Radiation Protection In Interventional Radiology Research Articles

Occupational orthopedic problems and its relation to personal radiation protection in interventional radiology

PurposeSeveral studies report occupational orthopedic problems among interventional cardiologists. These health problems are usually multifactorial. However, the personal protective equipment used should play a major role. An online survey was conducted to determine the frequency of such health problems among interventional radiologists and to correlate them with the use of personal radiation protective clothing. Material and MethodsAn anonymous online survey that comprised of 17 questions was sent via e-mail to 1427 members of the German Society for Interventional Radiology (DeGIR) in Germany, Austria and Switzerland. The questions were focused on interventional workload, the use of personal radiation protection apparel and orthopedic problems. Given the different scale levels, the associations between the variables were analyzed using different statistical methods. A significance level of p < 0.05 was chosen. ResultsThere were 221 survey responders (15.5% response rate). About half of responders (47.7%) suffered from more than five episodes of orthopedic problems during their interventional career. Lumbar spine was involved in 81.7% of these cases, cervical spine in 32.8%, shoulder in 28.5% and knee in 24.7%. Because of orthopedic problems, 16.1% of the responders had to reduce and 2.7% had to stop their interventional practice.The number of affected body regions correlates with the fit of the radiation protection means (p < 0.05, r = 0.135) and the reduction of activity as an interventional radiologist (p < 0.05, r = −0.148). ConclusionOverall, the survey reveals widespread orthopedic problems at several body regions among interventional radiologists, associated with the fit of radiation protection systems, among other factors. A connection between the orthopaedic complaints and the radiation protection system used could not be established.

Radiation exposure, organ and effective dose of CT-guided liver biopsy as a function of lesion depth and size

Computed tomography (CT)-guided percutaneous biopsies play an important role in the diagnostic workup of liver lesions. Because radiation dose accumulates rapidly due to repeated image acquisition in a relatively small scan area, analysing radiation exposure is critical for improving radiation protection of CT-guided interventions. The aim of this study was to assess the radiation dose of CT-guided liver biopsies and the influence of lesion parameters, and to establish a local diagnostic reference level (DRL). In this observational retrospective cohort study, dose data of 60 CT-guided liver biopsies between September 2016 and July 2017 were analysed. Radiation exposure was reported for volume-weighted CT dose index (CTDIvol), size-specific dose estimate (SSDE), dose-length product (DLP) and effective dose (ED). Radiation dose of CT-guided liver biopsy was (median (interquartile range)): CTDIvol 9.91 mGy (8.33–11.45 mGy), SSDE 10.42 mGy (9.39–11.70 mGy), DLP 542 mGy cm (410–733 mGy cm), ED 8.52 mSv (7.17–13.25 mSv). Radiation exposure was significantly higher in biopsies of deep liver lesions compared to superficial lesions (DLP 679 ± 285 mGy cm vs. 497 ± 167 mGy cm, p = 0.0046). No significant dose differences were observed for differences in lesion or needle size. With helical CT spirals additional to the biopsy-guiding axial CT scans, radiation exposure was significantly increased: 797 ± 287 mGy cm vs. 495 ± 162 mGy cm, p < 0.0001. The local DRL is CTDIvol 9.91 mGy, DLP 542 mGy cm. Radiation dose is significantly increased in biopsies of deeper liver lesions compared with superficial lesions. Interventions with additional biopsy-guiding CT spirals lead to higher radiation doses. This study provides a detailed analysis of local radiation doses for CT-guided liver biopsies and provides a benchmark for optimising radiation protection in interventional radiology.

Nursing care management in radiation protection in interventional radiology

RESUMO Objetivo: Refletir sobre os elementos da gestão do cuidado em enfermagem na proteção radiológica em radiologia intervencionista. Metodologia: Estudo reflexivo realizado a partir de artigos e legislação nacional e internacional abordando a temática da gestão do cuidado em enfermagem e proteção radiológica em radiologia intervencionista. Resultados: A partir das concepções de gestão do cuidado em enfermagem e atuação profissional na prática vislumbrou-se como elementos dessa gestão: conhecimentos e aplicabilidade dos princípios de proteção radiológica, efeitos biológicos da radiação ionizante, monitoramento de dose ocupacional, equipamentos de proteção individual e coletiva, segurança do paciente, educação em proteção radiológica, programa de garantia de qualidade. Conclusão: A gestão do cuidado em enfermagem em proteção radiológica em radiologia intervencionista é implementada de forma incipiente no que tange aos cuidados voltados para redução de dose, seja para trabalhadores ou paciente. Torna-se necessário reconhecer, compreender e caracterizar a gestão do cuidado em enfermagem nesse cenário.

