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Honorio da Silva E, Martin CJ, Vanhavere F, Dabin J, Buls N. An investigation into potential improvements in the design of lead glasses for protecting the eyes of interventional cardiologists. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:031501. [PMID: 35654011 DOI: 10.1088/1361-6498/ac758f] [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: 02/12/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
The lens of the eye can be damaged by ionising radiation, so individuals whose eyes are exposed to radiation during their work may need to protect their eyes from exposure. Lead glasses are widely available, but there are questions about their efficiency in providing eye protection. In this study, Monte Carlo simulations are used to assess the efficiency of lead glasses in protecting the sensitive volume of the eye lens. Two designs currently available for interventional cardiologists are a wraparound (WA) style and ones with flat frontal lenses with side shielding. These designs were considered together with four modifications that would impact upon their efficiency: changing the lead equivalent thickness, adding lead to the frames, elongating the frontal lenses, and adding a closing shield to the bottom rim. For the eye closest to the source, standard models of lead glasses only decrease the radiation reaching the most sensitive region of the eye lens by 22% or less. Varying the lead thickness between 0.4 mm and 0.75 mm had little influence on the protection provided in the simulation of clinical use, neither did adding lead to the frames. Improved shielding was obtained by elongating the frontal lens, which could reduce radiation reaching the eye lens by up to 76%. Glasses with lenses that had a rim at the base, extending towards the face of the user, also provided better shielding than current models, decreasing the dose by up to 80%. In conclusion, elongating the frontal lens of lead glasses, especially of the WA design, could provide a three-fold increase in shielding efficiency and this is still valid for lenses with 0.4 mm lead equivalence.
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Affiliation(s)
| | | | | | | | - Nico Buls
- Universitair Ziekenhuis, Vrije Universiteit Brussel, Brussels, Belgium
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Bärenfänger F, Walbersloh J, El Mouden R, Goerg F, Block A, Rohde S. Clinical evaluation of a novel head protection system for interventional radiologists. Eur J Radiol 2021; 147:110114. [PMID: 34968901 DOI: 10.1016/j.ejrad.2021.110114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/24/2021] [Accepted: 12/19/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE A novel two-part protective system consisting of a modified thyroid collar and a head protection is intended to reduce the radiation dose to the examiners head during fluoroscopy-guided interventions. In this pilot study, we tested this protection system under real-life conditions in general radiological and neuroradiological interventions. METHODS Two sets of the protection system (set A and B) were equipped with 12 thermoluminiscence detectors (TLD). For simultaneous measurement of radiation exposure and dose-reduction, each six TLDs were fixed to the inner side and on the corresponding outer side of the protection system. Set A was used exclusively for general radiological interventions and set B exclusively for neuroradiological interventions. To compare the staff exposure in general radiology and neuroradiology, dose values were normalized to a DAP of 10 000 µGy∙m2. RESULTS The sets were tested during 20 general radiological interventions and 32 neuroradiological interventions. In neuroradiology, the mean normalized radiation exposure was 13.44 ± 1.36 µSv/10000 µGy∙m2 at the head protection and 22.27 ± 2.09 µSv/10 000 µGy∙m2 at the thyroid collar. In general radiology, the corresponding results were 29.91 ± 4.19 µSv/10 000 µGy∙m2 (head protection) and 68.07 ± 17.25 µSv/10 000 µGy∙m2 (thyroid collar). Thus, mean dose exposure was 2.5 times higher in general radiological interventions (p = 0.016). The use of the protection system resulted in a mean dose reduction of 81.2 ± 11.1 % (general radiology) and 92.1 ± 4.2 % (neuroradiology; p = 0.016). CONCLUSION Fluoroscopy-guided interventions lead to significant radiation exposure of the head area for the examiner. The novel protection system tested led to a significant dose reduction of 80-90%, depending on the type of intervention.
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Affiliation(s)
- Felix Bärenfänger
- Klinikum Dortmund gGmbH, Department of Medical Physics and Radiation Protection, Beurhausstr. 40, 44137 Dortmund, Germany; University of Witten/Herdecke, Faculty for Health, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany.
| | - Jörg Walbersloh
- Materialprüfungsamt NRW, Department of Dosimetry, Marsbruchstr. 186, 44287 Dortmund, Germany.
| | - Rachid El Mouden
- Klinikum Dortmund gGmbH, Department of Radiology and Neuroradiology, Beurhausstr. 40, 44137 Dortmund, Germany.
| | - Fabian Goerg
- Klinikum Dortmund gGmbH, Department of Radiology and Neuroradiology, Beurhausstr. 40, 44137 Dortmund, Germany.
| | - Andreas Block
- Klinikum Dortmund gGmbH, Department of Medical Physics and Radiation Protection, Beurhausstr. 40, 44137 Dortmund, Germany.
| | - Stefan Rohde
- University of Witten/Herdecke, Faculty for Health, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany; Klinikum Dortmund gGmbH, Department of Radiology and Neuroradiology, Beurhausstr. 40, 44137 Dortmund, Germany.
