Radiation Protection Practices Research Articles

Occupational Exposure of the Eye Lens in Interventional Procedures: How to Assess and Manage Radiation Dose

Occupational exposure from interventional x-ray procedures is one of the areas in which increased eye lens exposure may occur. Accurate dosimetry is an important element to investigate the correlation of observed radiation effects with radiation dose, to verify the compliance with regulatory dose limits, and to optimize radiation protection practice. The objective of this work is to review eye lens dose levels in clinical practice that may occur from the use of ionizing radiation. The use of a dedicated eye lens dosimeter is the recommended methodology; however, in practice it cannot always be easily implemented. Alternatively, the eye lens dose could be assessed from measurements of other dosimetric quantities or other indirect parameters, such as patient dose. The practical implementation of monitoring eye lens doses and the use of adequate protective equipment still remains a challenge. The use of lead glasses with a good fit to the face, appropriate lateral coverage, and/or ceiling-suspended screens is recommended in workplaces with potential high eye lens doses.

An overview of ESR experience, with a focus on eurosafe imaging

The ESR launched EuroSafe Imaging, an ambitious radiation protection initiative, at ECR 2014 as a driver for improved quality and safety in medical imaging in Europe. The EuroSafe Imaging activities are led by a Steering Committee composed of stakeholder representatives, including EFOMP. The ‘EuroSafe Imaging Call for Action’ issued in September 2014 comprises 12 action items with concrete projects and specific goals to achieve EuroSafe Imaging’s objectives of promoting appropriateness in radiological imaging, maintaining radiation doses within diagnostic reference levels, using the ALARA principle and promoting the use of up-to-date equipment, empowering patients, and joining forces with various stakeholders. The ESR and EFOMP are collaborating in many activities under the umbrella of EuroSafe Imaging, including the projects “European Diagnostic Reference Levels for Paediatric Imaging” (PiDRL) and “BSS Transposition in the Medical Sector”. Other activities of EuroSafe Imaging focus on imaging referral guidelines embedded in clinical decision support (ESR iGuide), data collection (‘Is your Imaging EuroSafe?’), clinical audit, as well as appropriate image quality, clinical DRLs and a European CT repository. A network of institutions committed to best practice in radiation protection is created through the ‘EuroSafe Imaging Stars’ initiative. In addition, research in medical radiation protection is fostered. This variety of actions and the range of different stakeholders involved in EuroSafe Imaging reflect the ESR’s inclusive and holistic approach to medical radiation protection. EuroSafe Imaging serves as role model for medical radiation protection campaigns in other continents, such as Latin America Safe, Afro Safe and Canada Safe, and embraces a collaborative approach with these campaigns.

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

Ionizing radiation management is among the most important safety issues in interventional cardiology. Multiple radiation protection measures allow the minimization of x-ray exposure during interventional procedures.Our purpose was to assess the utilization and effectiveness of radiation protection and optimization techniques among interventional cardiologists in Lithuania.Interventional cardiologists of five cardiac centres were interviewed by anonymized questionnaire, addressing personal use of protective garments, shielding, table/detector positioning, frame rate (FR), resolution, field of view adjustment and collimation. Effective patient doses were compared between operators who work with and without x-ray optimization.Thirty one (68.9%) out of 45 Lithuanian interventional cardiologists participated in the survey. Protective aprons were universally used, but not the thyroid collars; 35.5% (n = 11) operators use protective eyewear and 12.9% (n = 4) wear radio-protective caps; 83.9% (n = 26) use overhanging shields, 58.1% (n = 18)—portable barriers; 12.9% (n = 4)—abdominal patient’s shielding; 35.5% (n = 11) work at a high table position; 87.1% (n = 27) keep an image intensifier/receiver close to the patient; 58.1% (n = 18) reduce the fluoroscopy FR; 6.5% (n = 2) reduce the fluoro image detail resolution; 83.9% (n = 26) use a ‘store fluoro’ option; 41.9% (N = 13) reduce magnification for catheter transit; 51.6% (n = 16) limit image magnification; and 35.5% (n = 11) use image collimation. Median effective patient doses were significantly lower with x-ray optimization techniques in both diagnostic and therapeutic interventions.Many of the ionizing radiation exposure reduction tools and techniques are underused by a considerable proportion of interventional cardiology operators. The application of basic radiation protection tools and techniques effectively reduces ionizing radiation exposure and should be routinely used in practice.

Radiation Protection Knowledge, Attitude and Practice (RP-KAP) as Predictors of Job Stress Among Radiation Workers in Tehran Province, Iran.

