Protective Apron Research Articles

Protective aprons in Interventional Radiology and Cardiology: An assessment of minimum requirements

It has been shown that lead-free and lead-composite aprons do not perform as well as their 100% lead counterparts, and secondary fluorescent radiation can contribute to staff doses. The aim of this project is to measure the transmission through the current cohort of aprons in use in our Cardiology and Interventional Radiology departments, to examine the effectiveness of their protection and determine the optimal transmission and design of protective aprons for future purchasing. Apron designs include full length, backless, skirt/vest aprons, both single panel and overlap. Measurements performed in narrow, broad and the recommended inverse-broad beam geometries (I.S.EN61331-1-2014) are compared with a 100% lead apron for a number of beam qualities. Aprons tested include Xenolite TB and NL, Safety First, Rayshield and Infab lead-free and bi-layer aprons, as well as a 100% lead Amray apron. Calibrated Harshaw TLD-100 and TLD-100H dosimeters were placed on the aprons of several members of staff, including an IR radiologist and a Cardiology registrar, to measure the effectiveness of the apron at multiple sites in a clinical setting. Preliminary results show that for high throughput/high dose procedures, lead equivalence of 0.25 mm is inadequate. The extent of the overlap is not sufficient on some models of apron, particularly on the side of the apron closest to the tube. The suitability of backless aprons will also be discussed. Results will inform minimum requirements, such as the type and thickness of barrier material, apron design and extent of the overlap required for optimal protection.

Protective aprons in Interventional Radiology and Cardiology: An assessment of minimum requirements

Protective aprons in Interventional Radiology and Cardiology: An assessment of minimum requirements

Development of Qualitative Evaluation of Medical Radiation Protective Apron

Development of Qualitative Evaluation of Medical Radiation Protective Apron

A Study of Shielding and Comfort Performance for Selected Fabrics Used as Casing Material for X-Ray Protective Aprons

Lead aprons are typically worn by radiographers to protect them from harmful radiation. As such, a good radiation shield must have a high Lead Equivalence to minimize the transmitted radiation dose during exposure. While most radiation shields fulfil this requirement by using matrices of lead and other substances, most aprons are uncomfortable to wear. Further, if the examination takes longer than expected, the radiographer will feel discomfort because of the heavy weight of the apron, or the smooth surface of the coated casing material. Another issue is the poor fit and design of the aprons due to the stiffness of the lead sheet. In general, the comfort characteristics of any textile material are related to air permeability, moisture management, abrasion resistance, fabric structure, thickness and weight, as well as yarn types. The objective of this study is to use standard testing methods to characterize some selected fabrics in terms of their X-ray shielding ability, physical, mechanical, and morphologic properties. The implication of this research will help for further study of this type of fabrics to improve thermal comfort of X-ray protective clothing.

Efficiency of personal dosimetry methods in vascular interventional radiology

PurposeThe aim of the present study was to determine the efficiency of six methods for calculate the effective dose (E) that is received by health professionals during vascular interventional procedures. MethodsWe evaluated the efficiency of six methods that are currently used to estimate professionals’ E, based on national and international recommendations for interventional radiology. Equivalent doses on the head, neck, chest, abdomen, feet, and hands of seven professionals were monitored during 50 vascular interventional radiology procedures. Professionals’ E was calculated for each procedure according to six methods that are commonly employed internationally. To determine the best method, a more efficient E calculation method was used to determine the reference value (reference E) for comparison. ResultsThe highest equivalent dose were found for the hands (0.34±0.93mSv). The two methods that are described by Brazilian regulations overestimated E by approximately 100% and 200%. The more efficient method was the one that is recommended by the United States National Council on Radiological Protection and Measurements (NCRP). The mean and median differences of this method relative to reference E were close to 0%, and its standard deviation was the lowest among the six methods. ConclusionsThe present study showed that the most precise method was the one that is recommended by the NCRP, which uses two dosimeters (one over and one under protective aprons). The use of methods that employ at least two dosimeters are more efficient and provide better information regarding estimates of E and doses for shielded and unshielded regions.