Radiation Protection in Interventional Radiology.

There has been a rapid development in the field of interventional radiology over recent years, and this has led to a rapid increase in the number of interventional radiology procedures being performed. There is, however, a growing concern regarding radiation exposure to the patients and the operators during these procedures. In this article, we review the basics of radiation exposure, radiation protection techniques, radiation protection tools available to interventional radiologists, and radiation protection during pregnancy.

Challenges in Occupational Dosimetry for Interventional Radiologists.

This review presents the challenges met by interventional radiologists in occupational dosimetry. The issues mentioned are derived from the recommendations of the International Commission on Radiological Protection, the CIRSE guidelines on "Occupational radiation protection in interventional radiology" and the requirements of the European directive on Basic Safety Standards. The criteria for a proper use of personal dosimeters and the need to introduce optimization actions in some cases are set out in this review. The pros and cons of the electronic real-time dosimeters are outlined and the potential pitfalls associated with the use of personal dosimeters summarized. The electronic dosimeters, together with the appropriate software, allow an active optimization of the interventional procedures.

A study to assess the knowledge and practice of medical professionals on radiation protection in interventional radiology.

Objective:Ionizing radiation has been extensively used in medical procedures throughout the world. Such interventional radiological procedures could result in occupational exposure that needs urgent control. Therefore, MPs (medical professionals) should receive education and appropriate training on occupational radiation protection. In this context, the present study is aimed to investigate the MPs' knowledge and practice regarding radiation protection principles during interventional radiological procedures.Material and Methods:A descriptive questionnaire-based study was carried out among 215 MPs involved in interventional fluoroscopy procedures. The practice of 31 MPs was studied using a checklist based on ALARA principles and ICRP guidelines.Results:A total of 43.3% and 45.1% answered correctly for knowledge and practice. However, the difference between radiation protection knowledge and practice between the physicians and nurses was statistically significant. The knowledge and practice survey of MPs demonstrated that nurses rarely adhered to radiation-protection measures.Conclusion:The present study reflects the lack of knowledge and practice concerning radiation protection concepts among the nurses. This deficiency needs to be resolved by periodic practical radiation protection courses in the curriculum of medicine.

インターベンショナルラジオロジー（IVR）における放射線防護の基本

インターベンショナルラジオロジー（IVR）における放射線防護の基本

Radiation Protection in Interventional Radiology

Radiation Protection in Interventional Radiology

Radiation Protection in Interventional Radiology: Survey Results of Attitudes and Use

PurposeTo assess attitudes of interventional radiologists toward personal radiation protection and the use of radiation protection devices. Materials and MethodsInvitations to an anonymous online survey that comprised eight questions focused on operator attitudes toward radiation protection devices were sent via e-mail to the active membership of the Society of Interventional Radiology (SIR): a total of 3,158 e-mail invitations. A single reminder e-mail was sent. ResultsThere were 504 survey responders (16% response rate). Reported radiation safety device use included lead apron (99%), thyroid shield (94%), leaded eyeglasses (54%), ceiling-suspended leaded shield (44%), rolling leaded shields (12%), ceiling-suspended/rolling lead-equivalent apron (4%), radiation-attenuating sterile surgical gloves (1%), and sterile lead-equivalent patient-mounted drape (4%). Reasons commonly cited for not using certain devices were comfort (eyewear), ease of use (mounted shields), and lack of availability (rolling/hanging shields and patient-mounted shields). ConclusionsInterventionalists have an array of tools from which to choose for personal radiation protection; however, for a variety of reasons related to lack of availability or choice, these tools are not universally employed. Further study may be of value to clarify why comfort was cited most often as the primary barrier to the use of protective eyewear and difficulty of use was cited as the primary barrier to use of mounted shields (despite reporting that concern for radiation-induced injury to the eye is paramount). It may also be of interest to further study why certain devices with demonstrable protection effects are not readily available, such as rolling/hanging and patient-mounted shields.

