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Safari A, Rafie P, Taeb S, Najafi M, Mortazavi SMJ. Development of Lead-Free Materials for Radiation Shielding in Medical Settings: A Review. J Biomed Phys Eng 2024; 14:229-244. [PMID: 39027711 PMCID: PMC11252547 DOI: 10.31661/jbpe.v0i0.2404-1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/20/2024] [Indexed: 07/20/2024]
Abstract
Radiation protection is an essential issue in diagnostic radiology to ensure the safety of patients, healthcare professionals, and the general public. Lead has traditionally been used as a shielding material due to its high atomic number, high density, and effectiveness in attenuating radiation. However, some concerns related to the long-term health effects of toxicity, environmental disease as well as heavy weight of lead have led to the search for alternative lead-free shielding materials. Leadfree multilayered polymer composites and non-lead nano-composite shields have been suggested as effective shielding materials to replace conventional lead-based and single metal shields. Using several elements with high density and atomic number, such as bismuth, barium, gadolinium, and tungsten, offer significant enhancements in the shielding ability of composites. This review focuses on the development and use of lead-free materials for radiation shielding in medical settings. It discusses the drawbacks of traditional lead shielding, such as toxicity, weight, and recycling challenges, and highlights the benefits of lead-free alternatives.
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Affiliation(s)
- Arash Safari
- Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Ionizing and Non-ionizing Radiation Protection Research Center (INIRPRC), Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payman Rafie
- Department of Nuclear Engineering, School of Mechanical Engineering, Shiraz University, Shiraz, Iran
| | - Shahram Taeb
- Department of Radiology, School of Paramedical Sciences, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoud Najafi
- Department of Radiology and Nuclear Medicine, School of Paramedical Sciences, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Seyed Mohammad Javad Mortazavi
- Ionizing and Non-ionizing Radiation Protection Research Center (INIRPRC), Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Salehi Z, Tayebi Khorami M. How efficient are metal-polymer and dual-metals-polymer non-lead radiation shields? J Med Radiat Sci 2024; 71:57-62. [PMID: 37875268 PMCID: PMC10920949 DOI: 10.1002/jmrs.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/07/2023] [Indexed: 10/26/2023] Open
Abstract
INTRODUCTION Lead shields are often used to attenuate ionising radiations. However, to make lighter, recyclable and more efficient shields compared to lead, combinations of new metallic compounds together with polymer, for example, flexible polyvinyl chloride (PVC) have been developed recently. In this study, the capabilities of non-lead radiation shields made of one or two metallic compounds and polymer were evaluated. METHODS Monte Carlo (MC)-based BEAMnrc code was used to build a functional model based on a Philips X-ray machine in the range of radiographic energies. The MC model was then verified by IPEM Report 78 as a standardised global reference. The MC model was then used to evaluate the efficiency of non-lead-based garments made of metallic compound and polymer (MCP) including BaSO4 -PVC, Bi2 O3 -PVC, Sn-PVC and W-PVC, as well as dual-metallic compounds and polymer (DMCP) including Bi2 O3 -BaSO4 -PVC, Bi2 O3 -Sn-PVC, W-Sn-PVC and W-BaSO4 -PVC. The absorbed doses were determined at the surface of a water phantom and compared directly with the doses obtained for 0.5 mm pure lead (Pb). RESULTS Bi2 O3 -BaSO4 -PVC and W-BaSO4 -PVC were found to be efficient shields for most of the energies. In addition to the above radiation shields, Bi2 O3 -Sn-PVC was also found to be effective for the spectrum of 60 keV. Bi2 O3 -BaSO4 -PVC as a non-lead dual metals-PVC shield was shown to be more efficient than pure lead in diagnostic X-ray range. CONCLUSION Combination of two metals-PVC, a low atomic number (Z) metal together with a high atomic number metal, and also single-metal-PVC shields were shown to be efficient enough to apply as radiation protection shields instead of lead-based garments.
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Affiliation(s)
- Zaker Salehi
- Department of Radiation Sciences, School of Paramedical SciencesYasuj University of Medical SciencesYasujIran
| | - Mansour Tayebi Khorami
- Department of Radiation Sciences, School of Paramedical SciencesYasuj University of Medical SciencesYasujIran
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Moradi F, Jalili M, Saraee KRE, Abdi MR, Rashid HAA. Radiation shielding assessment for interventional radiology personnel: Geant4 dosimetry of lead-free compositions. Biomed Phys Eng Express 2024; 10:025029. [PMID: 38320327 DOI: 10.1088/2057-1976/ad26d5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/06/2024] [Indexed: 02/08/2024]
Abstract
The inherent biological hazards associated with ionizing radiation necessitate the implementation of effective shielding measures, particularly in medical applications. Interventional radiology, in particular, poses a unique challenge as it often exposes medical personnel to prolonged periods of high x-ray doses. Historically, lead and lead-based compounds have been the primary materials employed for shielding against photons. However, the drawbacks of lead, including its substantial weight causing personnel's inflexibility and its toxicity, have raised concerns regarding its long-term impact on both human health and the environment. Barium tantalate has emerged as a promising alternative, due to its unique attenuation properties against low-energy x-rays, specifically targeting the weak absorption area of lead. In the present study, we employ the Geant4 Monte Carlo simulation tool to investigate various formulations of barium tantalate doped with rare earth elements. The aim is to identify the optimal composition for shielding x-rays in the context of interventional radiology. To achieve this, we employ a reference x-ray spectrum typical of interventional radiology procedures, with energies extending up to 90 keV, within a carefully designed simulation setup. Our primary performance indicator is the reduction in air kerma transmission. Furthermore, we assess the absorbed doses to critical organs at risk within a standard human body phantom protected by the shield. Our results demonstrate that specific concentrations of the examined rare earth impurities can enhance the shielding performance of barium tantalate. To mitigate x-ray exposure in interventional radiology, our analysis reveals that the most effective shielding performance is achieved when using barium tantalate compositions containing 15% Erbium or 10% Samarium by weight. These findings suggest the possibility of developing lead-free shielding solutions or apron for interventional radiology personnel, offering a remarkable reduction in weight (exceeding 30%) while maintaining shielding performance at levels comparable to traditional lead-based materials.
