Radiation Exposure Of Medical Staff Research Articles

Investigation of Radiation Exposure of Medical Staff During Lateral Fluoroscopy for Posterior Spinal Fusion Surgery

Background/Objectives: In spinal surgery, it is especially crucial to insert implants in the correct location. Intraoperative fluoroscopy is often necessary to safely perform spinal surgery because of serious complications that can occur if the screw deviates. However, the use of intraoperative fluoroscopy comes at the cost of radiation exposure to the surgeons and operating room staff. Therefore, it is desirable for spinal surgeons to understand the characteristics of radiation in order to minimize patient and medical staff exposure. This study aimed to create an aerial radiation dose distribution map for lateral fluoroscopy, a commonly used technique for posterior spinal fusion. Methods: A human body-equivalent phantom was placed in a prone position on the Jackson Table. The measurement method used was a lateral fluoroscopic evaluation, assuming posterior spinal fusion. Measurements were taken at three levels: 80 (gonadal), 100 (thoracoabdominal), and 150 cm (lens and thyroid). Results: The highest radiation doses were received by primary surgeons. The scrub nurse was the next most exposed. Conclusions: We developed an aerial dose distribution map for lateral fluoroscopy in posterior spinal fusion. Radiation exposure was the highest among primary surgeons.

Ensuring radiation safety: Evaluating dose and compliance among medical staff at King Faisal Medical Complex, Saudi Arabia

BackgroundRadiation is an integral part of routine medical practice, but it carries a risk to the health of medical staff. Hence, it should be assessed periodically. The study's goal was to quantify the levels of radiation exposure for medical staff at King Faisal Medical Complex (KFMC), Taif City Saudi Arabia, and to assess their radiation protective procedures in practice. MethodsThe study looked at the thermoluminescence dosimeters (TLDs) records of 50 medical professionals who were exposed to radiation while working at KFMC from 2019 to 2020 in Taif city, Saudi Arabia. In Riyadh, radiation exposure is read from skin TLDs using Harshaw model 6600 plus detectors. The Excel software was utilized to process the obtained data for calculating effective doses. A questionnaire was also distributed to the medical staff to assess their radiation protection procedures. The Statistical Package for Social Sciences (SPSS) program version 23 was used to analyze the obtained data. ResultsThe mean annual effective doses of the medical staff in 2019 and 2020 were determined to be 1.14 mSv and 1.4645 mSv, respectively, with no significant difference in effective doses between males and females in either year. The socio-demographic features of the medical personnel were examined, and the findings revealed that the majority of participants were male radiological technologists. The rate of adherence to radiation protection techniques was 68%, with a normally distributed dispersal. The amount of adherence varied significantly depending on nationality, occupation, and academic qualification. ConclusionAccording to the research, the mean annual effective dosage for medical professionals at KFMC was significantly below the recommended level, indicating satisfactory compliance with the ALARA radiation safety concept.

A simple, reliable and accurate approach for assessing [131I]-capsule activity leading to significant reduction of radiation exposure of medical staff during radioiodine therapy

PurposeAccording to German law, the [131I]-capsule activity has to be checked in the context of radioiodine therapy (RIT) immediately before application. The measurement leads to significant radiation exposure of the medical personnel, especially of their hands. We aimed to establish a method for estimating [131I]-capsule activity by measuring the dose rate (DR) at contact of the delivered lead closed container carrying the [131I]-capsules and to evaluate radiation exposure in comparison to conventional [131I]-capsule measurement using a dose calibrator. MethodsDR on the surface of the closed lead container was measured at two locations and correlated linearly with the [131I]-capsule activity measured in a dose calibrator to create calibrating curves. The hand and whole body (effective) doses were determined with official dose meters during validation of our method in clinical practice. ResultsThe determination coefficients (R2) of linear calibration curves were greater than 0.9974. The total relative uncertainty for estimating [131I]-capsule activity with our method was <±7.5% which is lower than the uncertainty of the nominal activity and quite close to the threshold limit for the maximum allowed uncertainty of ± 5% for measuring activity in radioactive drugs. The reduction of the hand dose caused by our method was 97% compared with the conventional measurements of the [131I]-capsules in a dose calibrator. ConclusionMeasuring DR on the surface of the closed lead containers enables the [131I]-capsules activity to be estimated simply, reliably and with sufficient accuracy leading to significant reduction of the radiation exposure for the medical staff.