Air kerma to HP(3) conversion coefficients for photons from 10 keV to 10 MeV, calculated in a cylindrical phantom

In the framework of the ORAMED project (Optimization of RAdiation protection for MEDical staff), funded by the European Union Seventh Framework Programme, different studies were aimed at improving the quality of radiation protection in interventional radiology and nuclear medicine. The main results of the project were presented during a final workshop held in Barcelona in January 2011, the proceedings of which are available in the open literature. One of the ORAMED tasks was focused on the problem of eye-lens photon exposure of the medical staff, a topic that gained more importance especially after the ICRP decision to lower the limiting equivalent dose to 20 mSv per year. The present technical note has the scope, besides briefly summarising the physical reasons of the proposal and the practical implications, to provide, in tabular form, a set of air kerma to Hp(3) conversion coefficients based on the adoption of a theoretical cylindrical model that is well suited for reproduction of the mass and the shape of a human head.

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

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

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

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.

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

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

Occupational radiation protection in interventional radiology: a joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology.

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.

Radiation risks in interventional radiology

The number, diversity and complexity of interventional radiological examinations have all increased markedly in recent years, and it is widely recognized that some of these procedures carry greater risks than many other radiological procedures. This Commentary uses a meeting on "Radiation Protection in Interventional Radiology" held at the British Institute of Radiology on 28 March 2007 as a template to discuss recent progress in this area, some current problems and plans for the future.

Radiation Protection in Interventional Radiology

There is growing concern regarding the radiation dose delivered during interventional procedures, particularly in view of the increasing frequency and complexity of these techniques. This paper reviews the radiation dose levels currently encountered in interventional procedures, the consequent risks to operators and patients and the dose reduction that may be achieved by employing a rigorous approach to radiation protection.Johnson, D.R. (2001). Clinical Radiology56, 99–106.

Radiation protection in interventional radiology.

Introduction Furthermore, this information is usually displayed at the operator’s console where it cannot be seen In recent years there has been an increase in by the interventionalist undertaking the examinthe number, type and complexity of interventional ation. Unfortunately, total elapsed fluoroscopy radiology procedures. The impetus behind this time does not correlate very well with maximum rapid and continuing expansion has been the desire skin entrance dose. The latter quantity being for improved, more cost-effective medicine, in dependent on the automatic dose-rate control setwhich the patient can look forward to an improved ting selected, patient’s size, focus–skin distance and prognosis. Often patients having interventional the period of time that the area of skin was radiology procedures are treated as either outirradiated. Equipment developments are required patients or day cases, whereas the alternative surgito enable the interventionalist to be provided with cal technique would require hospitalization. This an on-line display which provides a better indiexpansion in interventional radiology has occurred cation of the potential onset of deterministic effects. in many countries worldwide, irrespective of the Extended fluoroscopy times, sometimes coupled type of system for health care delivery, because of with higher than average fluoroscopy currents can the many benefits. lead to an increased risk of non-deterministic In the main, interventional procedures are characeffects such as leukaemia in which the probability terized by having extended fluoroscopy times, and of the effect is proportional to the dose. The risk sometimes requiring many radiographic images to of inducing a hypothetical cancer at some time in be taken. As a consequence, developments in interthe future from interventional radiology correlates ventional radiology have a number of profound reasonably well with dose–area product. radiation protection implications for both patients Dose–area product is a quantity which may be and staff. In particular, the application of the conmeasured using a large area ionization chamber cept of justification to these procedures is different placed at the output port of the X-ray tube or than to other radiological examinations, as both inferred from a knowledge of X-ray technique deterministic and non-deterministic effects on the factors and the field size. Measurement of dose– patient have to be considered. area product is also recommended in the National Patient Dosimetry Protocol [1]. Patient dose The maximum skin entrance dose can be deduced from the dose–area product if the field For the patient, long fluoroscopy times lead to size and focus–skin distance are known. higher radiation doses, sometimes limited to a Instrumentation that is able to accomplish this is small area of the patient’s skin surface. This in in an early developmental stage. The display of turn leads to the potential for deterministic effects, total dose–area product and the estimated maxisuch as skin erythema, to be seen in patients who mum skin entrance dose on the interventionalist’s have had interventional radiology procedures. television monitor would provide information Physicians treating patients who have had an about the two types of radiation effect. interventional radiology procedure need to be It is also important to minimize patient doses aware of this possibility. whenever possible. One method of trying to achieve The potential induction of deterministic effects patient dose reductions would be to provide the in the skin is compounded by the lack of approinterventionalist with online dose rate information. priate patient dosimetry information available to The interventionalist could then select techniques the interventionalist during the procedure. At prewhich resulted in a lower patient dose, if desired. sent, fluoroscopy units used for interventional radiology are only required to be fitted with an Staff dose indication of total elapsed fluoroscopy time.