Occupational exposure in orthopedic procedures under fluoroscopic control

In interventional radiology the highest radiation doses are usually recorded for both the medical staff and the patients. Interventional procedures with X-rays are implemented in a number of medical specializations. This paper concerns the exposure of interventional teams performing orthopedic procedures under X-rays control. Doses for interventional teams were measured in the 3 Łódź hospitals. Thermoluminescent dosemeters were applied to measure the following dose equivalents: Hp(3) for eye lens, Hp(0.07) for palm skin, Hp(10) at the level of the neck without a protective shield (i.e., collar) and Hp(10) for the whole body on the front surface of the trunk (measured under the protective apron at the level of the chest). Doses for the operator who performs surgery, assisting physicians and scrub nurse were measured during 95 procedures. The highest doses were received by the operator the dose for eyes per 1 procedure did not exceed 0.1 mSv, the highest dose for hands was 1.6 mSv and the highest recorded effective dose was 0.02 mSv. On the basis of the results of measurements and their comparison with the values reported in the literature it may be concluded that the obtained results fall within the published reference range (for non-vascular procedures). This proves the compatibility of practice in the monitored Łódź hospitals with routine methodology applied in other interventional departments. The measurement results confirm that the usage of thermoluminescent dosimetry is fully adequate for the evaluation of exposure in interventional radiology and that the usage of at least 2 dosemeters for that staff is necessary. Med Pr 2017;68(2):221-227.

Radiation Exposure of Patients and Interventional Radiologists during Prostatic Artery Embolization: A Prospective Single-Operator Study

PurposeTo prospectively analyze the radiation exposure of patients and interventional radiologists during prostatic artery embolization (PAE). Materials and MethodsTwenty-five consecutive PAE procedures performed with an Artis zee system in a single center by an interventional radiologist were prospectively monitored. The mean age, weight, and prostate volume of the patients were 65.7 year (range, 43–85 y), 71.4 kg (range, 54–88 kg), and 79 cm3 (range, 36–157 cm3), respectively. In addition to Digital Imaging and Communications in Medicine radiation data, direct measures were also obtained. Radiochromic film was used to evaluate peak skin dose (PSD). The radiologist wore a protective apron and a thyroid collar, and a ceiling-suspended screen and a table curtain were used. To estimate the absorbed doses, nine pairs of dosimeters were attached to the operator’s body. ResultsThe average fluoroscopy time was 30.9 minutes (range, 15.5–48.3 min). The mean total dose–area product (DAP) was 450.7 Gy·cm2 (range, 248.3–791.73 Gy·cm2) per procedure. Digital subtraction angiography was responsible for 71.5% of the total DAP, followed by fluoroscopy and cone-beam computed tomography. The mean PSD was 2,420.3 mGy (range, 1,390–3,616 mGy). The average effective dose for the interventional radiologist was 17 μSv (range, 4–47 μSv); values for the eyes, hands, and feet were obtained, and were all greater on the left side. ConclusionsPAE may lead to high x-ray exposures to patients and interventional radiologists.

Test of ring, eye lens and whole body dosemeters for the dose quantity Hp(3) to be used in interventional radiology

In its statement on tissue reactions approved on 21st April 2011, the International Commission on Radiological Protection (ICRP, 2012) reviewed its recommendation concerning the equivalent dose limit for the eye lens and reduced the dose limits for occupationally exposed persons to 20 mSv in a year, averaged over defined periods of 5 years, with no single year exceeding 50 mSv. This limit was approved and written down in the new EURATOM (European Atomic Energy Community) directive 2013/59 and in the IAEA (International Atomic Energy Agency) BSS (Basic Safety Standard) of July 2014.For that reason, the necessity to monitor the eye lens may become more important than it was before. However, specially dedicated dosemeters for the dose quantity Hp(3) are using very rarely. Commonly use are only whole body personal dosemeters for the personal dose equivalent quantities Hp(10) worn on the trunk and ring dosemeters worn on finger to measure the quantity Hp(0.07).Therefore, in this work it was investigated whether dosemeters from routine use calibrated in terms of Hp(10) and Hp(0.07) and worn on thyroid collar and protective apron could deliver similar results like dedicated eye lens dosemeter worn close to the eyes.The results show that the best method if dedicated eye lens dosimeters is not used is to measure doses in terms of Hp(0.07) on the thyroid collar (Pearson product, r=0.85). Obtained results shows also importance of proper localization of eye lens dosimeter (close to the eye, from side of the X-ray source).