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Affiliation(s)
- F Moradi
- Faculty of Engineering, Multimedia University, Cyberjaya, Malaysia
| | - M Jalili
- Faculty of Physics, University of Isfahan, Isfahan, Iran
| | | | - M R Abdi
- Faculty of Physics, University of Isfahan, Isfahan, Iran
| | - H A Abdul Rashid
- Faculty of Engineering, Multimedia University, Cyberjaya, Malaysia
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Maeda T, Hayashi H, Ando M, Kobayashi D, Nishigami R, Asahara T, Goto S, Lee C, Yamashita K, Higashino K, Konishi T, Murakami S, Maki M. Performance of elastic x-ray shield made by embedding Bi 2 O 3 particles in porous polyurethane. Med Phys 2024; 51:1061-1073. [PMID: 38103261 DOI: 10.1002/mp.16889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Many healthcare institutions have guidelines concerning the usage of protective procedures, and various x-ray shields have been used to reduce unwanted radiation exposure to medical staff and patients when using x-rays. Most x-ray shields are in the form of sheets and lack elasticity, which limits their effectiveness in shielding areas with movement, such as the thyroid. To overcome this limitation, we have developed an innovative elastic x-ray shield. PURPOSE The purpose of this study is to explain the methodology for developing and evaluating a novel elastic x-ray shield with sufficient x-ray shielding ability. Furthermore, valuable knowledge and evaluation indices are derived to assess our shield's performance. METHODS Our x-ray shield was developed through a process of embedding Bi2 O3 particles into porous polyurethane. Porous polyurethane with a thickness of 10 mm was dipped into a solution of water, metal particles, and chemical agents. Then, it was air-dried to fix the metal particles in the porous polyurethane. Thirteen investigational x-ray shields were fabricated, in which Bi2 O3 particles at various mass thicknesses (ranging from 585 to 2493 g/m2 ) were embedded. To determine the performance of the shielding material, three criteria were evaluated: (1) Dose Reduction Factor (D R F $DRF$ ), measured using inverse broad beam geometry; (2) uniformity, evaluated from the standard deviation (S D $SD$ ) of the x-ray image obtained using a clinical x-ray imaging detector; and (3) elasticity, evaluated by a compression test. RESULTS The elastic shield with small pores, containing 1200 g/m2 of the metal element (Bi), exhibited a well-balanced performance. TheD R F $DRF$ was approximately 80% for 70 kV diagnostic x-rays. This shield's elasticity was -0.62 N/mm, a loss of only 30% when compared to porous polyurethane without metal. Although the non-uniformity of the x-ray shield leads to poor shielding ability, it was found that the decrease in the shielding ability can be limited to a maximum of 6% when the shield is manufactured so that theS D $SD$ of the x-ray image of the shield is less than 10%. CONCLUSIONS It was verified that an elastic x-ray shield that offers an appropriate reduction in radiation exposure can be produced by embedding Bi2 O3 particles into porous polyurethane. Our findings can lead to the development of novel x-ray shielding products that can reduce the physical and mental stress on users.
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Affiliation(s)
- Tatsuya Maeda
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroaki Hayashi
- College of Medical, Pharmaceutical and Health Sciences, Kanazawa, Ishikawa, Japan
| | - Miku Ando
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Daiki Kobayashi
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Rina Nishigami
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takashi Asahara
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
- Okayama University Hospital, Kitaku, Okayama, Japan
| | - Sota Goto
- Faculty of Health Sciences, Kobe Tokiwa University, Kobe, Hyogo, Japan
| | - Cheonghae Lee
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, School of Medicine, Tokushima University, Tokushima, Tokushima, Japan
| | - Kosaku Higashino
- Department of Orthopedics and Rehabilitation, Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa, Japan
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Sarıbal GŞ, Canger EM, Yaray K. Evaluation of the radiation protection effectiveness of a lead-free homopolymer in cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:91-101. [PMID: 37002015 DOI: 10.1016/j.oooo.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/26/2022] [Accepted: 01/28/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The objective was to compare the radiation protection effectiveness of a lead-free thermoplastic homopolymer (Anti-RAD) to conventional lead shielding in cone beam computed tomography (CBCT) exposures. STUDY DESIGN Thermoluminescent dosimeters were placed on a human bone- and soft tissue-equivalent phantom to record equivalent doses in the thyroid gland, thyroid skin, and breast areas. CBCT images were obtained with the following 3 protocols: (1) without radiation shielding; (2) with 0.5-mm lead equivalent lead-containing shielding; and (3) with 0.5-mm lead equivalent Anti-RAD shielding. Independent t tests were used to evaluate the results. RESULTS Compared with exposures without shielding, both lead and Anti-RAD protective devices reduced thyroid gland equivalent doses by approximately 40%, thyroid skin doses by approximately 75%, right breast skin doses by approximately 80%, and left breast skin doses by 75%. The differences in equivalent dose for both types of shielding compared with exposure with no shielding were statistically significant (P ≤ .042). However, there were no significant differences in dose reduction at any site between lead and Anti-RAD shielding (P ≥ .135). CONCLUSIONS Radiation protection equivalent to lead can be provided with the Anti-RAD shield. With the use of this material, disadvantages such as damage to the aprons, lead toxicity, weight of lead aprons, and microbial contamination can be reduced.
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Affiliation(s)
- Gamze Şirin Sarıbal
- Research Assistant, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey.
| | - Emin Murat Canger
- Associate Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University-Kayseri, Turkey
| | - Kadir Yaray
- Department of Radiation Oncology, University of Erciyes Faculty of Medicine, Kayseri, Turkey
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Mehnati P, Malekzadeh R, Hussein HA, Obaid NH, Ebrahimiyan S, Sooteh MY, Refahi S. Trade-off between breast dose and image quality using composite bismuth shields in computed tomography: A phantom study. J Med Imaging Radiat Sci 2023; 54:145-152. [PMID: 36646544 DOI: 10.1016/j.jmir.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/26/2022] [Accepted: 12/07/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Many researchers have suggested that bismuth composite shields (BCS) reduce breast dose remarkably; however, the level of this reduction and its impact on image quality has not been assessed. This study aimed to evaluate the efficiency of nano- and micro- BCS in reducing the dose and image quality during chest computed tomography (CT) scans. MATERIALS AND METHODS Bismuth shields composed of 15 weighting percentage (wt%) and 20 wt% bismuth oxide (Bi2O3) nano- and micro-particles mixed in silicon rubber polymer were constructed in 1 and 1.5 mm thicknesses. The physical properties of nanoparticles were assessed using a scanning electron microscope (SEM), X-ray diffraction (XRD), and energy-dispersive X-ray (EDX). Breast radiation doses were measured experimentally during chest CT using PMMA standard dosimetry phantom (body phantom, 76-419-4150, Fluke Biomedical) in the presence of the shields. The image quality was assessed by calculating signal and noise values in different regions. RESULTS The SEM images showed that the average size of Bi2O3 nano- and micro-particles was about 70 nm and 150 μm, respectively. The breast doses were reduced by increasing the shield thickness/bismuth weight percentage. The maximum dose reduction was related to the 20% weight of Bi2O3 nano-particles and a thickness of 1.5 mm. The minimum dose reduction was related to the 15% weight of Bi2O3 micro-particles with a thickness of 1 mm. The mean noise was higher in nano-particle bismuth shields than in micro-particles. CONCLUSION Composite shields containing bismuth nano- and micro-particles can reduce the breast dose during chest CT examinations while negatively impacting diagnostic image quality. Several critical factors, such as bismuth concentration, particle size, and shield thickness, directly affect the efficiency.
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Affiliation(s)
- Parinaz Mehnati
- Department of Medical Physics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Malekzadeh
- Department of Medical Physics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Noor H Obaid
- Anesthesia Techniques Department, Al-Mustaqbal University College, Babylon, Iraq
| | - Saadat Ebrahimiyan
- Department of Medical Physics and Radiology, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mohammad Yousefi Sooteh
- Department of Medical Physics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soheila Refahi
- Department of Medical Physics, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
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González-López A. Technical note: Characteristics of the energy spread kernels of scattered radiation in an x-ray room. Med Phys 2023; 50:643-650. [PMID: 35908179 DOI: 10.1002/mp.15891] [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: 04/13/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To describe the scattered radiation spectra inside an x-ray room for different scattering conditions. METHODS Monte Carlo simulations of an x-ray room using phantoms of different size, varying field sizes, and a range of mono-energetic beams were carried out. For each energy, the particle fluence spectrum of scattered photons was collected at different spherical zones to describe the radiation reaching the different boundaries of the x-ray room. The effect on the scattered spectrum of the room floor was also considered. RESULTS The scattered spectra for mono-energetic primary beams at a given spherical zone give rise to oriented energy spread kernels (OESKs) that can be used to calculate the scattered spectrum for any poly-energetic beam at that zone. Despite the large differences, which can be seen in the OESKs when the scattering conditions vary, an important invariance is also observed: the position of the broad scatter peak for a given primary energy and zone. CONCLUSIONS The result of breaking down the calculation of the scattered radiation spectrum into the different factors that influence it allows estimating the spectrum in a wide range of situations. The invariant position of the broad scatter peak can be used to estimate the highest energy of the scattered photons for a given primary energy and zone, which may determine radiation shielding needs.