Radiation Exposure of Medical Staff Conducting Stress Myocardial Perfusion Imaging.

Background: The myocardial perfusion stress conducted by physicians and nurses requires two imaging sessions, one during stress and the other during rest. Echocardiography is sometimes performed before delayed imaging, and medical laboratory technicians (MLTs) have similar exposure in such cases. This study was designed to investigate the radiation exposure of physicians, nurses, radiologists, and MLTs involved in thallium-201 chloride (201TlCl) stress myocardial perfusion imaging and echocardiography, the details of which have not been reported to date. Methods: The dose rate at thallium-201 (201Tl) was examined using a cylindrical phantom. The exposure of physicians, nurses, and radiologists involved in the 201TlCl stress myocardial perfusion imaging was measured using pocket dosimeters, and that of the MLTs in charge of echocardiography were measured using glass-batch dosimeters. Results: The attenuation of radiation exposure from the phantom with distance was 95% at 50 cm from the center of the phantom, demonstrated that the attenuation of the exposure dose increased with distance. The exposure dose for physicians, nurses, and radiological technologists that participated in 201TlCl stress myocardial perfusion imaging was 0.20-0.23 μSv per exam, whereas it was 6.67-10.00 μSv per exam for MLTs. Conclusion: This study measured the dose received by physicians, nurses, and radiological technologists during stress MPI and the dose received by MLTs during echocardiography. The results provided advanced knowledge for the management of dose received by medical personnel.

C-Arm-Free Anterior Correction for Adolescent Idiopathic Scoliosis (Lenke Type 5C): Analysis of Early Outcomes and Complications

Computer-assisted spinal surgery as a technique for reducing radiation exposure to the operating staff and the complications of spinal deformity are receiving considerable attention. However, no technical reports have described the technique for navigating anterior correction of adolescent idiopathic scoliosis without C-arm fluoroscopy. The purpose of this study was to evaluate the efficacy and safety of this new C-arm-free anterior correction for scoliosis. This study investigated 38 consecutive patients with Lenke type 5C curves who underwent selective lumbar or thoracolumbar fusion, comprising 26 patients with conventional anterior correction surgery, and 12 patients with C-arm-free navigation surgery. The 2 groups were evaluated immediately postoperatively and at the 2-year follow-up. No vascular injuries, screw malpositioning, or major complications were associated with the surgical procedure in either group. Correction rates of the lumbar curve were satisfactory with no significant difference between groups (mean, 82.6% ± 5.7% vs. 80.7% ± 10.2%, respectively). However, mean time for fluoroscopy in group C was 133 ± 9.5 seconds (P < 0.0001). No significant differences in intraoperative blood loss (642 ± 123 mL vs. 731 ± 222 mL, respectively) or surgical time (251 ± 13 min vs. 301 ± 38 min, respectively) were seen between groups. Mean final follow-up Scoliosis Research Society Outcomes Questionnaire (SRS-22) was also excellent for both group C (4.2 ± 0.19) and group N (4.3 ± 0.20). C-arm-free anterior correction offers safe, effective surgery for adolescent idiopathic scoliosis. The advantage of this new technique is no radiation exposure for medical staff at centers performing large numbers of spinal procedures.

