroscopy and cone-beam computed tomography. The mean PSD was 2,420.3 mGy (range, 1,390-3,616 mGy). The average effective dose for the interventional radiologist was 17 μSv (range, 4-47 μSv); values for the eyes, hands, and feet were obtained, and were all greater on the left side.

CONCLUSIONS

PAE may lead to high x-ray exposures to patients and interventional radiologists.

Prostatic artery embolization: radiation exposure to patients and staff

The aim of this study was to evaluate the radiation doses to patients and staff received from the first cases of prostatic artery embolization (PAE) conducted in a public hospital in Recife, Brazil. Five PAE procedures for 5 men diagnosed with benign prostatic hyperplasia were investigated. In order to characterize patient exposure, dosimetric quantities, such as the air kerma-area product (P KA), the cumulative air kerma at the interventional reference point (Ka,r), the number of images, etc, were registered. To evaluate the possibility for deterministic effects, the peak skin dose (PSD) was measured using radiochromic films. For evaluation of personal dose equivalent and effective dose to the medical staff, thermoluminescent dosemeters (TLD-100) were used. The effective dose was estimated using the double dosimetry alghoritm of von Boetticher. The results showed that the mean patient's PSD per procedure was 2674.2 mGy. With regard to the medical staff, the mean, minimum and maximum effective doses estimated per procedure were: 18 μSv, 12 μSv and 21 μSv respectively. High personal equivalent doses were found for the feet, hands and lens of the eye, due to the use of multiple left anterior oblique projections and the improper use of the suspended lead screen and the lead curtain during procedures.

Radiation protection of the eye lens in medical workers--basis and impact of the ICRP recommendations

The aim of this article was to explore the evidence for the revised European Union basic safety standard (BSS) radiation dose limits to the lens of the eye, in the context of medical occupational radiation exposures. Publications in the open literature have been reviewed in order to draw conclusions on the exposure profiles and doses received by medical radiation workers and to bring together the limited evidence for cataract development in medical occupationally exposed populations. The current status of relevant radiation-protection and monitoring practices and procedures is also considered. In conclusion, medical radiation workers do receive high doses in some circumstances, and thus working practices will be impacted by the new BSS. However, there is strong evidence to suggest that compliance with the new lower dose limits will be possible, although education and training of staff alongside effective use of personal protective equipment will be paramount. A number of suggested actions are given with the aim of assisting medical and associated radiation-protection professionals in understanding the requirements.