Radiation Protection in Interventional Radiology/Cardiology-Is State-of-the-Art Equipment Used?

Medical staff monitoring in interventional cardiology: over apron dosemeter placement based on measurements and simulations

Interventional cardiology is characterized by high radiation exposure for both the patient and the operator. Adequate shielding and monitoring of the operator are fundamental to comply with radiation protection principles. In a previous work, the effect on the dose of the dosemeter position on the chest was studied. In this paper, the investigation has been completed, employing an anthropomorphic thorax phantom, equipped with arms. Although there are differences between the Monte Carlo simulations and the measurements, similar trends are observed, showing that the reduction in dose, due to the arms, is between 20 and 60%, compared with the situation without arms. For that reason, considering a dosemeter placed on the chest, the upper position, which is the least affected by the arms, should be preferred while the extreme lateral position, near the armpit, should be avoided.

Occupational Risks of Radiation Exposure to Cardiologists

PURPOSE OF REVIEW

Invasive cardiologists are exposed to large amounts of ionizing radiation. This review aims to summarize the main occupational risks in a radiation-exposed cardiology practice.

RECENT FINDINGS

We carried out a literature review on the subject. The studies reviewed allowed us to list six main health risk categories possibly associated with radiation exposure among cardiologists: deoxyribonucleic acid (DNA) and biochemical damages; cancers; ocular manifestations; olfaction, vascular, and neuropsychological alterations; musculoskeletal problems; and reproductive risks. Our descriptive analysis demonstrates higher risks of DNA damage and lens opacities among radiation-exposed cardiology staff. Surveys and questionnaires have demonstrated a higher risk of musculoskeletal disease in exposed workers. Studies reported no difference in cancer frequency between radiation-exposed workers and controls. Changes in olfactory performance, neuropsychological aspects, and vascular changes have also been reported. Limited literature supports the security of continuing radiation-exposed work during pregnancy. Therefore, there is an urgent need to increase knowledge of the occupational risks of radiation exposure and to adopt technologies to reduce them.

Analysis of Periprocedural X-ray Exposure in Transarterial Radioembolization with Glass or Resin Microspheres

Background: Transarterial Radioembolization (TARE) is an effective treatment option for both primary and secondary liver malignancies. However, challenging anatomical conditions can lead to prolonged fluoroscopy times (FT), elevated doses of periprocedural X-radiation (DAP), and increased use of contrast agents (CAs). In this study, we examined the influence of our radiologists' experience and the choice of microspheres on X-ray exposure and CA doses in TARE. Material and Methods: Datasets comprising 161 TARE and 164 preprocedural evaluation angiographies (TARE-EVA) were analyzed. Our study focused on assessing DAP, FT, and CA concerning both microsphere types, the radiologist's experience, and whether the same radiologist performed both the TARE-EVA and the actual TARE. Results: In TARE, the use of resin microspheres resulted in significantly higher FT and CA compared to glass microspheres (14.3 ± 1.6 min vs. 10.6 ± 1.1 min and 43 ± 2.2 mL vs. 33.6 ± 2.1 mL, p < 0.05), with no notable differences in DAP (p = 0.13). Experienced radiologists demonstrated reduced FT/DAP, with a 19% decrease in DAP and 53% in FT during the evaluation angiography (p < 0.05) and a 49% reduction in DAP during the actual TARE (p < 0.05), with no statistical differences in FT. Performing TARE and TARE-EVA under the same radiologist led to a 43% reduction in DAP and a 25% decrease in FT (p < 0.05, respectively). Conclusions: To mitigate X-radiation exposure, it is advisable for radiologists to undergo thorough training, and, ideally, the same radiologist should conduct both the TARE and the TARE-EVA. While the use of glass spheres may decrease intraarterial CA, it does not significantly impact periprocedural X-ray exposure.

Efficacy and User Experience of a Novel X-Ray Shield on Operator Radiation Exposure During Cardiac Catheterization: A Randomized Controlled Trial

BACKGROUND

Radiation shielding is mandatory during cardiac catheterization, but there is a need to improve efficacy and ease of use.

METHODS

The aim of the study was to assess the shielding effect and user feedback for a novel flexible multiconfiguration x-ray shield (FMX). The 0.5-mm Pb equivalent FMX can be selectively configured to accommodate for variations in patient morphology, access site, and type of procedure with maintained visualization, vascular access, and shielding. To evaluate efficacy, relative operator dose (operator dose indexed for given dose) was measured during 103 consecutive procedures randomized in a 1:1 proportion to the current routine setup or FMX+routine. User feedback was collected on function, relevance, and likelihood of adoption into clinical practice.

RESULTS

Median relative operator dose was 3.63 μSv/µGy·m2×10-3 (IQR, 2.62-6.37) with routine setup and 0.57 μSv/µGy·m2×10-3 (IQR, 0.27-1.06) with FMX+routine, which amounts to an 84.4% reduction (P<0.001). For 500 procedures/year, this corresponds to an estimated yearly dose reduction from 3.6 to 0.7 mSv. User feedback regarding size, functionality, ease of use, likely to use, critical issues, shielding, draping, procedure time, vascular access, patient discomfort, and risk was 99% positive. No critical issues were identified. There was no significant difference in patient radiation exposure.