The radiation environment of anaesthesiologists in the endoscopic retrograde cholangiopancreatography room

Anaesthesiologists are increasingly involved in nonoperating room anaesthesia (NORA) for fluoroscopic procedures. However, the radiation exposure of medical staff differs among NORA settings. Therefore, we aimed to investigate the radiation environment generated by fluoroscopic endoscopic retrograde cholangiopancreatography (ERCP) and the radiation exposure of anaesthesiologists. The dose area product (DAP), radiation entrance dose (RED), and fluoroscopy time (FT) according to the procedures and monthly cumulative radiation exposure were analysed at two sites (neck and wrist) from 363 procedures in 316 patients performed within 3 months. The total RED and DAP were 43643.1 mGy and 13681.1 Gy cm2, respectively. DAP and RED (r = 0.924) were strongly correlated and DAP and FT (r = 0.701) and RED and FT (r = 0.749) were moderately correlated. The radiation environment per procedure varied widely, DAP and RED per FT were the highest during stent insertion with esophagogastroduodenoscopy. Monthly cumulative deep dose equivalents at the wrist and neck ranged between 0.31–1.27 mSv and 0.33–0.59 mSv, respectively, but they were related to jaw thrust manipulation (r = 0.997, P = 0.047) and not to the radiation environment. The anaesthesiologists may be exposed to high dose of radiation in the ERCP room, which depends on the volume of procedures performed and perhaps the anaesthesiologists’ practice patterns.

36] Dynamic contrast-enhanced ultrasonography for better percutaneous nephrolithotomy puncture

ObjectiveTo assess the efficiency of dynamic contrast-enhanced ultrasonography (DCE-US) for percutaneous nephrolithotomy (PCNL) puncture, as in recent years US contrast agents (microbubbles) have been used safely for cardiovascular and liver diseases diagnosis, and also to identify complex renal cysts, thus could be used to better delineate the pyelocalyceal system during PCNL puncture and reduce the radiation exposure for medical staff and patients.

Ultrasound-assisted catheter placement in CT-guided HDR brachytherapy for the local ablation of abdominal malignancies: Initial experience.

To evaluate the safety and feasibility of sonographically-assisted catheter placement in interstitial high-dose-rate brachytherapy of abdominal malignancies. In an initial cohort of 12 patients and 16 abdominal tumors (colorectal liver metastases n = 9; renal cell cancer n = 3; hepatocellular carcinoma n = 2; cholangiocellular carcinoma n = 2), initial puncture and catheter placement for CT-guided brachytherapy were performed under sonographic assistance when possible. The interventional procedure was prospectively recorded and in-patient data were collected. All data underwent descriptive statistics and comparative analysis by the Mann-Whitney test. In 12 out of 16 lesions (diameter 1.5 - 12.9 cm), initial puncture was successfully achieved under ultrasound guidance without utilization of CT fluoroscopy, yielding a significantly shorter mean total fluoroscopy time (14.5 vs. 105.5 s; p = 0.006). In 8 lesions visibility was rated better in ultrasound than in CT fluoroscopy (p = 0.2). No major or minor complications occurred within 30 days after treatment. Ultrasound-assisted catheter placement during interstitial CT-guided brachytherapy of abdominal tumors could improve catheter positioning and reduce radiation exposure for medical staff. Ultrasound-assisted catheter placement in CT-guided brachytherapy is safe and feasible. Ultrasound puncture may improve catheter positioning. Reduced CT fluoroscopy time can significantly help to minimize radiation exposure for medical staff. · Damm R, El-Sanosy S, Omari J et al. Ultrasound-assisted catheter placement in CT-guided HDR brachytherapy for the local ablation of abdominal malignancies: Initial experience. Fortschr Röntgenstr 2019; 191: 48 - 53.

919 - Pre- and intraoperative radiation exposure of medical staff during dynamic sentinel node biopsy in penile cancer patients

919 - Pre- and intraoperative radiation exposure of medical staff during dynamic sentinel node biopsy in penile cancer patients

Monte Carlo study of the scattered radiation field near the eyes of the operator in interventional procedures