BackgroundIn recent years, much attention has been paid to occupational stress, but relatively little or no research has been conducted on the influence of knowledge, attitude, and practice of radiation protection (RP-KAP) on job stress among radiation workersObjectivesThis study aims to assess job stress among health care workers in Iran who are occupationally exposed to radiation in order to determine the effects of KAP on self-protection against radiation on their job stress.Materials and MethodsThe population in this descriptive cross-sectional study comprised 670 healthcare workers, including 428 staff with a degree in radiology and 242 other medical personnel who were working in 16 hospitals affiliated with Tehran University of Medical Sciences (TUMS) in Tehran, Iran. The census method was used to sample the workers. In total, 264 staff with a degree in radiology and 149 other medical personnel completed the job content questionnaire (JCQ) and the RP-KAP questionnaire from May to November 2014.ResultsThe prevalence rate of job stress was 22.5% based on calculation formulas and possible scores on the JCQ. Sex, RP-knowledge, attitude, practice, and in-service training predicted 41.8% of the variance in job stress. According to the results of the binary logistic regression, workers with higher scores on knowledge (OR = 0.82, 95% CI: 0.75 - 0.90), attitude (OR = 0.71, 95% CI: 0.63 - 0.82), and practice (OR = 0.78, 95% CI: 0.72 - 0.86) and those who had participated in training programs had significantly lower rates of job stress (OR = 0.51, 95% CI: 0.28 - 0.93).ConclusionsThe effects of RP knowledge, attitude, and practice on job stress were significant. In order to reduce job stress in radiation environments, ongoing training programs related to self-care and protection principles are recommended.

Occupational dose constraints for the lens of the eye for interventional radiologists and interventional cardiologists in the UK.

The International Commission on Radiological Protection (ICRP) has recommended a 20 mSv year(-1) dose limit for the lens of the eye, which has been adopted in the European Union Basic Safety Standards. Interventional radiologists (IRs) and interventional cardiologists (ICs) are likely to be affected by this. The effects of radiation in the lens are somewhat uncertain, and the ICRP explicitly recommend optimization. Occupational dose constraints are part of the optimization process and define a level of dose which ought to be achievable in a well-managed practice. This commentary calls on the professional bodies to review a need for national constraints to guide local decisions. Consideration is given to developing such constraints using maximum expected doses in high-workload facilities with good radiation protection practices and application of a factor allowing for attenuation by lead glasses (LG). Doses are based on a Public Health England survey of eye dose in the UK. Maximum expected doses for ICs are approximately 21 mSv year(-1), neglecting LG. However, the extent of IR exposure is not yet fully known, and further evidence is required before conclusions are drawn. A Health and Safety Laboratory review of LG established a conservative dose reduction factor of 3 for models available in 2012. Application of this factor provides a dose constraint of 7 mSv year(-1) to the eye for ICs. To achieve this constraint, those employers with the most exposed ICs will have to provide and ensure the correct use of a ceiling-suspended eye shield and LG.

Radiation Protection Measures in Radio-Diagnostic Centers in Gaza Hospitals, Palestine

Whereas radio-diagnostic centers have potential to present hazardous effects due of ionizing radiation. Radio-diagnostic workers awareness, practices regarding radiation protection issues, availability of radiation protection devices and effective personal radiation exposure monitoring process has an important role to safe working in these places. We carried out this study in nine governmental Gaza governorates hospitals. The study instrument was close-ended structured questionnaire consists of five parts. 182 radio-diagnostic workers participated in the work. Based on the obtained data, the participants reported that 35.2% of personal radiation protection devices are available in the radio-diagnostic centers at governmental Gaza governorates hospitals. In spite the fact that 74.8% of participants have awareness about radiation protection issues, but it is only about 53.4% of participants follows the radiation protection practices. There is an obvious poor of personal radiation exposure monitoring process. Conclusively, the results represented in this work reflect that majority of participants believe there is no radiation safety officer to provide the service. Therefore, there is a desperate need for rules, regulations and radiation protection act in the field of radiation in medical field.

Radiation Safety in Nuclear Medicine Procedures.

Since the nuclear disaster at the Fukushima Daiichi Nuclear Power Plant in 2011, radiation safety has become an important issue in nuclear medicine. Many structured guidelines or recommendations of various academic societies or international campaigns demonstrate important issues of radiation safety in nuclear medicine procedures. There are ongoing efforts to fulfill the basic principles of radiation protection in daily nuclear medicine practice. This article reviews important principles of radiation protection in nuclear medicine procedures. Useful references, important issues, future perspectives of the optimization of nuclear medicine procedures, and diagnostic reference level are also discussed.