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Affiliation(s)
- Antonio González-López
- Hospital Clínico Universitario Virgen de la Arrixaca - IMIB, ctra. Madrid-Cartagena, El Palmar, Murcia, Spain
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Budošová D, Horváthová M, Bárdyová Z, Balázs T. CURRENT TRENDS OF RADIATION PROTECTION EQUIPMENT IN INTERVENTIONAL RADIOLOGY. RADIATION PROTECTION DOSIMETRY 2022; 198:554-559. [PMID: 36005965 DOI: 10.1093/rpd/ncac098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/11/2022] [Accepted: 05/22/2020] [Indexed: 06/15/2023]
Abstract
Interventional radiology represents subspecialty of radiology, which does not use imaging modalities only for diagnostics, but mostly for therapeutic purposes. Realisation of interventional procedures is done through X-rays, which replaces direct visual control done by interventional radiologist or cardiologist. For the targeted reduction of the radiation exposure, the interventional radiology staff use personal protective equipment. Usually, aprons with lead-equivalent are used, which provide protection for 75% of the radiosensitive organs. As the eye lens and thyroid gland belong to the radiosensitive organs, lead eyeglasses and thyroid collar are commonly used for their protection. Cap and gloves with lead-equivalent can be utilised as an additional personal protective equipment, that is commercially available. Innovative protection systems, such as mobile radiation protection cabin and suspended radiation protection, have been designed to ensure better radiation protection and safety. These systems provide the comfort for the interventional radiologists at work, while offering better protection against ionising radiation.
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Affiliation(s)
- Darina Budošová
- Trnava University in Trnava, Faculty of Health Care and Social Work, Department of Laboratory Medicine, Univerzitné námestie 1, Trnava 918 43, Slovakia
| | - Martina Horváthová
- Trnava University in Trnava, Faculty of Health Care and Social Work, Department of Laboratory Medicine, Univerzitné námestie 1, Trnava 918 43, Slovakia
| | - Zuzana Bárdyová
- Trnava University in Trnava, Faculty of Health Care and Social Work, Department of Laboratory Medicine, Univerzitné námestie 1, Trnava 918 43, Slovakia
| | - Tibor Balázs
- CINRE s.r.o., Center for Interventional Neuroradiology and Endovascular Treatment, Tematínska 5/a, Bratislava 851 05, Slovakia
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Chida K. What are useful methods to reduce occupational radiation exposure among radiological medical workers, especially for interventional radiology personnel? Radiol Phys Technol 2022; 15:101-115. [PMID: 35608759 DOI: 10.1007/s12194-022-00660-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
Protection against occupational radiation exposure in clinical settings is important. This paper clarifies the present status of medical occupational exposure protection and possible additional safety measures. Radiation injuries, such as cataracts, have been reported in physicians and staff who perform interventional radiology (IVR), thus, it is important that they use shielding devices (e.g., lead glasses and ceiling-suspended shields). Currently, there is no single perfect radiation shield; combinations of radiation shields are required. Radiological medical workers must be appropriately educated in terms of reducing radiation exposure among both patients and staff. They also need to be aware of the various methods available for estimating/reducing patient dose and occupational exposure. When the optimizing the dose to the patient, such as eliminating a patient dose that is higher than necessary, is applied, exposure of radiological medical workers also decreases without any loss of diagnostic benefit. Thus, decreasing the patient dose also reduces occupational exposure. We propose a novel four-point policy for protecting medical staff from radiation: patient dose Optimization, Distance, Shielding, and Time (pdO-DST). Patient dose optimization means that the patient never receives a higher dose than is necessary, which also reduces the dose received by the staff. The patient dose must be optimized: shielding is critical, but it is only one component of protection from radiation used in medical procedures. Here, we review the radiation protection/reduction basics for radiological medical workers, especially for IVR staff.
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Affiliation(s)
- Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai, 980-8575, Japan. .,Division of Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 468-1 Aoba, Aramaki, Aoba-ku, Sendai, 980-8572, Japan.
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Goula A, Chatzis A, Stamouli MA, Kelesi M, Kaba E, Brilakis E. Assessment of Health Professionals' Attitudes on Radiation Protection Measures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413380. [PMID: 34948989 PMCID: PMC8708066 DOI: 10.3390/ijerph182413380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Health professionals' knowledge, beliefs and perceptions concerning radiation protection may affect their behaviour during surgery and consequently influence the quality of health services. This study highlights the health professionals' average knowledge level and captures the beliefs, perceptions, and behaviours in a large public Greek hospital. (2) Materials and Methods: A cross-sectional study was carried out, including health professionals working in operating rooms. One hundred thirty-two staff members participated by responding to an original questionnaire. The sample consisted of nurses, radiographers and medical doctors of various specialties involved daily in surgical procedures where ionizing radiation is required. The survey was conducted from March to June 2021, and the response rate was 97%. (3) Results: The level of overall knowledge of health professionals regarding radiation protection safety was not satisfactory. Females and employees with a lower level of education had more misconceptions about radiation and radiation protection. Employees of younger ages and with less previous experience were more likely to have negative emotions towards radiation exposure. Finally, employees with fewer children tended to express physical complaints caused by their negative emotions due to radiation exposure. (4) Conclusions: Health professionals' lack of basic and specialized knowledge concerning radiation protection safety had a negative impact on the provision of health services. The continuing training of the staff seemed to be the only solution to reverse this trend. The training should highlight how radiation exposure can be minimized, safeguarding health professionals' trust and sense of security by significantly improving their working environment.
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Affiliation(s)
- Aspasia Goula
- Master of Health and Social Care Management, Department of Business Administration, School of Administrative, Economics and Social Sciences, University of West Attica, 12243 Athens, Greece; (A.C.); (M.-A.S.)
- Correspondence:
| | - Athanasios Chatzis
- Master of Health and Social Care Management, Department of Business Administration, School of Administrative, Economics and Social Sciences, University of West Attica, 12243 Athens, Greece; (A.C.); (M.-A.S.)
| | - Maria-Aggeliki Stamouli
- Master of Health and Social Care Management, Department of Business Administration, School of Administrative, Economics and Social Sciences, University of West Attica, 12243 Athens, Greece; (A.C.); (M.-A.S.)
| | - Martha Kelesi
- Department of Nursing, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (M.K.); (E.K.)
| | - Evridiki Kaba
- Department of Nursing, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (M.K.); (E.K.)
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A comprehensive Monte Carlo study to design a novel multi-nanoparticle loaded nanocomposites for augmentation of attenuation coefficient in the energy range of diagnostic X-rays. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2021. [DOI: 10.2478/pjmpe-2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Introduction: The present study aimed to investigate the radiation protection properties of silicon-based composites doped with nano-sized Bi2O3, PbO, Sm2O3, Gd2O3, WO3, and IrO2 particles. Radiation shielding properties of Sm2O3 and IrO2 nanoparticles were investigated for the first time in the current study.