Interventional radiology and cardiology guarantee high benefits for patients, but are known to be associated with a high level of radiation exposure of medical staff. The recently suggested decrease of the annual dose limit for the eye lens, from 150 to 20 mSv, caused a need for a reconsideration of practices ensuring sufficient protection for the lens of the eyes of medical staff. In such context the study of the scattered radiation around the operator’s head could help in finding the best solutions to be adopted for the ceiling-suspended shield and lead glasses in the most common situations in interventional practices.MCNPX Monte Carlo code was employed with anthropomorphic mathematical phantoms to simulate interventional practice projections. For each projection the effect of changing selected parameters on the evaluated scattered radiation towards the operator’s head has been calculated.The variety of modelled situations provides plentiful material regarding the spatial distribution of the scattered radiation, useful to improve eye lens radiation protection, such as the following: (a) Glasses, which provide shielding from both lateral and bottom-up scattered radiation, can reduce by ten times the exposure to the most exposed eyes; (b) The ceiling-suspended shield offers valuable protection, but such effectiveness can diminish by 90% if the shielding is not correctly positioned; (c) The transition from femoral to radial access usually intensifies the scattered radiation toward the operator head (a factor of 1.5 for AP projection), but for RAO projections, a reduction of the order by two to three times, in the case of radial access, can be seen, due to the protection provided by the image receptor.The detailed fluence outcomes show that there is a preferential direction of the impinging scattered radiation that should be considered when radiation protection options are evaluated or when a dedicated eye lens dosemeter is used for monitoring.

10-Year experience regarding the reliability and morbidity of radio guided lymph node biopsy in penile cancer patients and the associated radiation exposure of medical staff in this procedure.

BackgroundThe guidelines of the European Association of Urologists (EAU), of the German Society of Nuclear Medicine (DGN), and the European Society for Medical Oncology (ESMO) recommend sentinel lymph node biopsy (SLNB) for lymph node staging in penile cancer with non-palpable inguinal lymph nodes as one diagnostic method. Despite this, the method is neither widely nor regularly applied in Germany – the same applies to many other countries, which may be due to insecurity in dealing with open radioactive tracers. This study aims to assess the reliability and morbidity of this method, as well as the associated radioactive burden for clinical staff.MethodsBetween 2006 and 2016, 34 patients with an invasive penile carcinoma and inconspicuous inguinal lymph node status underwent SLNB in 57 groins after application of a radiotracer (Tc-99 m nanocolloid). We collected the results prospectively. The reliability of the method was assessed by determining the false-negative rate. In addition, we evaluated complication rates and determined the radioactive burden for the clinical staff both pre- and intraoperatively.ResultsSLNB was performed in 34 patients with penile cancer with non-palpable inguinal lymph nodes in 57 groins. In two patients inguinal lymph node metastases were detected by means of SLNB. In one patient recurrent inguinal lymph node disease was found after negative SLNB in both groins. Thus, the false negative rate was 3.13 % per patient (1/32 patients) and 3.51 % per groin (2/57 groins). The morbidity rate was 2.94 % per patient (1/34 patients) and 1.75 % per groin (1/57 groins). Radiation exposure for the clinical staff during this procedure was low at a maximum of ca. four μSV per intervention.ConclusionsSLNB is a reliable method with low morbidity that is associated with a low radiation burden for clinical staff. Due to the enhanced methodological and logistic demands, this intervention should be performed in specialized centres and in an interdisciplinary approach.

Radiation Exposure of Medical Staff in Interventional Radiology

The aim of this study was to assess the radiation dose received by doctors, nurses, X-ray technician medical staff during cardiac catheterization in a representative sample of the staff in our angiography department. Radiation from X-ray machines can cause serious side effects. Radiation exposure of angiography staff (doctors, nurses, medical staff and X-ray technicians) has been recognized as a necessary hazard in angiography department. The purpose of our work is to determine angiography staff radiation doses during interventional radiology, to identify procedures associated with higher radiation doses, and to determine the effects of various parameters on staff doses. This study was performed at Suleyman Demirel University Medical Faculty Hospital. The procedure of study was performed in an interventional radiology department. We have recorded radiation doses data during all related imaging procedures performed as a part of department activity. The distances from the X-ray tube were 0 cm (doctor), 60 cm (nurse), 120 cm (medical staff) and 180 cm (X-ray technician). It is important to understand the radiation effects on medical staff in interventional radiology procedures. Determinants of radiation risk include not only radiation dose levels but also medical staff number, ages, gender and their position. These factors can increase or decrease the risk of exposure.