Data and methods to assess occupational exposure to personnel involved in cardiac catheterization procedures

PurposeTo provide normalized scatter exposure data and methods for reliable estimation of cumulative effective dose and eye-lens equivalent dose to personnel involved in fluoroscopically guided cardiac catheterization (FGCC) procedures. MethodsAn anthropomorphic phantom was placed supine on the table of a modern digital C-arm angiographic system and 17 different fluoroscopic projections commonly employed during FGCC procedures were represented. Scatter exposure rates at the waist and eye level were measured for varying exposure parameters and position in the operating room. The effect of beam field size, patient size, use of radioprotective garments and small variations in projection angulation and table height on scatter radiation was investigated. ResultsApart from the position and use of radio-protective garments, radiation burden to operators during fluoroscopic guidance was found to remarkably depend beam field size (>45% reduction if a 10 × 10 cm2 instead of 15 × 15 cm2 fluoroscopy beam is used) and patient size (>25% increased scatter for obese patients). In contrast, the variation of measured scatter exposure from a given projection was found to be <10% when the source to skin distance was altered by ±10 cm or beam angulation of a specific projection was altered by ±10°. ConclusionPresented scatter exposure data charts and methods allow for prospective and retrospective estimation of effective dose and eye-lens equivalent dose to personnel involved in any FGCC procedure. Projection specific maps of scatter exposure produced may enhance familiarization of involved medical staff to good radiation protection practice and optimization of working habits in the cardiac catheterization lab.

Knowledge of Radiation Hazards, Radiation Protection Practices and Clinical Profile of Health Workers in a Teaching Hospital in Northern Nigeria.

Use of ionizing radiation in medical imaging for diagnostic and interventional purposes has risen dramatically in recent years with a concomitant increase in exposure of patients and health workers to radiation hazards. To assess the knowledge of radiation hazards, radiation protection practices and clinical profile of health workers in UDUTH, Sokoto, Nigeria. A cross-sectional study was conducted among 110 Radiology, Radiotherapy and Dentistry staff selected by universal sampling technique. The study comprised of administration of standardized semi-structured pre-tested questionnaire (to obtain information on socio-demographic characteristics, knowledge of radiation hazards, and radiation protection practices of participants), clinical assessment (comprising of chest X-ray, abdominal ultrasound and laboratory investigation on hematological parameters), and evaluation of radiation exposure of participants (extracted from existing hospital records on their radiation exposure status). The participants were aged 20 to 65 years (mean = 34.04 ± 8.83), most of them were males (67.3%) and married (65.7%). Sixty five (59.1%) had good knowledge of radiation hazards, 58 (52.7%) had good knowledge of Personal Protective Devices (PPDs), less than a third, 30 (27.3%) consistently wore dosimeter, and very few (10.9% and below) consistently wore the various PPDs at work. The average annual radiation exposure over a 4 year period ranged from 0.0475mSv to 1.8725mSv. Only 1 (1.2%) of 86 participants had abnormal chest X-ray findings, 8 (9.4%) of 85 participants had abnormal abdominal ultrasound findings; while 17 (15.5%) and 11 (10.0%) of 110 participants had anemia and leucopenia respectively. This study demonstrated poor radiation protection practices despite good knowledge of radiation hazards among the participants, but radiation exposure and prevalence of abnormal clinical conditions were found to be low. Periodic in-service training and monitoring on radiation safety was suggested.

Radiation Protection Practices during the Helium Circulator Maintenance of the 10 MW High Temperature Gas-Cooled Reactor-Test Module (HTR-10)

Current radiation protection methodology offers abundant experiences on light-water reactors, but very few studies on high temperature gas-cooled reactor (HTR). To fill this gap, a comprehensive investigation was performed to the radiation protection practices in the helium circulator maintenance of the Chinese 10 MW HTR test module (HTR-10) in this paper. The investigation reveals the unique behaviour of HTR-10’s radiation sources in the maintenance as well as its radionuclide species and presents the radiation protection methods that were tailored to these features. Owing to these practices, the radioactivity level was kept low throughout the maintenance and only low-level radioactive waste was generated. The quantitative analysis further demonstrates that the decontamination efficiency was over 89% for surface contamination and over 34% forγdose rate and the occupational exposure was much lower than both the limits of regulatory and the exposure levels in comparable literature. These results demonstrate the effectiveness of the reported radiation protection practices, which directly provides hands-on experience for the future HTR-PM reactor and adds to the completeness of the radiation protection methodology.