Material and methods: The MCNPX (2.7.0) Monte Carlo code was utilized to calculate the linear attenuation coefficients of single and multi-nano structured composites over the X-ray energy range of 10–140 keV. Homogenous distribution of spherical nanoparticles with a diameter of 100 nm in a silicon rubber matrix was simulated. The narrow beam geometry was used to calculate the photon flux after attenuation by designed nanocomposites.
Results: Based on results obtained for single nanoparticle composites, three combinations of different nano-sized fillers Sm2O3+WO3+Bi2O3, Gd2O3+WO3+Bi2O3, and Sm2O3+WO3+PbO were selected, and their shielding properties were estimated. In the energy range of 20-60 keV Sm2O3 and Gd2O3 nanoparticles, in 70-100 keV energy range WO3 and for photons energy higher than 90 keV, PbO and Bi2O3 nanoparticles showed higher attenuation. Despite its higher density, IrO2 had lower attenuation compared to other nanocomposites. The results showed that the nanocomposite containing Sm2O3, WO3, and Bi2O3 nanoparticles provided better shielding among the studied samples.
Conclusions: All studied multi-nanoparticle nanocomposites provided optimum shielding properties and almost 8% higher attenuation relative to single nano-based composites over a wide range of photon energy used in diagnostic radiology. Application of these new composites is recommended in radiation protection. Further experimental studies are suggested to validate our findings.
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Law M, Ng DH, Yoon DK, Djeng SK. Performing angiographic intervention with a femoral entry shield: Element analysis microscopy and hand dose reduction for interventional radiologist. NUCLEAR ENGINEERING AND TECHNOLOGY 2021. [DOI: 10.1016/j.net.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Eder H, Schlattl H. Shielding effectiveness of X-ray protective garment. Phys Med 2021; 82:343-350. [PMID: 33765649 DOI: 10.1016/j.ejmp.2021.01.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Certification of the X-ray shielding garment is based on attenuation testing on flat material samples. We investigated the difference of shielding effectiveness compared to realistic use when the garment is worn on the body of a staff person. METHODS Attenuation factors of X-ray protective aprons have been evaluated for several clinical scenarios with Monte Carlo (MC) calculations based on the ICRP female reference model and an experimental setup. The MC calculated attenuation factors refer to the effective dose E, whereas the measured attenuation factors refer to the personal dose equivalent Hp(10). The calculated/measured factors were compared to the attenuation factors of the identical materials measured under the conditions of the standard IEC 61331-1 that is currently in use for the type testing of X-ray protective aprons. RESULTS As a result, for example, at a common tube voltage of 80 kV, the real attenuation factors of a 0.35 mm Pb apron worn by a 3-dimensional body were 38% to 76% higher than when measured under IEC conditions on flat samples. The MC-calculated organ doses show the maximum contribution to E being within the operatoŕs abdomen/pelvis region. CONCLUSIONS With our findings, personal X-ray protective garments could be improved in effectiveness.
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Affiliation(s)
- H Eder
- Formerly Bavarian Environment Agency, priv. Am Stadtpark 43, D-81243 München, Germany.
| | - H Schlattl
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Ingolstädter Landstraße 1, D-85764 Neuherberg, Germany.
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Saeedi-Moghadam M, Tayebi M, Chegeni N, Sina S, Kolayi T. Efficiency of non-lead and lead thyroid shields in radiation protection of CT examinations. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2020.109265] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Nowak M, Carbonez P, Krauss M, Verdun FR, Damet J. Characterisation and mapping of scattered radiation fields in interventional radiology theatres. Sci Rep 2020; 10:18754. [PMID: 33127938 PMCID: PMC7599331 DOI: 10.1038/s41598-020-75257-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 09/30/2020] [Indexed: 12/02/2022] Open
Abstract
We used the Timepix3 hybrid pixel detector technology in order to determine the exposure of medical personnel to ionizing radiation in an interventional radiology room. We measured the energy spectra of the scattered radiation generated by the patient during X-ray image-guided interventional procedures. We performed measurements at different positions and heights within the theatre. We first observed a difference in fluence for each staff member. As expected, we found that the person closest to the X-ray tube is the most exposed while the least exposed staff member is positioned at the patient’s feet. Additionally, we observed a shift in energy from head to toe for practitioners, clearly indicating a non-homogenous energy exposure. The photon counting Timepix3 detector provides a new tool for radiation field characterisation that is easier-to-use and more compact than conventional X-ray spectrometers. The spectral information is particularly valuable for optimising the use of radiation protection gear and improving dosimetry surveillance programs. We also found the device very useful for training purposes to provide awareness and understanding about radiation protection principles among interventional radiology staff.
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Affiliation(s)
- M Nowak
- CERN, European Organization for Nuclear Research, Geneva, Switzerland. .,Institut of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - P Carbonez
- CERN, European Organization for Nuclear Research, Geneva, Switzerland.,Department of Radiology, University of Otago, Christchurch, New Zealand
| | - M Krauss
- Department of Radiology, University of Otago, Christchurch, New Zealand.,Department of Interventional Radiology, Christchurch Hospital, Christchurch, New Zealand
| | - F R Verdun
- Institut of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - J Damet
- CERN, European Organization for Nuclear Research, Geneva, Switzerland.,Institut of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Radiology, University of Otago, Christchurch, New Zealand
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16
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Zohdiaghdam R, Mahmoudian M, Salimi S. Evaluation of synergistic effects of the single walled carbon nanotube and CeO2-hybrid based-nanocomposite against X-ray radiation in diagnostic radiology. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Wargo RR, Aljabal AF, Lin PP. Evaluation and verification of a simplified lead equivalency measurement method. J Appl Clin Med Phys 2020; 21:152-156. [PMID: 31916401 PMCID: PMC7020982 DOI: 10.1002/acm2.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/15/2019] [Accepted: 12/05/2019] [Indexed: 11/11/2022] Open
Abstract
Purpose This technical note presents an inexpensive tool and method for determining lead equivalency using digital radiography x‐ray equipment. Methods A test tool was developed using commercially available lead tape (3M™ Lead Foil Tape 421). The test tool consisted of nine varying lead thick squares arranged in a larger square (0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, and 1.0 mm). It was imaged on a DR plate with a digital portable x‐ray unit across a range of energies (60–120 kVp) and two beam filtrations. Lead equivalency was determined by using the linear relationship between dose to the detector and pixel values in the raw images. The lead equivalency of the tape was validated using known lead thicknesses (physically measured with caliper). Additional lead equivalency measurements were made for protective eyewear, a thyroid shield, and a lead apron. Results The test tool and method measured the two known lead thicknesses to be –9.7% to 7.1% different from the actual values across the range of energies under normal x‐ray beam conditions and under a 1‐mm copper filtered x‐ray beam. The additional lead equivalency measurements of radiation protection apparel across energies ranged from –6% to 20% for both beam conditions when compared with the values provided by the manufacturer. Conclusion This work validates the test tool and methodology as an inexpensive alternative to checking the lead equivalency of radiation protection apparel in a clinical setting. The methodology is equipment independent with a few prerequisites.