4:21 PMAbstract No. 147 - Occupational radiation exposure for medical staff performing 90Y loaded microsphere radioembolization

4:21 PMAbstract No. 147 - Occupational radiation exposure for medical staff performing 90Y loaded microsphere radioembolization

Occupational radiation exposure of medical staff performing ⁹⁰Y-loaded microsphere radioembolization.

Radioembolization of liver cancer with (90)Y-loaded microspheres is increasingly used but data regarding hospital staff exposure are scarce. We evaluated the radiation exposure of medical staff while preparing and injecting (90)Y-loaded glass and resin microspheres especially in view of the increasing use of these products. Exposure of the chest and finger of the radiopharmacist, nuclear medicine physician and interventional radiologist during preparation and injection of 78 glass microsphere preparations and 16 resin microsphere preparations was monitored. Electronic dosimeters were used to measure chest exposure and ring dosimeters were used to measure finger exposure. Chest exposure was very low for both products used (<10 μSv from preparation and injection). In our experience, finger exposure was significantly lower than the annual limit of 500 mSv for both products. With glass microspheres, the mean finger exposure was 13.7 ± 5.2 μSv/GBq for the radiopharmacist, and initially 17.9 ± 5.4 μSv/GBq for the nuclear medicine physician reducing to 13.97 ± 7.9 μSv/GBq with increasing experience. With resin microspheres, finger exposure was more significant: mean finger exposure for the radiopharmacist was 295.1 ± 271.9 μSv/GBq but with a reduction with increasing experience to 97.5 ± 35.2 μSv/GBq for the six most recent dose preparations. For administration of resin microspheres, the greatest mean finger exposure for the nuclear medicine physician (the most exposed operator) was 235.5 ± 156 μSv/GBq. Medical staff performing (90)Y-loaded microsphere radioembolization procedures are exposed to safe levels of radiation. Exposure is lower than that from treatments using (131)I-lipiodol. The lowest finger exposure is from glass microspheres. With resin microspheres finger exposure is acceptable but could be optimized in accordance with the ALARA principle, and especially in view of the increasing use of radioembolization.

Evaluation of Radiation Exposure of Medical Staff During CT-Guided Interventions

PurposeThe purpose of this prospective study was to investigate absolute radiation exposure values and factors that influence radiation exposure of interventionists during CT-guided interventions (CTGIs). To our knowledge, no data exist regarding the radiation dose to which the interventionist is exposed during these procedures. MethodsAbsolute radiation dose values from a total of 131 CTGIs were analyzed. Radiation dose values were collected by thermoluminescent dosimeters that were positioned above the lead protection being worn, on the forehead, thyroid, chest, gonads, and right and left hand and foot.The radiation doses were analyzed with respect to the experience level of the person performing the procedure, the degree of difficulty measured on a 4-point Likert scale, the lesion size measured on a 3-point Likert scale, and the CT system used. ResultsMedian whole-body dose was 12 μSv. With the exception of the forehead, all whole-body radiation doses were statistically significantly lower in CTGIs performed using the modern dual-source CT system compared with the 16-slice multi-detector CT. For CTGIs rated as more complex, the radiation exposure of the radiologist performing the procedure was statistically significantly higher, with the exception of the left hand. A statistically significantly lower median whole-body dose was measured for inexperienced compared with experienced radiologists. However, a few dose measurements of more than 1 mSv were found at the right hand. ConclusionsRadiation exposure measured during CTGIs is low (<50 μSv). Because the radiation dose was higher in more-complex interventions and for 16-slice multi-detector row CT, inexperienced radiologists should focus on less-complex procedures.