MOX燃料施設における眼の水晶体の線量評価の現状と課題

At the JAEA MOX fuel facilities, workers engaged in glove box operations uses two personal dosemeters, one worn on the trunk under a protective apron and the other at the collar over the apron. The recorded lens of the eye dose is based on the photon dose measured by the collar dosemeter plus the neutron dose measured by the under-apron dosemeter. To estimate preliminarily the potential impact of the ICRP-proposed eye dose limit which reduced down to 20 mSv per year on the current plant operation, we carried out an investigation of the dose records for the workers over last 11 years. Of a total of 2,843 workers' records analyzed, no worker's annual eye dose exceeded the proposed limit of 20 mSv; about 0.9 % was greater than 15 mSv, with a maximum of 18.9 mSv. This result suggests that keeping the eye dose under 20 mSv per year would be achievable without an extremely major impact on plant operation; but the fact that the effective dose is certain to be limited by the eye dose likely to be closer to the relevant dose limit will result in more stringent administrative control on the eye dose and might require, if necessary, additional shield and a protective eyewear for some workers.

A Study of Changes in the Primary Dose Penetrating the Protective Apron on SID in X-ray Radiography

A Study of Changes in the Primary Dose Penetrating the Protective Apron on SID in X-ray Radiography

Estimating head and neck tissue dose from x-ray scatter to physicians performing x-ray guided cardiovascular procedures: a phantom study

Physicians performing x-ray guided interventional procedures have a keen interest in radiation safety. Radiation dose to tissues and organs of the head and neck are of particular interest because they are not routinely protected by wearable radiation safety devices. This study was conducted to facilitate estimation of radiation dose to tissues of the head and neck of interventional physicians based on the dose recorded by a personal dosimeter worn on the left collar. Scatter beam qualities maximum energy and HVL were measured for 40 scatter beams emitting from an anthropomorphic patient phantom. Variables of the scatter beams included scatter angle (35° and 90°), primary beam peak tube potential (60, 80, 100, and 120 kVp), and 5 Cu spectral filter thicknesses (0–0.9 mm). Four reference scatter beam qualities were selected to represent the range of scatter beams realized in a typical practice. A general radiographic x-ray tube was tuned to produce scatter-equivalent radiographic beams and used to simultaneously expose the head and neck of an anthropomorphic operator phantom and radiochromic film. The geometric relationship between the x-ray source of the scatter-equivalent beams and the operator phantom was set to mimic that between a patient and physician performing an invasive cardiovascular procedure. Dose to the exterior surface of the operator phantom was measured with both 3 × 3 cm2 pieces of film and personal dosimeters positioned at the location of the left collar. All films were scanned with a calibrated flatbed scanner, which converted the film’s reflective density to dose. Films from the transverse planes of the operator phantom provided 2D maps of the dose distribution within the phantom. These dose maps were normalized by the dose at the left collar, providing 2D percent of left collar dose (LCD) maps. The percent LCD maps were overlain with bony anatomy CT images of the operator phantom and estimates of percent LCD to the left, right and whole brain, brain stem, lenses of the eyes, and carotid arteries were calculated. Per expectation, results indicated greater percent dose to superficial versus deep tissues and increasing percent dose to deep tissues with increasing scatter-equivalent beam energy and HVL. The results enable estimation of the scatter dose to tissues of the head and neck of interventional physicians based on occupational dose measured by a personal dosimeter worn at the collar outside the protective apron.

Risk factors for leptospirosis seropositivity in slaughterhouse workers in western Kenya

ObjectivesLeptospirosis has been documented in slaughterhouse workers around the world. Risk factors include smoking and drinking at work, and performing tasks such as cleaning offal. This paper examined risk factors...

Breast Radiation Exposure in Female Orthopaedic Surgeons.