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Affiliation(s)
- Richard Ryan Wargo
- Department of Radiology Virginia Commonwealth University Richmond VA USA
| | - Areej Fawzi Aljabal
- Division of Medical Physics Department of Radiation Oncology Virginia Commonwealth University Richmond VA USA
| | - Pei‐Jan Paul Lin
- Department of Radiology Virginia Commonwealth University Richmond VA USA
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Şakar E, Özpolat ÖF, Alım B, Sayyed M, Kurudirek M. Phy-X / PSD: Development of a user friendly online software for calculation of parameters relevant to radiation shielding and dosimetry. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108496] [Citation(s) in RCA: 401] [Impact Index Per Article: 100.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Aljabal AF, Wargo RR, Lin PJP. Evaluation of lead equivalence of radiation protection apparatuses as a function of tube potential and spectral shaping filter. J Appl Clin Med Phys 2019; 20:204-209. [PMID: 31738469 PMCID: PMC6909127 DOI: 10.1002/acm2.12768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 05/29/2019] [Accepted: 10/11/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose This study aims to evaluate the lead equivalence (LE) of radiation protective apparatuses under various combinations of tube potentials and spectral shaping filter. Method In this study, the commercially available 3M™ Lead Foil Tape 421, with nominal lead thickness of 0.1 mm, was employed to determine the LE of four different radiation protective apparatuses. The LE of protective apparatus was determined by utilizing the X‐ray transmission curves obtained with the lead foil tape at 60–120 kVp in combination with the spectral shaping filters of 0.1, 0.2, 0.3, 0.6, and 0.9 mmCu. The experimental setup and test method, for the transmission measurements with narrow beam geometry, was performed in accordance to ASTM Designation F2547‐18 Standards. All measurements were obtained using cardiovascular interventional angiography system. Results A much larger discrepancies between the measured LE and stated (nominal) LE were observed at low tube potential (<70 kVp) for non‐lead protective apparatus. At higher tube potentials (>80 kVp) and thicker spectral shaping filters, the measured LE appears to be more consistent with the manufacturer specified nominal thickness for the protective apparatus investigated. On the other hand, for the lead protective eyeglasses, the measured lead equivalence of both the lead side shield and the lens of eyeglasses (0.38 and 0.85 mmPb respectively) are consistent across all tube voltage. Conclusion The conventional specification of LE without considering spectral shaping filter is a valid measure for tube voltages at and above 80 kVp. The measured LE generally exceed the specifications. The difference is most significant at lower tube potentials, and especially with thicker spectral shaping filters. At higher voltages (>100 kVp), the measured LE and the nominal LE are in good agreement with each other irrespective of the spectral shaping filter thickness.
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Affiliation(s)
- Areej Fawzi Aljabal
- Division of Medical Physics, Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Richard Ryan Wargo
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Pei-Jan Paul Lin
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
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Fakhoury E, Provencher JA, Subramaniam R, Finlay DJ. Not all lightweight lead aprons and thyroid shields are alike. J Vasc Surg 2019; 70:246-250. [DOI: 10.1016/j.jvs.2018.07.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/05/2018] [Indexed: 11/27/2022]
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21
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Protection evaluation of non-lead radiation-shielding fabric: preliminary exposure-dose study. Oral Radiol 2018; 35:224-229. [PMID: 30484195 DOI: 10.1007/s11282-018-0338-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effectiveness and shielding performance of a novel recently developed non-lead radiation-shielding fabric containing bismuth oxide (BO-fabric). METHODS BO-fabric was fabricated using urethane resin and bismuth nanopowder. A dose-measurement method was employed to evaluate the radiation-attenuation characteristics of the shielding fabric in accordance with the Korean Standards standard. The shielding performances (%) were calculated by measuring the radiation doses after lamination with increasing layers of fabric (1-10 layers). The physical performance of the fabric in terms of flexural and abrasion resistances was evaluated by the Korea Apparel Testing and Research Institute (KATRI). RESULTS The radiation-attenuation capabilities of one layer of BO-fabric were 58.5, 49.9, and 43.0% at tube voltages of 60, 80, and 100 kVp, respectively. The radiation-shielding performance upon lamination of BO-fabric gradually increased as the number of layers increased. Excellent flexural and abrasion resistances were observed in the KATRI evaluation. CONCLUSIONS A non-lead radiation-shielding fabric based on urethane resin and bismuth was fabricated and examined, revealing an excellent shielding performance. Owing to the flexibility and simple operation of the fabric, it can be employed for various designs of clothing and protective apparel with many purposes.
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Johansen S, Hauge IHR, Hogg P, England A, Lança L, Gunn C, Sanderud A. Are Antimony-Bismuth Aprons as Efficient as Lead Rubber Aprons in Providing Shielding against Scattered Radiation? J Med Imaging Radiat Sci 2018; 49:201-206. [PMID: 32074039 DOI: 10.1016/j.jmir.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/12/2017] [Accepted: 02/01/2018] [Indexed: 10/17/2022]
Abstract
AIM The aim of this study is to compare the absorption ability of two lead-free aprons with a lead apron. METHOD The absorption ability of three aprons was measured and compared; Opaque Fusion 0.35 mm (OpaqFu) bilayer apron containing bismuth and antimony, No Lead 0.35 mm (NoLead) one-layer apron containing antimony, and a lead apron. The measurements were repeated with and without each of the aprons present in both primary and scattered beams. The selected tube voltages were between 60 and 113 kVp with constant mAs, a fixed field size, and fixed source-to-object distance. RESULTS No significant difference in absorption ability of the two lead-free aprons compared with that of the lead apron was observed when the dose was measured in the primary beam. When measurements were performed in the scatter radiation field, the absorption ability of the OpaqFu apron was 1.3 times higher than that of NoLead apron and nearly equal to the absorption ability of the lead apron. An increase in the difference between the OpaqFu and NoLead aprons was observed for the tube energies higher than 100 kVp in favour of OpaqFu apron. CONCLUSION It is safe to use the lead-free aprons that were tested in this study in a clinical environment for the tube energy range of 60 kVp-113 kVp.
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Affiliation(s)
- Safora Johansen
- Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway; Division of Cancer Medicine, Department of Oncology, Oslo University Hospital-Radium Hospital, Oslo, Norway.
