Occupational Radiation Protection in Interventional Radiology: A Joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology

Abstract

Fluoroscopically guided interventional procedures are performed in large numbers in Europe and in the United States. The number of procedures performed annually throughout the world has increased over the past 20 years [1]. The benefits of interventional radiology to patients are both extensive and beyond dispute, but many of these procedures also have the potential to produce patient radiation doses high enough to cause radiation effects and occupational doses to interventional radiologists high enough to cause concern [1–4]. A joint SIR–CIRSE guideline on patient radiation management has addressed patient issues [3]. This guideline is intended to serve as a companion to that document and provides guidance to help minimize occupational radiation dose. The radiation dose received by interventional radiologists can vary by more than an order of magnitude for the same type of procedure and for similar patient dose [4]. Recently, there has been particular concern regarding occupational dose to the lens of the eye in interventional radiologists [2]. New data from exposed human populations suggest that lens opacities (cataracts) occur at doses far lower than those previously believed to cause cataracts [5, 6]. Statistical analysis of the available data suggests absence of a threshold dose, although if one does exist, it is possible that it is less than 0.1 Gy [7, 8]. Additionally, it appears that the latency period for radiation cataract formation is inversely related to the radiation dose [5]. Occupational radiation protection is a necessity whenever radiation is used in the practice of medicine. It is especially important for image-guided medical procedures [4, 9]. These procedures may involve high radiation dose rates in the interventional laboratory [10, 11]. Occupational radiation protection is necessary, not only during fluoroscopically guided procedures but also during CT-guided procedures, including CT fluoroscopy. CT fluoroscopy is not really fluoroscopy at all. It differs from conventional fluoroscopy in both equipment and technique. The radiation protection concerns for CT fluoroscopy differ somewhat, particularly in terms of avoiding an excessive radiation dose to the interventional radiologist’s hands [12, 13]. Occupational radiation protection requires both the appropriate education and training for the interventional radiologist and the availability of appropriate protection tools and equipment. Occupational radiation protection measures must also comply with local and national regulations, and should also consider the ergonomic detriment caused by personal protective devices [14–16]. Occupational radiation protection measures are necessary for all individuals who work in the interventional fluoroscopy suite. This includes not only technologists and nurses, who spend a substantial amount of time in a radiation environment, but also individuals such as anesthesiologists who may be in a radiation environment only occasionally. All of these individuals may be considered radiation workers, depending on their level of exposure and on national regulations. All workers require appropriate monitoring, as well as protection tools and equipment. They must also receive education and training appropriate to their jobs [14]. The level of training should be based on the level of risk. This guideline is intended to offer a basic review of the medical physics relevant to occupational radiation safety and to provide advice and guidance to interventional radiologists who perform procedures with the guidance of ionizing radiation and their staff. In this document, the emphasis is radiation protection during fluoroscopically guided procedures.