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Hiles P, Gilligan P, Damilakis J, Briers E, Candela-Juan C, Faj D, Foley S, Frija G, Granata C, de Las Heras Gala H, Pauwels R, Sans Merce M, Simantirakis G, Vano E. European consensus on patient contact shielding. Radiography (Lond) 2021; 28:353-359. [PMID: 34953726 DOI: 10.1016/j.radi.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.
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Affiliation(s)
- P Hiles
- Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK.
| | - P Gilligan
- European Federation of Organizations for Medical Physics, Utrecht, the Netherlands; Mater Private Hospital, Eccles St., Dublin 7, Ireland
| | - J Damilakis
- European Society of Radiology, EuroSafe Imaging, Vienna, Austria; University of Crete, Iraklion, Crete, Greece
| | - E Briers
- Member ESR-Patient Advisory Group, Patient Advocate, Hasselt, Belgium
| | - C Candela-Juan
- European Federation of Organizations for Medical Physics, Utrecht, the Netherlands; Centro Nacional de Dosimetría (CND), Instituto Nacional de Gestión Sanitaria, Valencia, Spain
| | - D Faj
- European Radiation Dosimetry Group, Neuherberg, Germany; Faculty of Dental Medicine and Health, Osijek, Croatia
| | - S Foley
- European Federation of Radiographer Societies, Utrecht, the Netherlands; Radiography & Diagnostic Imaging, University College Dublin, Ireland
| | - G Frija
- European Society of Radiology, EuroSafe Imaging, Vienna, Austria; Université de Paris, France
| | - C Granata
- European Society of Paediatric Radiology, Le Kremlin-Bicêtre, France; Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - H de Las Heras Gala
- European Federation of Organizations for Medical Physics, Utrecht, the Netherlands; Federal Office for Radiation Protection, Oberschleißheim, Germany
| | - R Pauwels
- Aarhus Institute of Advanced Studies, Aarhus University, Denmark
| | - M Sans Merce
- European Radiation Dosimetry Group, Neuherberg, Germany; Geneva University Hospitals, Geneva, Switzerland
| | - G Simantirakis
- European Radiation Dosimetry Group, Neuherberg, Germany; Greek Atomic Energy Commission, Agia Paraskevi, Athens, Greece
| | - E Vano
- European Society of Radiology, EuroSafe Imaging, Vienna, Austria; Radiology Department, Complutense University, Spain
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Merce MS, Candela-Juan C, Dabin J, Faj D, Gallagher A, de las Heras Gala H, Knežević Ž, Malchair F, De Monte F, Simantirakis G, Theodorakou C. Review of guidelines and legislative documents regarding the use of patient contact out-of-field shielding. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Dabin J, Blidéanu V, Bjelac OC, Deleu M, De Monte F, Feghali J, Gallagher A, Knežević Ž, Maccia C, Malchair F, Merce MS, Simantirakis G. Comparison of 10 skin dose mapping software products in interventional cardiology following a common protocol: results of the VERIDIC project. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00465-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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O'Connor U, Carinou E, Clairand I, Ciraj-Bjelac O, De Monte F, Domienik-Andrzejewska J, Ferrari P, Ginjaume M, Hršak H, Hupe O, Knežević Ž, Sans Merce M, Sarmento S, Siiskonen T, Vanhavere F. Recommendations for the use of active personal dosemeters (APDs) in interventional workplaces in hospitals. Phys Med 2021; 87:131-135. [PMID: 34153572 DOI: 10.1016/j.ejmp.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022] Open
Abstract
Occupational radiation doses from interventional procedures have the potential to be relatively high. The requirement to optimise these doses encourages the use of electronic or active personal dosimeters (APDs) which are now increasingly used in hospitals. They are typically used in tandem with a routine passive dosimetry monitoring programme, with APDs used for real-time readings, for training purposes and when new imaging technology is introduced. However, there are limitations when using APDs. A survey in hospitals to identify issues related to the use of APDs was recently completed, along with an extensive series of APD tests by the EURADOS Working Group 12 on Dosimetry for Medical Imaging. The aim of this review paper is to summarise the state of the art regarding the use of APDs. We also used the results of our survey and our tests to develop a set of recommendations for the use of APDs in the clinical interventional radiology/cardiology settings, and draw attention to some of the current challenges.