| | - Ingrid Helen Ryste Hauge
- Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway; Division of Radiology and Nuclear Medicine, Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Peter Hogg
- School of Health Sciences, University of Salford, Manchester, UK
| | - Andrew England
- School of Health Sciences, University of Salford, Manchester, UK
| | - Luís Lança
- ESTeSL - Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisboa, Portugal; Karolinska Institutet, Stockholm, Sweden
| | - Catherine Gunn
- School of Health Sciences, Dalhousie University, Halifax, Canada
| | - Audun Sanderud
- Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
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23
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Jones AK, Pasciak AS, Wagner LK. Impact of using scatter-mimicking beams instead of standard beams to measure penetration when assessing the protective value of radiation-protective garments. Med Phys 2018; 45:1071-1079. [PMID: 29314058 DOI: 10.1002/mp.12743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Use standardized methods to determine how assessment of protective value of radiation-protective garments changes under conditions employing standard beam qualities, scatter-mimicking primary beams, and a modified Hp (10) measurement. METHODS The shielding properties of radiation-protective garments depend on the spectrum of beam energies striking the garment and the attenuation properties of materials used to construct the garment, including x-ray fluorescence produced by these materials. In this study the primary beam spectra employed during clinical interventional radiology and cardiology procedures (clinical primary beams, CPB) were identified using radiation dose structured reports (RDSR) and fluoroscope log data. Monte Carlo simulation was used to determine the scattered radiation spectra produced by these CPB during typical clinical application. For these scattered spectra, scatter-mimicking primary beams (SMPB) were determined using numerical optimization-based spectral reconstruction that adjusted kV and filtration to produce the SMPB that optimally matched the scattered spectrum for each CPB. The penetration of a subset of SMPB through four radiation-protective garments of varying compositions and nominal thicknesses was measured using a geometry specified by the International Electrotechnical Commission (IEC). The diagnostic radiological index of protection (DRIP), which increases with increasing penetration through a garment, was calculated using these measurements. Penetration through the same garments was measured for standard beams specified by the American Society of Testing and Materials (ASTM). Finally, 10 mm of PMMA was affixed to the inside of each garment and the DRIP remeasured in this configuration to simulate Hp (10). RESULTS The SMPB based on actual CPB were in general characterized by lower kV (range 60-76) and higher half-value layer (HVL, range 3.44-4.89 mm Al) than standard beam qualities specified by ASTM (kV range 70-85; HVL range 3.4-4.0 mm Al). A lead garment of nominal thickness 0.5 mm (D) had a DRIP of 0.8%, two lead-free garments of 0.5 mm nominal thickness had DRIPs of 1.2% (A) and 2.2% (B), and a lead-free bilayer (C) had a DRIP of 1.4%. When standard beam qualities specified by the ASTM were used, the DRIP for D was 2.2%, 175% higher than the DRIP measured using SMPB, and for A, B, and C was 2.8%, 3.2%, and 2.9%, respectively. This was 133%, 45%, and 107% higher than the DRIP measured using SMPB. Differences between the DRIP of lead-alternative garments and the lead garment were reduced when measured with 10 mm of PMMA. Using this method, the measured DRIPs were 2.2% (A), 3.1% (B), 2.5% (C), and 2.3% (D). CONCLUSIONS Penetration of radiation through radiation-protective garments depended strongly on the methods and X-ray spectra used for evaluation. The DRIP was higher (i.e., protective value was lower) for lead-alternative garments than for lead garments in this evaluation. The DRIP was lower for all garments when SMPB based on actual clinical beam quality data were used to measure penetration compared to ASTM standard beams. Differences in penetration between lead-alternative and lead garments were less when the DRIP was measured with 10 mm of PMMA between the garment and the chamber.
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Affiliation(s)
- A Kyle Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Louis K Wagner
- Department of Diagnostic and Interventional Imaging, John P. and Kathrine G. McGovern Medical School, Houston, TX, 77030, USA
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Abstract
Medical staff should not be exposed to the primary X-ray beam during fluoroscopy-guided interventional procedures (FGIP). The main source of staff exposure is scatter radiation from the patient, which can be significant. Although many aspects of X-ray exposure to the patient as well as occupational exposure to interventional radiologists and other staff are strongly regulated and monitored in most countries, it is surprising how loosely the labeling and testing of the protective aprons is regulated. Interventional radiologists (IRs) have to be experts in interventional radiology as well as in basic facts regarding ways to provide a satisfactory level of protection from occupational exposure. IRs, however, are not familiar with the apron testing methods. The accompanying documents provided with aprons by manufacturers may not be informative enough. Vendors often report apron effectiveness at a single beam quality and attenuation. The vendor reports repeatedly disagree with independent reports, which clearly show that the attenuation of these garments at other important unreported energies may be lower than expected. Better trust no one and check your protective garment yourself, or, better yet, consult a medical physicist when making purchasing decisions related to protective garments. Each interventionist should choose garments that are appropriately protective for that individual's practice. Review of past personal dosimetry results and consultation with a medical physicist can help the IR make the best decision. This article will help the reader to understand why all protective garments are not created equally, and provides some practical tools that will allow safe and healthy practice in FGIP.
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Affiliation(s)
- Gabriel Bartal
- Department of Medical Imaging and Interventional Radiology, Meir Medical Center, Kfar Saba 44281, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
| | - Anna M Sailer
- Department of Radiology,Stanford University School of Medicine, Stanford, CA; Department of Radiology,Maastricht University Medical Center, Maastricht, Netherlands
| | - Eliseo Vano
- Radiology Department, Eliseo Vano, Medical School, Complutense University and Medical Physics Service, San Carlos University Hospital (IdISSC), Madrid, Spain
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The interaction between encapsulated Gd2O3 particles and polymeric matrix: The mechanism of fracture and X-ray attenuation properties. Colloids Surf A Physicochem Eng Asp 2017. [DOI: 10.1016/j.colsurfa.2017.09.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Verma S, Sanghi SK, Amritphale SS. Development of Advanced, Non-toxic, X-ray Radiation Shielding Glass Possessing Barium, Boron Substituted Kornerupine Crystallites in the Glassy Matrix. J Inorg Organomet Polym Mater 2017. [DOI: 10.1007/s10904-017-0697-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Peters SMB, Zweers D, de Lange F, Mourik JEM. LEAD COMPOSITE VS. NONLEAD PROTECTIVE GARMENTS: WHICH ARE BETTER? A MULTIVENDOR COMPARISON. RADIATION PROTECTION DOSIMETRY 2017; 175:460-465. [PMID: 28074020 DOI: 10.1093/rpd/ncw373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/02/2016] [Indexed: 06/06/2023]
Abstract
This study aims to provide more insight in attenuation characteristics and corresponding lead (Pb) equivalences of a broad range of commercially available lead composite and nonlead protective garments. Thirty garments of five manufacturers (listed as 0.25-0.35-0.50 mm Pb equivalent) were tested. Transmission values were determined at 70, 90 and 110 kVp using an inverse broad beam geometry. Pb equivalence was determined using lead sheets as reference material. A substantial variability in photon transmission across garments was found. Differences between lead composite and nonlead garments were not statistically significant. Depending on tube voltage, between 9 and 12 out of 30 garments had a lower Pb equivalence than the indicated value. This work shows that lead equivalence as indicated on a garment's label may overestimate its protective performance. Depending on the application a more thorough verification of the effectiveness of protective garments at the desired kVp is warranted.
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Affiliation(s)
- S M B Peters
- Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Geert Grooteplein-Zuid 10, 6500 HBNijmegen, the Netherlands
| | - D Zweers
- Leiden University Medical Center, Department of Radiology, Albinusdreef 2, 2333 ZALeiden, the Netherlands
| | - F de Lange
- Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Geert Grooteplein-Zuid 10, 6500 HBNijmegen, the Netherlands
| | - J E M Mourik
- Franciscus Gasthuis & Vlietland, Department of Radiology, Kleiweg 500, 3045 PMRotterdam, the Netherlands
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Çetin H, Yurt A, Yüksel SH. THE ABSORPTION PROPERTIES OF LEAD-FREE GARMENTS FOR USE IN RADIATION PROTECTION. RADIATION PROTECTION DOSIMETRY 2017; 173:345-350. [PMID: 26884505 DOI: 10.1093/rpd/ncw004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/23/2015] [Indexed: 06/05/2023]
Abstract
In this study, the absorption capability and the weight of various radiation-shielding materials were evaluated, for applications as alternatives to lead garments. Toxicity, atomic number, density, K-edge absorption energy and availability of elements that can serve as an alternative to lead, including tin, antimony, bismuth and tungsten, were considered. The attenuation coefficients of these elements were determined using the XCOM software package, and these metals were mixed with polymers at 50, 70, 80 and 85 % mass ratios. It can be concluded that all of the new shielding materials used in the study can be used for a diagnostic range of X-rays. However, they were compared with the commercial lead garments in terms of weight and attenuation coefficient; the 85 % samples were lighter than a 0.5-mm lead garment and provided superior radiation protection, which demonstrates its potential for commercial applications.