Application of hand phantoms in simulations to determine the radiation exposure of medical staff

Concerning ionizing radiation, medical workers are the largest group of exposed workers worldwide. The handling of high-energy beta emitters and the CT fluoroscopy are among the highest exposure scenarios for medical staff. With the growing use of nuclear medicine therapies and interventional procedures using real-time image control by means of fluoroscopy combined with a computed tomography (CT), detailed research concerning the radiation protection for the personnel working in these fields becomes more and more important. In this work we focus on CT fluoroscopy. To investigate exposures in detail two feasibility studies using hand phantoms are presented. The codes MCNPX and GMctdospp are employed. A comparison with thermoluminescence detector measurements is given.

Medical dosimetry in Hungary

Radiation exposure of medical staff during cardiological and radiological procedures was investigated. The exposure of medical staff is directly connected to patient exposure. The aim of this study was to determine the distribution of doses on uncovered part of body of medical staff using LiF thermoluminescent (TL) dosimeters in seven locations.Individual Kodak film dosimeters (as authorized dosimetry system) were used for the assessment of medical staff's effective dose. Results achieved on dose distribution measurements confirm that wearing only one film badge under the lead apron does not provide enough information on the personal dose.The value of estimated annual doses on eye lens and extremities (fingers) were in good correlation with international publications.

Investigation of radiation exposure of medical staff: Measurements supported by simulations with an articulated hand phantom

Abstract To evaluate and optimise extremity doses in nuclear medicine, work package 4 of the ORAMED project ( ORAMED, 2011 ) focussed on investigating skin doses of nuclear medicine worker hands ( Carnicer, 2010 ). In addition to a measurement campaign, selected scenarios were simulated by means of hand wax phantoms. The phantoms were modelled according to the scenario of radiopharmaceutical syringe handling. The wax phantoms in the position of interest were scanned and introduced as lattice (voxel) geometry into the simulation input geometry. In this article the mathematical articulated hand model developed at KIT ( Blunck et al., 2009 ) is compared to these models. This mathematical hand phantom consists of rigid and flexible elements, allowing for an adaptable anatomy and flexible hand poses. In contrast to the static voxel models obtained by a complex procedure based on CT-scanned images, the articulated hand phantom can be used comparably simply for differing scenarios.

Radiation exposure for medical staff performing quantitative coronary perfusion PET with 13N-ammonia

To evaluate radiation doses to medical staff performing quantitative (13)N-ammonia myocardial perfusion positron emission tomography (PET). Seventeen PET examinations were performed. Nine examinations consisted of two PET scans (one during rest and one after pharmacological stress with dipyridamole) and eight examinations consisted of three PET scans (additionally a scan after cold pressor testing). The two nuclear technologists and the physician attending the examinations were equipped with an electronic dosemeter over the chest and thermoluminescent dosimetry chips on the right index finger and wrist. The highest mean equivalent dose per examination for a staff member was 453 microSv (417-490 microSv) to the right index finger, 138 microSv (127-149 microSv) to the right wrist and 13 +/- 0.8 microSv to the chest. Myocardial perfusion PET with (13)N-ammonia exposes the staff to radiation doses that are comparable to doses from (18)F-fluoro-deoxy-glucose scans and the annual doses are well within the recommended upper limits for radiation workers.

Radiation exposure of medical staff from interventional x-ray procedures: a multicentre study

The purpose of this study was to analyse the radiation exposure of medical staff from interventional x-ray procedures. Partial-body dose measurements were performed with thermoluminescent dosimeters (TLD) in 39 physicians and nine assistants conducting 73 interventional procedures of nine different types in 14 hospitals in Germany. Fluoroscopy time and the dose-area product (DAP) were recorded too. The median (maximum) equivalent body dose per procedure was 16 (2,500) microSv for an unshielded person; the partial-body dose per procedure was 2.8 (240) microSv to the eye lens, 4.1 (730) microSv to the thyroid, 44 (1,800) microSv to one of the feet and 75 (13,000) microSv to one of the hands. A weak correlation between fluoroscopy time or DAP and the mean TLD dose was observed. Generally, the doses were within an acceptable range from a radiation hygiene point of view. However, relatively high exposures were measured to the hand in some cases and could cause a partial-body dose above the annual dose limit of 500 mSv. Thus, the use of finger dosimeters is strongly recommended.