CONCLUSIONS

The FMX reduces radiation exposure considerably. The FMX represents an effective and attractive solution for radiation protection that can easily be implemented in existing workflow. FMX has potential for general use with maintained visualization, vascular access, and shielding in routine cardiac catheterization.

Lead Cap Use in Interventional Cardiology: Time to Protect Our Head in the Cardiac Catheterisation Laboratory?

Background: Radiation exposure is an occupational hazard for interventional cardiologists and cardiac catheterisation laboratory staff that can manifest with serious long-term health consequences. Personal protective equipment, including lead jackets and glasses, is common, but the use of radiation protective lead caps is inconsistent. Methods: A systematic review qualitative assessment of five observational studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines protocol was performed. Results: It was concluded that lead caps significantly reduce radiation exposure to the head, even when a ceiling-mounted lead shield was present. Conclusion: Although newer protective systems are being studied and introduced, tools, such as lead caps, need to be strongly considered and employed in the catheterisation laboratory as mainstay personal protective equipment.

Occupational radiation exposure of neurointerventionalists during endovascular stroke treatment

BACKGROUND

Radiological neuro-interventions, especially endovascular stroke treatment (EST), are increasing in case numbers worldwide with increasing occupational radiation exposure. Aim of this study was to define the radiation exposure of neurointerventionalists (NI) during EST and to compare the accumulated dose reaching the left arm with the left temple.

METHODS

This is a prospective observational study in a tertiary stroke center conducted between 11/2021 and 07/2022. Radiation exposure was measured using real time dosimetry with dosimeters being carried by the NI during EST simultaneously at the left temple and left arm. The effective dose [µSV] per dose area product (DAP) and potential influencing factors were compared in univariate analysis between the two dosimeter positions.

RESULTS

In total, 82 ESTs were analyzed with a median DAP of 6179 µGy*m² (IQR 3271 µGy*m²-11720 µGy*m²). The accumulated dose at the left arm and left temple correlated with the DAP and fluoroscopy time of the EST (DAP and arm: p = 0.01, DAP and temple: p = 0.006). The radiation exposure (RE) showed a wide range and did not differ between the two dosimeter positions (median, IQR arm 7 µSV, IQR 3.1-16.9 µSV, min. 0.3 µSV max. 64.5 µSV) vs. head 7 µSv, IQR 3.2-17.4 µSV, min. 0.38 µSV, max. 48.6 µSV, p = 0.94). Occupational RE depends on the number of thrombectomy attempts, but not the target vessel occlusion location or the NI's body height.

CONCLUSION

Neurointerventionalists experience a generally low but very variable radiation exposure during EST, which depends on the intervention's fluoroscopy time and dose area product as well as thrombectomy attempts but does not differ between left temple and left arm.

[Persistent fatigue symptoms following COVID-19 infection in healthcare workers: risk factors and impact on quality of life]

Hintergrund und Ziel

Durch ihre Tätigkeit sind Menschen aus medizinisch-pflegerischen Berufen einem erhöhten Risiko für eine SARS-CoV-2-Infektion ausgesetzt und dadurch öfter von Krankheitsfolgen betroffen. In bisherigen Studien wurde als häufigste Krankheitsfolge die postvirale Fatigue (Erschöpfungssyndrom nach viraler Infektion) identifiziert. Das Ziel der Studie war die Untersuchung von Risikofaktoren für anhaltende Fatiguesymptome infolge einer COVID-19-Infektion und deren Auswirkungen bei Beschäftigten im Gesundheitswesen.

Methoden

Im Frühjahr 2021 wurden 4315 Versicherte der Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW) für eine schriftliche Befragung zu ihrer COVID-19-Erkrankung im Jahr 2020 und den Krankheitsfolgen angeschrieben. Dabei wurden Symptome der Akutinfektion, Krankheitsfolgen, mögliche Risikofaktoren sowie der körperliche und psychische Gesundheitszustand nach der SARS-CoV-2-Infektion erhoben. Als Fatiguescreening wurde die Skala „Allgemeine Erschöpfung“ des Multidimensional Fatigue Inventory (MFI) eingesetzt. Zur Datenanalyse wurden Regressionsanalysen und multivariate Varianzanalysen berechnet.

Ergebnisse

10,7 % der Befragten wiesen schwere Fatiguewerte auf. Als Risikofaktoren für eine klinische Fatiguesymptomatik konnten u. a. Vorerkrankungen der Psyche und Atemwege sowie die Schwere der Akutinfektion identifiziert werden. Weiterhin war eine schwere Long‑/Post-COVID-Fatigue mit einer höheren psychischen Belastung, einer niedrigeren gesundheitsbezogenen Lebensqualität sowie mit einer häufigeren Arbeitsunfähigkeit assoziiert.

Diskussion

Von schwerer Long‑/Post-COVID-Fatigue geht ein hoher Leidensdruck aus, der spezifische Rehabilitationsansätze erfordert und Sozialversicherungsträger sowie Unfallversicherer vor die Herausforderung stellt, geeignete Rehabilitationskonzepte zu entwickeln.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-022-03511-4) enthalten.