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Affiliation(s)
- Hüseyin Çetin
- Medical Physics, The Health Science Institute, Izmir, Balçova, Turkey
| | - Aysegül Yurt
- Medical Physics, The Health Science Institute, Izmir, Balçova, Turkey
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Subramanian S, Waller BR, Winders N, Bird LE, Agrawal V, Zurakowski D, Kuhls-Gilcrist A, Khandkar A, Sathanandam SK. Clinical evaluation of a radio-protective cream for the hands of the pediatric interventional cardiologist. Catheter Cardiovasc Interv 2017; 89:709-716. [PMID: 27888578 DOI: 10.1002/ccd.26845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/08/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effectiveness of UltraBLOX™ radiation attenuating hand cream during lengthy cardiac catheterization procedures in children. BACKGROUND The hands of interventional cardiologists receive high doses of radiation due to their proximity to the X-ray beam. Radiation attenuating gloves have about a 26% attenuation rate, but reduce dexterity and tactile sensation. The UltraBLOX™ cream is a new FDA-approved X-ray attenuating cream that can be applied to the operator's hands for radio-protection. METHODS Two nanoDot™ dosimeters were secured side by side on the dorsum of the operator's (n = 2) left hand close to the wrist. One dosimeter and the rest of the hand were covered with 0.2 mm layer of the cream. The other dosimeter was unshielded. Procedures were performed using 110 kVp fluoroscopy at 15 pulses/sec. The measurements were categorized into four groups dependent on the duration of the procedure. The patients in all four groups were well matched for age and size. RESULTS Procedural and cumulative hand radiation doses were higher with longer procedural duration. The overall % attenuation by the cream was 39.7% (28.6-51.5) and was unaffected by the length of the procedure (median: 40.9% at 30 min and 41.4% at 180 min; P = 0.66) or the dose of radiation. The kappa statistic for interobserver agreement for good tactile sensitivity was 0.82. CONCLUSIONS UltraBLOX™ cream provides a new option for radio-protection for the hands of interventional cardiologists without impairing tactile sensitivity. There was no decrease in attenuation up to 180 min. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Saradha Subramanian
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - B Rush Waller
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | | | - Lindsey E Bird
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Vijaykumar Agrawal
- Department of Radiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - David Zurakowski
- Department of Biostatistics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Shyam K Sathanandam
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
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Tayebi M, Shooli FS, Saeedi-Moghadam M. Evaluation of the scattered radiations of lead and lead-free aprons in diagnostic radiology by MCNPX. Technol Health Care 2017; 25:513-520. [PMID: 28085021 DOI: 10.3233/thc-161293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Over the past few years, because of high attenuation and lightweight, non-toxic, lead-free aprons (LFAs) have been replaced by lead aprons (LAs). Lots of studies declared that this fact was based on the interactions of diagnostic X-ray with material such as the photoelectric effect (PE) and Compton scattering. These studies have demonstrated that in these types of aprons, due to the presence of different K-edge absorption, PE has a wide absorption in various metals with divers K-edges. The measurement geometry in most of these studies was narrow beam geometry, i.e. a collimated source and a collimated detector with a large source-detector distance. OBJECTIVE The present study intended to evaluate the attenuation of radiology scattered radiations in LAs and LFAs in both narrow and broad beam geometries, which is a more realistic situation, in order to check whether or not the higher attenuation is valid. METHODS In this study, a lead apron contains (Pb + EPV) and two non-lead compounds of (W + Sn + EPVC) with different weight percent (Wt%) were evaluated in the energy range of diagnostic radiology (100 kVp). The MCNPX code was applied to simulate broad - and narrow-beam measurement geometries. The evaluations have been performed in three situations: 1st) the same density thickness of LA and LFAs 2nd) same line thickness of LA and LFAs 3rd) considering the thickness of LFAs which has the same attenuation with LAs i.e. lead equivalent thickness for LFAs in the narrow beam. Finally, the x-ray transmission ratio (I/I_0) of LAs and LFAs was compared in 100 kVp for three mentioned conditions. RESULTS Our results indicated that LFAs had more radiation attenuation rather than LA in the 1st and 2nd conditions with both geometries. However, LFAs had lower attenuation in comparison to LAs in the 3rd condition with broad beam geometry. More importantly, the transmission ratio (I/I_0) of LFAs in the broad beam condition was more significant than LA. CONCLUSION The scattered radiations produced by LFAs are more than LAs because of the production of characteristic radiations resulted from K-edge absorption in composited aprons. Consequently, the LFAs should be evaluated in both narrow and broad beam situation using the lead equivalent thickness of LFAs to make sure that the non-lead aprons do not increase the radiation dose of the user.
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Affiliation(s)
- Mansour Tayebi
- Ionizing and Non-Ionizing Radiation Protection Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Shekoohi Shooli
- Ionizing and Non-Ionizing Radiation Protection Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Saeedi-Moghadam
- Medical Imaging Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
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Burns KM, Shoag JM, Kahlon SS, Parsons PJ, Bijur PE, Taragin BH, Markowitz M. Lead Aprons Are a Lead Exposure Hazard. J Am Coll Radiol 2017; 14:641-647. [PMID: 28082154 DOI: 10.1016/j.jacr.2016.10.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine whether lead-containing shields have lead dust on the external surface. METHODS Institutional review board approval was obtained for this descriptive study of a convenience sample of 172 shields. Each shield was tested for external lead dust via a qualitative rapid on-site test and a laboratory-based quantitative dust wipe analysis, flame atomic absorption spectrometry (FAAS). The χ2 test was used to test the association with age, type of shield, lead sheet thickness, storage method, and visual and radiographic appearance. RESULTS Sixty-three percent (95% confidence interval [CI]: 56%-70%) of the shields had detectable surface lead by FAAS and 50% (95% CI: 43%-57%) by the qualitative method. Lead dust by FAAS ranged from undetectable to 998 μg/ft2. The quantitative detection of lead was significantly associated with the following: (1) visual appearance of the shield (1 = best, 3 = worst): 88% of shields that scored 3 had detectable dust lead; (2) type of shield: a greater proportion of the pediatric patient, full-body, and thyroid shields were positive than vests and skirts; (3) use of a hanger for storage: 27% of shields on a hanger were positive versus 67% not on hangers. Radiographic determination of shield intactness, thickness of interior lead sheets, and age of shield were unrelated to presence of surface dust lead. CONCLUSIONS Sixty-three percent of shields had detectable surface lead that was associated with visual appearance, type of shield, and storage method. Lead-containing shields are a newly identified, potentially widespread source of lead exposure in the health industry.