History and Organizations for Radiological Protection.

International Commission on Radiological Protection (ICRP), an independent international organization established in 1925, develops, maintains, and elaborates radiological protection standards, legislation, and guidelines. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) provides scientific evidence. World Health Organization (WHO) and International Atomic Energy Agency (IAEA) utilise the ICRP recommendations to implement radiation protection in practice. Finally, radiation protection agencies in each country adopt the policies, and adapt them to each situation. In Korea, Nuclear Safety and Security Commission is the governmental body for nuclear safety regulation and Korea Institute of Nuclear Safety is a public organization for technical support and R&D in nuclear safety and radiation protection.

Radiation Protection Awareness and Practices in Cameroon Dental Health Care Facilities

Introduction: Strict adherence to the radiation exposure guidelines is mandatory when using X-rays for disease detection in order to minimize its harmful effects. The objective of this study was to determine the radiation protection awareness and practices in Cameroon Dental Health care facilities. Materials and Methods: This multiregional questionnaire-based study was conducted among dental clinics located in the capitals of the Littoral, Central, South West, and North West regions of Cameroon. Results: The majority 63 (90.0%) of the participants reported awareness of the adverse effects of radiation on patients and dental professionals. Only 22.9% reported awareness of the agency in-charge of X-ray protection and standardization in Cameroon. The majority of the X-ray machine were located inside the operating room of the dental clinic. The most vulnerable group to the effects of radiation reported was pregnant women while the most vulnerable part of the body to the effects of radiation reported was reproductive organs. The lead shield was the dominantly utilized radioprotective device among the participants. Six meters away from the direction of radiation was the most frequently adopted radioprotection positioning among the participants. Conclusion: Data from this study revealed that many aspects of radiation protection in dental radiology is suboptimal; hence, specific training in education and training in radiation protection is deemed necessary among dental health care professionals in Cameroon. It is recommended that Cameroon National Radiation Protection Agency should establish radiation protection guidelines in dental health care delivery.

Activation of homologous recombination DNA repair in human skin fibroblasts continuously exposed to X-ray radiation.

Molecular and cellular responses to protracted ionizing radiation exposures are poorly understood. Using immunofluorescence microscopy, we studied the kinetics of DNA repair foci formation in normal human fibroblasts exposed to X-rays at a dose rate of 4.5 mGy/min for up to 6 h. We showed that both the number of γH2AX foci and their integral fluorescence intensity grew linearly with time of irradiation up to 2 h. A plateau was observed between 2 and 6 h of exposure, indicating a state of balance between formation and repair of DNA double-strand breaks. In contrast, the number and intensity of foci formed by homologous recombination protein RAD51 demonstrated a continuous increase during 6 h of irradiation. We further showed that the enhancement of the homologous recombination repair was not due to redistribution of cell cycle phases. Our results indicate that continuous irradiation of normal human cells triggers DNA repair responses that are different from those elicited after acute irradiation. The observed activation of the error-free homologous recombination DNA double-strand break repair pathway suggests compensatory adaptive mechanisms that may help alleviate long-term biological consequences and could potentially be utilized both in radiation protection and medical practices.

Radiation protection in interventional cardiology

INTERVENTIONAL: cardiology progress makes each year a greater number of procedures and increasing complexity with a very good success rate. The problem is that this progress brings greater dose of radiation not only for the patient but to occupationally exposed workers as well. Simple methods for reducing or minimizing occupational radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in radiation protection for all interventional cardiology personnel, and the availability and use of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of radiation protection in the interventional suite.

Su1615 U.S. Survey Assessing Current ERCP-Related Radiation Protection Practices

ERCP is associated with radiation exposure due to use of fluoroscopy. Radiation exposure poses health hazards to patients and to health care providers. However, no data is available regarding radiation protection practices among endoscopists performing ERCP in the United States (U.S.). The aim of this study is to evaluate current radiation protection practices among U.S. therapeutic endoscopists.

Measuring scatter radiation in diagnostic X rays for radiation protection purposes.

During the last decades, radiation protection and dosimetry in medical X-ray imaging practice has been extensively studied. The purpose of this study was to measure secondary radiation in a conventional radiographic room, in terms of ambient dose rate equivalent H*(10) and its dependence on the radiographic exposure parameters such as X-ray tube voltage, tube current and distance. With some exceptions, the results indicated that the scattered radiation was uniform in the space around the water cylindrical phantom. The results also showed that the tube voltage and filtration affect the dose rate due to the scatter radiation. Finally, the scattered X-ray energy distribution was experimentally calculated.