Breast cancer prevalence is higher among female orthopaedic surgeons compared with U.S. women. The most common breast cancer site, the upper outer quadrant (UOQ), may not be adequately shielded from intraoperative radiation. Factors associated with higher breast radiation exposure (protective apron size and type, surgeon position, and C-arm position) have yet to be established. An anthropomorphic torso phantom, simulating the female surgeon, was placed adjacent to a standard operating table. Dosimeters were placed over the UOQ and lower inner quadrant (LIQ) of the breast, bilaterally. Scatter radiation dose-equivalent rates were measured during continuous fluoroscopy to a pelvic phantom (simulating the patient). Four apron sizes (small, medium, large, and extra-large), 2 apron types (cross-back and vest), 2 surgeon positions (facing the table and 90° to the table), and 2 C-arm positions (anteroposterior and cross-table lateral projection) were tested. The median dose-equivalent rate of scatter radiation to the UOQ (0.40 mrem/hr) was higher than that to the LIQ of the breast (0.06 mrem/hr) across all testing, although this was not statistically significant (p = 0.05). The cross-back aprons provided higher protection to the LIQ compared with the vests (p < 0.05). Lead protection in sizes that were too small or too large for the torso had higher breast radiation dose-equivalent rates. C-arm cross-table lateral projection was associated with higher breast radiation exposure (0.98 mrem/hr) compared with anteroposterior projection (0.13 mrem/hr) (p < 0.001). Breast radiation exposure is higher in a C-arm lateral projection compared with an anteroposterior projection. Higher dose-equivalent rates were observed for the UOQ compared with the LIQ of the breast and for aprons that were too small or too large, although these differences did not reach significance. Factors that may reduce radiation exposure include lead protection of appropriate size and distancing the axilla from the patient and x-ray tube. Increased breast cancer prevalence has been reported for female orthopaedic surgeons. The UOQ of the breast may be at risk for intraoperative radiation exposure. Methods of reducing exposure are warranted.

Relating factors to wearing personal radiation protectors among healthcare professionals.

BackgroundWith increasing use of medical radiologic procedures, wearing proper protector should be emphasized to reduce occupational radiation exposures. This research describes the rates of lead apron wearing for radiation protection and assessed occupational factors related to wearing rates for various types of healthcare professionals.MethodsWe conducted a self-administered questionnaire survey through a website, on-site visits, fax, and mail. Of the 13,489 participants, 8858 workers who could not completely separate themselves from radiological procedure areas. Their general characteristics (sex and age), work history (job title, duration of employment, and hospital type), and practices (frequency of radiation procedures, ability to completely separate from radiation, and frequency of wearing protective lead aprons) were examined.ResultsThe mean rate of lead apron wearing during radiologic procedures was 48.0 %. The rate was different according to sex (male: 52.9 %, female: 39.6 %), hospital type (general hospital: 63.0 %, hospital: 51.3 %, clinic: 35.6 %, dental hospital/clinic: 13.3 %, public health center: 22.8 %), and job title (radiologic technologist: 50.3 %, doctor: 70.3 %, dentist/dental hygienist: 15.0 %, nurse/nursing assistant: 64.5 %) (p < 0.001). By logistic regression analysis stratified by job title, use of lead aprons by radiologic technologists and nurses/nursing assistants was associated with hospital type and exposure frequency score. For doctors, apron wearing was associated with employment duration. For dentists/dental hygienists, apron wearing was associated with the exposure frequency score.ConclusionsTo improve working environments for healthcare professionals exposed to radiation, it is necessary to consider related factors, such as job title, duration of employment, and hospital type, when utilizing a planning and management system to prevent radiation-related health problems.

STUDY OF DOSES TO HIPPOCAMPUS OF INTERVENTIONAL CARDIOLOGISTS AND THEIR IMPLICATION FOR DOSIMETRIC MONITORING.

Dosimetric monitoring and protection of the personnel involved into interventional procedures is one of the key issues nowadays, yet doses received by their brains were left without rigorous consideration so far. The paper is the fast track of the results of the pilot study of possible magnitude of operator's doses with particular focus on difference between doses in left and right hippocampi and their relation to effective doses of personnel using protective aprons. Monte Carlo simulation of irradiation in a typical interventional cardiology (IC) operation room shows that for standard C-arm angulations difference in doses between left and right hippocampi can be as large as 5-fold (depending on energy and projection), under certain conditions dose to left (most exposed) hippocampus can be up to two times higher than effective dose estimated by a common double dosimetry algorithm. This finding calls for closer attention to possible manifestations of health detriment associated with occupational irradiation of left hippocampus in course of IC practice.

Evaluation of lead aprons and their maintenance and management at our hospital.