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Affiliation(s)
| | - E Carinou
- Greek Atomic Energy Commission, EEAE, Agia Paraskevi, Attiki, Greece
| | - I Clairand
- IRSN, Institute for Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France
| | - O Ciraj-Bjelac
- Vinca Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - F De Monte
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - P Ferrari
- ENEA. IRP-Radiation Protection Institute, Bologna, Italy
| | - M Ginjaume
- UPC, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - H Hršak
- University Hospital Centre Zagreb, Croatia
| | - O Hupe
- Physikalisch-Technische Bundesanstalt (PTB), 38116 Braunschweig, Germany
| | - Ž Knežević
- Ruđer Bošković Institute RBI, Zagreb, Croatia
| | - M Sans Merce
- CHUV, University Hospital of Lausanne, Lausanne, Switzerland; HUG, University Hospital of Geneva, Geneva, Switzerland
| | - S Sarmento
- IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | | | - F Vanhavere
- SCK-CEN, Belgian Nuclear Research Centre, Mol, Belgium
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Vanhavere F, Carinou E, Clairand I, Ciraj-Bjelac O, De Monte F, Domienik-Andrzejewska J, Ferrari P, Ginjaume M, Hršak H, Hupe O, Knezevic Z, O'Connor U, Merce MS, Sarmento S, Savary A, Siskoonen T. THE USE OF ACTIVE PERSONAL DOSEMETERS IN INTERVENTIONAL WORKPLACES IN HOSPITALS: COMPARISON BETWEEN ACTIVE AND PASSIVE DOSEMETERS WORN SIMULTANEOUSLY BY MEDICAL STAFF. Radiat Prot Dosimetry 2020; 188:22-29. [PMID: 31832653 DOI: 10.1093/rpd/ncz253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/11/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
Medical staff in interventional procedures are among the professionals with the highest occupational doses. Active personal dosemeters (APDs) can help in optimizing the exposure during interventional procedures. However, there can be problems when using APDs during interventional procedures, due to the specific energy and angular distribution of the radiation field and because of the pulsed nature of the radiation. Many parameters like the type of interventional procedure, personal habits and working techniques, protection tools used and X-ray field characteristics influence the occupational exposure and the scattered radiation around the patient. In this paper, we compare the results from three types of APDs with a passive personal dosimetry system while being used in real clinical environment by the interventional staff. The results show that there is a large spread in the ratios of the passive and active devices.
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Affiliation(s)
- F Vanhavere
- SCK-CEN, Belgian Nuclear Research Centre, Mol, Belgium
| | - E Carinou
- Greek Atomic Energy Commission, EEAE, Agia Paraskevi, Attiki, Greece
| | - I Clairand
- IRSN, Institute for Radiological Protection and Nuclear Safery, Fontenay-Aux-Roses, France
| | - O Ciraj-Bjelac
- Vinca Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - F De Monte
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - P Ferrari
- ENEA. IRP-Radiation Protection Institute, Bologna, Italy
| | - M Ginjaume
- UPC, Universitat Politècnica de Catalunya, Barcelona, Spain
| | | | - O Hupe
- Physikalisch-Technische Bundesanstalt (PTB), 38116 Braunschweig, Germany
| | - Z Knezevic
- Ruder Boskovic Institute RBI, Zagreb, Croatia
| | | | - M Sans Merce
- CHUV, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - S Sarmento
- Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - A Savary
- IRSN, Institute for Radiological Protection and Nuclear Safery, Fontenay-Aux-Roses, France
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6
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Siiskonen T, Ciraj-Bjelac O, Dabin J, Diklic A, Domienik-Andrzejewska J, Farah J, Fernandez J, Gallagher A, Hourdakis C, Jurkovic S, Järvinen H, Järvinen J, Knežević Ž, Koukorava C, Maccia C, Majer M, Malchair F, Riccardi L, Rizk C, Sanchez R, Sandborg M, Merce MS, Segota D, Sierpowska J, Simantirakis G, Sukupova L, Thrapsanioti Z, Vano E. Establishing the European diagnostic reference levels for interventional cardiology. Phys Med 2018; 54:42-48. [DOI: 10.1016/j.ejmp.2018.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/19/2018] [Accepted: 09/23/2018] [Indexed: 11/29/2022] Open
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7
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Carnicer A, Ginjaume M, Duch M, Vanhavere F, Sans Merce M, Baechler S, Barth I, Donadille L, Ferrari P, Fulop M, Gualdrini G, Krim S, Mariotti M, Ortega X, Rimpler A, Ruiz N, Olko P. The use of different types of thermoluminescent dosimeters to measure extremity doses in nuclear medicine. RADIAT MEAS 2011. [DOI: 10.1016/j.radmeas.2011.06.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sans Merce M, Ruiz N, Barth I, Carnicer A, Donadille L, Ferrari P, Fulop M, Ginjaume M, Gualdrini G, Krim S, Mariotti F, Ortega X, Rimpler A, Vanhavere F, Baechler S. Extremity exposure in nuclear medicine: preliminary results of a European study. Radiat Prot Dosimetry 2011; 144:515-520. [PMID: 21233097 DOI: 10.1093/rpd/ncq574] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The Work Package 4 of the ORAMED project, a collaborative project (2008-11) supported by the European Commission within its seventh Framework Programme, is concerned with the optimisation of the extremity dosimetry of medical staff in nuclear medicine. To evaluate the extremity doses and dose distributions across the hands of medical staff working in nuclear medicine departments, an extensive measurement programme has been started in 32 nuclear medicine departments in Europe. This was done using a standard protocol recording all relevant information for radiation exposure, i.e. radiation protection devices and tools. This study shows the preliminary results obtained for this measurement campaign. For diagnostic purposes, the two most-used radionuclides were considered: (99m)Tc and (18)F. For therapeutic treatments, Zevalin(®) and DOTATOC (both labelled with (90)Y) were chosen. Large variations of doses were observed across the hands depending on different parameters. Furthermore, this study highlights the importance of the positioning of the extremity dosemeter for a correct estimate of the maximum skin doses.