Measurement and analysis of patient attenuation correction factor during radioiodine therapy.

The calculated dose rate from the radioiodine therapy patient should normally include a factor accounting for the attenuation and scatter of patient body tissues. The attenuation factor is currently neglected, and not applied in operational radiation protection. Realistic estimation of radiation dose rate levels from radioiodine therapy patients when properly performed will reduce operational cost and optimise institutional radiation protection practice. In this work, the existence of a patient body tissue attenuation factor is verified by comparing the dose rates measured from the radioiodine capsules immediately before administration with those measured from the patient immediately after administration. The correlation between the factors suspected to influence the patient body tissue attenuation and the measured dose rates from the patient normalised per unit activity is statistically analysed. The calculated attenuation correction factor based on authors' measurements was (0.55 ± 0.17). The measured dose rate per unit of radioactivity from the patient showed a negative correlation with their body mass index.

Application of an informatics-based decision-making framework and process to the assessment of radiation safety in nanotechnology.

The National Council on Radiation Protection and Measurements (NCRP) established NCRP Scientific Committee 2-6 to develop a report on the current state of knowledge and guidance for radiation safety programs involved with nanotechnology. Nanotechnology is the understanding and control of matter at the nanoscale, at dimensions between ∼1 and 100 nm, where unique phenomena enable novel applications. While the full report is in preparation, this paper presents and applies an informatics-based decision-making framework and process through which the radiation protection community can anticipate that nano-enabled applications, processes, nanomaterials, and nanoparticles are likely to become present or are already present in radiation-related activities; recognize specific situations where environmental and worker safety, health, well-being, and productivity may be affected by nano-related activities; evaluate how radiation protection practices may need to be altered to improve protection; control information, interpretations, assumptions, and conclusions to implement scientifically sound decisions and actions; and confirm that desired protection outcomes have been achieved. This generally applicable framework and supporting process can be continuously applied to achieve health and safety at the convergence of nanotechnology and radiation-related activities.

Estimation of patient attenuation factor for iodine-131 based on direct dose rate measurements from radioiodine therapy patients.

The aim of the study was to measure the actual dose at 1 m from the patients per unit activity with the aim of providing a more accurate prediction of the dose levels around radioiodine patients in the hospital, as well as to compare our results with the literature. In this work the demonstration of a patient body tissue attenuation factor is verified by comparing the dose rates measured from the patients with those measured from the unshielded radioiodine capsules immediately after administration of the radioactivity. The normalized dose rate per unit activity is therefore proposed as an operational quantity that can be used to predict exposure rates to staff and patients' relatives. The average dose rate measured from our patient per unit activity was 38.4±11.8 μSv/h/GBq. The calculated attenuation correction factor based on our measurements was 0.55±0.17. The calculated dose rate from a radioiodine therapy patient should normally include a factor accounting for patient body tissue attenuation and scatter. The attenuation factor is currently neglected and not applied in operational radiation protection. Realistic estimation of radiation dose levels from radioiodine therapy patients when properly performed will reduce the operational cost and optimize institutional radiation protection practice. It is recommended to include patient attenuation factors in risk assessment exercises - in particular, when accurate estimates of total effective doses to exposed individuals are required when direct measurements are not possible. The information provided about patient attenuation might benefit radiation protection specialists and regulators.

Radiation protection in dentistry - Do we practice what we learn?

Aim: Easy availability, overuse, and lack of reinforcement of the radiation hazards facts have unknowingly resulted in overlooking of as low as reasonably achievable (ALARA) among many dentists. The current survey was designed to assess the awareness, concern, and practice of radiation protection in general dental practice. Materials and Methods: The survey involved 156 dentists in West Bengal, India. A cross-sectional self-administered questionnaire consisting of a total of 28 items was employed. The obtained data were compiled systemically and significance of difference was calculated by Chi-squared test using Statistical Package for Social Sciences 17. Results: Bisecting angle technique and use of E-speed films with manual processing were the most common. The majority of the participants had no idea about the type of cone used (37.2%), tube current (37.8%), kVp 56.4% (88). Exposure time was equally variable with maximum variability in the case of digital radiographs. Use of lead barriers and aprons were poor. Conclusion: The knowledge and practice of radiation protection are not satisfactory. Repeated reinforcement and training and the most importantly change in attitude to follow ALARA is required.