Lead aprons are worn by medical workers to reduce the effects of the radiation doses to which they are exposed during radiography and surgery performed with radioscopic apparatus. Regarding the management of such aprons, the Radiation Protection Section of the Japanese Society of Radiological Technology issued the "Guidelines for the Management of Lead Aprons" in 2000, and common management criteria have been set for all institutions. However, we found that the lead aprons used in operating rooms had not been closely inspected before 2014 in our hospital. Thus, we examined the extent of damage of such aprons in our operation room via computed tomography (CT) scout imaging, as well as visual and tactile inspections. Although no abnormality was detected upon visual and tactile inspections, CT images revealed that protective aprons used for 6years or more had damaged internal radiation shields, thus risking radiation exposure. In response to these results, we fully realized the need to examine the date of the initial use of currently used lead aprons, to routinely perform visual and tactile inspections, and to regularly evaluate the extent of damage to the internal radiation shields via fluoroscopy in cooperation with the radiation management section.

B.321 - X-ray transmission evaluation of lead-free protective aprons

B.321 - X-ray transmission evaluation of lead-free protective aprons

Abstract 10261: Musculoskeletal Pain in Cardiac Sonographers: A Multisite Case Control Study

Background: Transthoracic echocardiography is the mainstay of cardiac imaging and is highly dependent upon cardiac sonographers for whom image acquisition can be physically demanding and associated with musculoskeletal pain. Prior studies are limited by the absence of adequate control groups and a lack of adjustment for potential confounders. Objectives: The purpose of this study was to determine the prevalence and impact of work-related musculoskeletal pain in cardiac sonographers as compared to a large control group of non-invasive healthcare professionals with similar demographics. Methods: An electronic survey was administered to Mayo Clinic employees identified by human resources at six major patient care facilities in four different states. Results: There were 2682 employees within the departments of cardiology and radiology who were contacted and 1532 (57%) completed the survey. After exclusion of those who wear protective lead aprons, 517 employees comprised the control group and 66 cardiac sonographers made up the study group. Cardiac sonographers and the control group were similar in age, sex, BMI, length of employment and history of prior musculoskeletal pain. Cardiac sonographers reported work-related musculoskeletal pain more frequently than the control group (88% vs 40%; p&lt;0.001). This association persisted after multivariable adjustment for age, sex, body mass index, length of current employment and history of pre-existing musculoskeletal pain (OR 11.6; (95% CI 5.32, 25.5); p&lt;0.001). Cardiac sonographers were more likely to seek medical care for their work-related pain (55% vs 21%; p&lt;0.001) and to have missed work due to pain (35% vs 12%, p&lt;0.001). Conclusions: In this multi-site case control study, cardiac sonographers experienced significantly more work-related pain and missed more work due to pain than a large control group of non-invasive healthcare professionals with similar demographics.

Development of special clothes for the protection from X-ray radiation

The article is dedicated to the issues of development of special clothes for the protection from X-ray radiation, that are maximally comply with exploitation norms. On the basis of complex research improved construction and technology of making of protective double-sided apron is offered for the personnel of interventional radiology, and its experimental sample is made.

SU-E-I-57: Estimating the Occupational Eye Lens Dose in Interventional Radiology Using Active Personal Dosimeters Worn On the Chest

Purpose: To provide a general formalism for determination of occupational eye lens dose based on the response of an active personal dosimeter (APD) worn at chest level above the radiation protection apron. Methods: The formalism consists of three factors: (1) APD conversion factor converting the reading at chest level (APDchest) to the corresponding personal dose equivalent at eye level, (2) Dose conversion factor transferring the measured dose quantity, Hp(10), into a dose quantity relevant for the eye lens dose, (3) Correction factor accounting for differences in exposure of the eye(s) compared to the exposure at chest level (e.g., due to protective lead glasses).The different factors were investigated and evaluated based on phantom and clinical measurements performed in an x-ray angiography suite for interventional cardiology. Results: The eye lens dose can be conservatively estimated by assigning an appropriate numerical value to each factor entering the formalism that in most circumstances overestimates the dose. Doing so, the eye lens dose to the primary operator and assisting staff was estimated in this work as D_eye,primary = 2.0 APDchest and D_eye,assisting = 1.0 APDchest, respectively.The annual eye lens dose to three nurses and one cardiologist was estimated to be 2, 2, 2, and 13 mSv (Hp(0.07)), respectively, using a TLD dosimeter worn at eye level. In comparison, using the formalism and APDchest measurements, the respective doses were 2, 2, 2, and 16 mSv (Hp(3)). Conclusion: The formalism outlined in this work can be used to estimate the occupational eye lens dose from the response of an APD worn on the chest. The formalism is general and could be applied also to other types of dosimeters. However, the numerical value of the different factors may differ from those obtained with the APD's used in this work due to differences in dosimeter properties.