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Affiliation(s)
- M Sans Merce
- Institute of Radiation Physics, University Hospital Center of Lausanne, Grand-pré 1, 1007 Lausanne, Switzerland.
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9
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Ginjaume M, Carinou E, Donadille L, Jankowski J, Rimpler A, Sans Merce M, Vanhavere F, Denoziere M, Daures J, Bordy JM, Itie C, Covens P. Extremity ring dosimetry intercomparison in reference and workplace fields. Radiat Prot Dosimetry 2008; 131:67-72. [PMID: 18757894 DOI: 10.1093/rpd/ncn230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
An intercomparison of ring dosemeters has been organised with the aim of assessing the technical capabilities of available extremity dosemeters and focusing on their performance at clinical workplaces with potentially high extremity doses. Twenty-four services from 16 countries participated in the intercomparison. The dosemeters were exposed to reference photon ((137)Cs) and beta ((147)Pm, (85)Kr and (90)Sr/(90)Y) fields together with fields representing realistic exposure situations in interventional radiology (direct and scattered radiation) and nuclear medicine ((99 m)Tc and (18)F). It has been found that most dosemeters provided satisfactory measurements of H(p)(0.07) for photon radiation, both in reference and realistic fields. However, only four dosemeters fulfilled the established requirements for all radiation qualities. The main difficulties were found for the measurement of low-energy beta radiation. Finally, the results also showed a general under-response of detectors to (18)F, which was attributed to the difficulties of the dosimetric systems to measure the positron contribution to the dose.
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Affiliation(s)
- M Ginjaume
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya, Diagonal 647, 08028 Barcelona, Spain.
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Donadille L, Carinou E, Ginjaume M, Jankowski J, Rimpler A, Sans Merce M, Vanhavere F. An overview of the use of extremity dosemeters in some European countries for medical applications. Radiat Prot Dosimetry 2008; 131:62-66. [PMID: 18723854 DOI: 10.1093/rpd/ncn229] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Some medical applications are associated with high doses to the extremities of the staff exposed to ionising radiation. At workplaces in nuclear medicine, interventional radiology, interventional cardiology and brachytherapy, extremities can be the limiting organs as far as regulatory dose limits for workers are concerned. However, although the need for routine extremity monitoring is clear for these applications, no data about the status of routine extremity monitoring reported by different countries was collected and analysed so far, at least at a European level. In this article, data collected from seven European countries are presented. They are compared with extremity doses extracted from dedicated studies published in the literature which were reviewed in a previous publication. The analysis shows that dedicated studies lead to extremity doses significantly higher than the reported doses, suggesting that either the most exposed workers are not monitored, or the dosemeters are not routinely worn or not worn at appropriate positions.
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Affiliation(s)
- L Donadille
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), BP 17, 92262 Fontenay-aux-Roses Cedex, France.
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Vanhavere F, Carinou E, Donadille L, Ginjaume M, Jankowski J, Rimpler A, Sans Merce M. An overview on extremity dosimetry in medical applications. Radiat Prot Dosimetry 2008; 129:350-355. [PMID: 18448440 DOI: 10.1093/rpd/ncn149] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Some activities of EURADOS Working Group 9 (WG9) are presently funded by the European Commission (CONRAD project). The objective of WG9 is to promote and co-ordinate research activities for the assessment of occupational exposures to staff at workplaces in interventional radiology (IR) and nuclear medicine. For some of these applications, the skin of the fingers is the limiting organ for individual monitoring of external radiation. Therefore, sub-group 1 of WG9 deals with the use of extremity dosemeters in medical radiation fields. The wide variety of radiation field characteristics present in a medical environment together with the difficulties in measuring a local dose that is representative for the maximum skin dose, usually with one single detector, makes it difficult to perform accurate extremity dosimetry. Sub-group 1 worked out a thorough literature review on extremity dosimetry issues in diagnostic and therapeutic nuclear medicine and positron emission tomography, interventional radiology and interventional cardiology and brachytherapy. Some studies showed that the annual dose limits could be exceeded if the required protection measures are not taken, especially in nuclear medicine. The continuous progress in new applications and techniques requires an important effort in radiation protection and training.
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Affiliation(s)
- F Vanhavere
- Belgian Nuclear Research Centre, Boeretang 200, 2400 Mol, Belgium.
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12
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Carinou E, Donadille L, Ginjaume M, Jankowski J, Rimpler A, Sans Merce M, Vanhavere F, Denoziere M, Daures J, Bordy J, Itie C, Covens P. Intercomparison on measurements of the quantity personal dose equivalent, (0.07), by extremity ring dosimeters in medical fields. RADIAT MEAS 2008. [DOI: 10.1016/j.radmeas.2008.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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