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Affiliation(s)
- Kevin M Burns
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
| | - Jamie M Shoag
- Department of Pediatrics, New York University Langone Medical Center, New York, New York
| | - Sukhraj S Kahlon
- Department of Radiology, University of California, Davis Medical Center, Sacramento, California
| | - Patrick J Parsons
- Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Department of Environmental Health Sciences, School of Public Health, The University at Albany, Albany, New York
| | - Polly E Bijur
- Albert Einstein College of Medicine, Bronx, New York
| | - Benjamin H Taragin
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Morri Markowitz
- Department of Pediatrics, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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Valuckiene Z, Jurenas M, Cibulskaite I. Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:695-708. [PMID: 27556787 DOI: 10.1088/0952-4746/36/3/695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ionizing radiation management is among the most important safety issues in interventional cardiology. Multiple radiation protection measures allow the minimization of x-ray exposure during interventional procedures. Our purpose was to assess the utilization and effectiveness of radiation protection and optimization techniques among interventional cardiologists in Lithuania. Interventional cardiologists of five cardiac centres were interviewed by anonymized questionnaire, addressing personal use of protective garments, shielding, table/detector positioning, frame rate (FR), resolution, field of view adjustment and collimation. Effective patient doses were compared between operators who work with and without x-ray optimization. Thirty one (68.9%) out of 45 Lithuanian interventional cardiologists participated in the survey. Protective aprons were universally used, but not the thyroid collars; 35.5% (n = 11) operators use protective eyewear and 12.9% (n = 4) wear radio-protective caps; 83.9% (n = 26) use overhanging shields, 58.1% (n = 18)-portable barriers; 12.9% (n = 4)-abdominal patient's shielding; 35.5% (n = 11) work at a high table position; 87.1% (n = 27) keep an image intensifier/receiver close to the patient; 58.1% (n = 18) reduce the fluoroscopy FR; 6.5% (n = 2) reduce the fluoro image detail resolution; 83.9% (n = 26) use a 'store fluoro' option; 41.9% (N = 13) reduce magnification for catheter transit; 51.6% (n = 16) limit image magnification; and 35.5% (n = 11) use image collimation. Median effective patient doses were significantly lower with x-ray optimization techniques in both diagnostic and therapeutic interventions. Many of the ionizing radiation exposure reduction tools and techniques are underused by a considerable proportion of interventional cardiology operators. The application of basic radiation protection tools and techniques effectively reduces ionizing radiation exposure and should be routinely used in practice.
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Affiliation(s)
- Zivile Valuckiene
- Department of Cardiology, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania
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Abstract
OBJECTIVE The purposes of this article are to review available data regarding the range of protection devices and garments with a focus on eye protection and to summarize techniques for reducing scatter radiation exposure. CONCLUSION Fluoroscopy operators and staff can greatly reduce their radiation exposure by wearing properly fitted protective garments, positioning protective devices to block scatter radiation, and adhering to good radiation practices. By understanding the essentials of radiation physics, protective equipment, and the features of each imaging system, operators and staff can capitalize on opportunities for radiation protection while minimizing ergonomic strain. Practicing and promoting a culture of radiation safety can help fluoroscopy operators and staff enjoy long, productive careers helping patients.
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Jones AK, Pasciak AS, Wagner LK. Sensitivity of the diagnostic radiological index of protection to procedural factors in fluoroscopy. Med Phys 2016; 43:4133. [PMID: 27370133 DOI: 10.1118/1.4952400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the sensitivity of the diagnostic radiological index of protection (DRIP), used to quantify the protective value of radioprotective garments, to procedural factors in fluoroscopy in an effort to determine an appropriate set of scatter-mimicking primary beams to be used in measuring the DRIP. METHODS Monte Carlo simulations were performed to determine the shape of the scattered x-ray spectra incident on the operator in different clinical fluoroscopy scenarios, including interventional radiology and interventional cardiology (IC). Two clinical simulations studied the sensitivity of the scattered spectrum to gantry angle and patient size, while technical factors were varied according to measured automatic dose rate control (ADRC) data. Factorial simulations studied the sensitivity of the scattered spectrum to gantry angle, field of view, patient size, and beam quality for constant technical factors. Average energy (Eavg) was the figure of merit used to condense fluence in each energy bin to a single numerical index. RESULTS Beam quality had the strongest influence on the scattered spectrum in fluoroscopy. Many procedural factors affect the scattered spectrum indirectly through their effect on primary beam quality through ADRC, e.g., gantry angle and patient size. Lateral C-arm rotation, common in IC, increased the energy of the scattered spectrum, regardless of the direction of rotation. The effect of patient size on scattered radiation depended on ADRC characteristics, patient size, and procedure type. CONCLUSIONS The scattered spectrum striking the operator in fluoroscopy is most strongly influenced by primary beam quality, particularly kV. Use cases for protective garments should be classified by typical procedural primary beam qualities, which are governed by the ADRC according to the impacts of patient size, anatomical location, and gantry angle.
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Affiliation(s)
- A Kyle Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - Alexander S Pasciak
- Department of Radiology, The University of Tennessee Medical Center at Knoxville, Knoxville, Tennessee 37922
| | - Louis K Wagner
- Department of Diagnostic and Interventional Imaging, The John P. and Katharine G. McGovern Medical School, Houston, Texas 77030
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La LB, Leong YK, Leatherday C, Au PI, Hayward KJ, Zhang LC. X-ray protection, surface chemistry and rheology of ball-milled submicron Gd2O3 aqueous suspension. Colloids Surf A Physicochem Eng Asp 2016. [DOI: 10.1016/j.colsurfa.2016.04.058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Santos FA, Galeano DC, Santos WS, Carvalho Júnior AB. Evaluation of medical exposure and exposure by the public in a typical scenario of examinations using mobile X-ray equipment through the Monte Carlo simulation. RADIAT MEAS 2016. [DOI: 10.1016/j.radmeas.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Uthoff H, Quesada R, Roberts JS, Baumann F, Schernthaner M, Zaremski L, Hajirawala L, Katzen BT, Staub D, Kreusch AS. Radioprotective lightweight caps in the interventional cardiology setting: a randomised controlled trial (PROTECT). EUROINTERVENTION 2015; 11:53-9. [DOI: 10.4244/eijv11i1a9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dixon S, Schick D, Harper J. Radiation protection methods for the interventionalist's hands: use of an extension tube. Cardiovasc Intervent Radiol 2014; 38:463-9. [PMID: 24798133 DOI: 10.1007/s00270-014-0893-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/06/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Cumulative radiation exposure to the hands during certain interventional procedures may be high. It is important to decrease the amount of radiation to the operator due to the possibility of deterministic effects. We performed a pilot study to demonstrate a significant decrease in operator dose when using extension tubing (ET) in combination with shielding and collimation during a simulated percutaneous transhepatic cholangiogram (PTC) procedure. METHODS A whole body, anthropomorphic phantom was used to simulate the patient. A Unfors-Xi Survey detector (to measure scatter) supported by a retort stand and trolley was placed in various positions to simulate the position of hands and eyes/thyroid of an interventionalist. Radiation dose was measured simulating left and right-sided PTC punctures with and without a lead shield, and with and without ET. RESULTS Regarding the radiation dose to the hands; the use of an ET reduces dose by 54 % in right-sided PTC punctures without a shield and by 91 % if used in combination with a shield. For left-sided PTC punctures, ET reduces hand dose by 75 %. The use of collimation decreases hand dose by approximately 60 %. The use of shielding reduces dose to the eyes/thyroid by 98 %. CONCLUSIONS The dose to the hands can be significantly reduced with the appropriate use of a shield, ET, and tight collimation. The use of a shield is paramount to reduce dose to the eyes/thyroid. It is important for interventionalists to adhere to radiation protective practice considering the potential deterministic effects during a lifelong career.
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Affiliation(s)
- Shaheen Dixon
- Department of Interventional Radiology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia,
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Smilowitz NR, Balter S, Weisz G. Occupational hazards of interventional cardiology. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:223-8. [DOI: 10.1016/j.carrev.2013.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/01/2013] [Accepted: 05/03/2013] [Indexed: 10/26/2022]
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