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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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Petrucci C. Review of experimental estimates for the protection afforded by eyewear for interventional x-ray staff. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:R46-R70. [PMID: 32143203 DOI: 10.1088/1361-6498/ab7d8c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This paper attempts to systematise all published experimental results for the dose reduction factor (DRF) offered by leaded eyewear on clinicians performing interventional procedures. We aim to present a comprehensive analysis of the issue and a comparison of the various equipment models at different exposure geometries. The main purpose of the paper is, however, to clarify the best choice for the DRF within the possible diverse contexts and approaches to eye lens dose assessment. Evidence has been obtained that the lowest estimates of DRF are associated with larger scatter incidence angles and that, except for the slightly better performance exhibited by wraparound eyeglasses, there is no real distinction between the DRFs for the different equipment categories. The dataset as a whole confirms that, when measurements for the concerned eyewear model and irradiation conditions are unattainable, assuming DRF = 2 represents an adequately conservative choice. Nonetheless, this value includes only 17% of all results from the literature, whereas their histogram follows a distribution skewed towards higher values, represented by a median equal to 5. Therefore, if more realistic dose reconstructions are necessary, such as for purposes of epidemiological investigations or compensation decisions, the adoption of this central tendency index appears to be more reasonable. The complexity of characterising the DRF behaviour as a function of the various exposure factors reinforces the consideration of a statistical approach to eye lens dose assessment as a viable alternative. In this perspective, assuming for DRF a lognormal distribution with parameters [Formula: see text] and [Formula: see text] which has been verified to satisfactorily approximate the literature data distribution, should be deemed to be an appropriate option.
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Affiliation(s)
- Caterina Petrucci
- Department of Medicine, Epidemiology, Workplace and Environmental Hygiene, National Institute for Insurance against Accidents at Work (INAIL), via Fontana Candida 1, 00078 Monte Porzio Catone, Roma, Italy
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Angular dependence of shielding effect of radiation protective eyewear for radiation protection of crystalline lens. Radiol Phys Technol 2019; 12:401-408. [PMID: 31617146 DOI: 10.1007/s12194-019-00538-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
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.
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Velazquez-Kronen R, Borrego D, Gilbert ES, Miller DL, Moysich K, Freudenheim JL, Wactawski-Wende J, Cahoon EK, Little MP, Millen AE, Balter S, Alexander BH, Simon SL, Linet MS, Kitahara CM. Cataract risk in US radiologic technologists assisting with fluoroscopically guided interventional procedures: a retrospective cohort study. Occup Environ Med 2019; 76:317-325. [PMID: 30890565 PMCID: PMC6686674 DOI: 10.1136/oemed-2018-105360] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/30/2019] [Accepted: 02/18/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess radiation exposure-related work history and risk of cataract and cataract surgery among radiologic technologists assisting with fluoroscopically guided interventional procedures (FGIP). METHODS This retrospective study included 35 751 radiologic technologists who reported being cataract-free at baseline (1994-1998) and completed a follow-up questionnaire (2013-2014). Frequencies of assisting with 21 types of FGIP and use of radiation protection equipment during five time periods (before 1970, 1970-1979, 1980-1989, 1990-1999, 2000-2009) were derived from an additional self-administered questionnaire in 2013-2014. Multivariable-adjusted relative risks (RRs) for self-reported cataract diagnosis and cataract surgery were estimated according to FGIP work history. RESULTS During follow-up, 9372 technologists reported incident physician-diagnosed cataract; 4278 of incident cases reported undergoing cataract surgery. Technologists who ever assisted with FGIP had increased risk for cataract compared with those who never assisted with FGIP (RR: 1.18, 95% CI 1.11 to 1.25). Risk increased with increasing cumulative number of FGIP; the RR for technologists who assisted with >5000 FGIP compared with those who never assisted was 1.38 (95% CI 1.24 to 1.53; p trend <0.001). These associations were more pronounced for FGIP when technologists were located ≤3 feet (≤0.9 m) from the patient compared with >3 feet (>0.9 m) (RRs for >5000 at ≤3 feet vs never FGIP were 1.48, 95% CI 1.27 to 1.74 and 1.15, 95% CI 0.98 to 1.35, respectively; pdifference=0.04). Similar risks, although not statistically significant, were observed for cataract surgery. CONCLUSION Technologists who reported assisting with FGIP, particularly high-volume FGIP within 3 feet of the patient, had increased risk of incident cataract. Additional investigation should evaluate estimated dose response and medically validated cataract type.
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Affiliation(s)
- Raquel Velazquez-Kronen
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, USA, 20892
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA, 14214
| | - David Borrego
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, USA, 20892
| | - Ethel S. Gilbert
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, USA, 20892
| | - Donald L. Miller
- Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA, 20993
| | - Kirsten Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA, 14263
| | - Jo L. Freudenheim
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA, 14214
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA, 14214
| | - Elizabeth K. Cahoon
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, USA, 20892
| | - Mark P. Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, USA, 20892
| | - Amy E. Millen
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA, 14214
| | - Stephen Balter
- Departments of Radiology and Medicine, Columbia University, New York, NY, USA, 10032
| | - Bruce H. Alexander
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN, USA, 55455
| | - Steven L. Simon
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, USA, 20892
| | - Martha S. Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, USA, 20892
| | - Cari M. Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, USA, 20892
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Monte Carlo simulation of eye lens dose reduction from CT scan using organ based tube current modulation. Phys Med 2018; 48:72-75. [PMID: 29728232 DOI: 10.1016/j.ejmp.2018.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/11/2018] [Accepted: 03/20/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate lens dose reduction with organ based tube current modulation (TCM) using the Monte Carlo method. METHODS To calculate lens dose with organ based TCM, 36 pairs of X-ray sources with bowtie filters were placed around the patient head using a projection angle interval of 10° for one rotation of Computed Tomography (CT). Each projection was simulated respectively. Both voxelized and stylized eye models and Chinese reference male phantoms were used in the simulation, and tube voltages 80, 100, 120 and 140 kVp were used. RESULTS Dose differences between two eye models were less than 20%, but large variations were observed among dose results from different projections of all tube voltages investigated. Dose results from 0° (AP) directions were 60 times greater than those from 180° (PA) directions, which enables organ based TCM reduce lens doses by more than 47%. CONCLUSIONS Organ based TCM may be used to reduce lens doses. Stylized eye models are more anatomically realistic compared with voxelized eye models and are more reliable for dose evaluation.
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