Abstract
Background: Numerous studies have demonstrated increasing evidence for cataractogenesis at lower levels of ionizing radiation than previously believed, with some suggesting possible absence of a threshold. Genetic differences between individuals also result in increased susceptibility in some operators, who might not be aware. European occupational exposure limits have been reduced and operators are seeking protective measures. Objective: To evaluate the protective effect of a face-shield equipped suspended protection system (Zero-Gravity®, TIDI Products, Neenah, WI) along with adherence to safety practices against radiation dose to the eye lens for an interventional radiologist performing a wide variety of procedures. Materials and Methods: In this institutional review board-approved single-institution study, one interventional radiologist wore a highly sensitive personnel monitoring dosimeter badge on the cap near the left eye while performing 299 procedures (3690 fluoroscopy minutes) over 18 consecutive months while utilizing the suspended protection system along with adherence to other generally recommended safety practices and movement away from the field during angiographic power injections. Dosimetry reports and procedural information were retrospectively reviewed. Results: Total lens dose equivalent to the left eye over 18 months was 0.11 mSv (annualized dose = 0.073 mSv, or 7.3 mRem). The patient-dose-area product standardized dose of 0.00576 μSv/Gy⋅cm2 is well below reports of conventional lead aprons, shields, and protective eyewear. Conclusion: Eye exposures were kept to near-background levels using the materials and methods of this study while performing a wide variety of complex procedures from all positions around the patient.
Highlights
Many studies have suggested that based on epidemiological evidence, cataracts may occur following exposure to lower doses of ionizing radiation than previously believed and may occur in a stochastic manner [1] [2] [3] [4]
Procedures performed from the head of the table, which are associated with higher exposures than standing at the patient’s side, included transjugular intrahepatic portosytemic shunts, trans-jugular liver biopsies, IVC filter retrievals, and line placements [27]
This study demonstrated very large reductions in lens doses compared to clinical reports of conventional shields and lead glasses
Summary
Many studies have suggested that based on epidemiological evidence, cataracts may occur following exposure to lower doses of ionizing radiation than previously believed and may occur in a stochastic manner [1] [2] [3] [4]. The European Union (EU) responded to the new ICRP recommendation by incorporating the new dose limits into the current European basic safety standard, while in the United States the National Council on Radiation Protection and Measurements (NCRP) has not advocated a reduction from the 7.5 fold higher annual limit of 15,000 mrem (150 mSv) [6] [7] This information has led interventional radiologists, interventional cardiologists and radiological technologists to revisit protective measures to combat radiation-induced cataractogenesis [4] [5] [8] [9]. A 2015 study concluded that any lens exposure may have associated cataract risk and suggested that interventional radiology work increases probability of cataract development [9] Employing protective measures such as leaded glasses, patient-supported protective blankets, and suspended ceiling shields have shown to reduce lens doses [7]. Conclusion: Eye exposures were kept to near-background levels using the materials and methods of this study while performing a wide variety of complex procedures from all positions around the patient
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