Thyroid Shield Research Articles

67. Experimental validation of algorithms used to estimate effective dose during interventional radiology procedures

Purpose During interventional radiology procedures the medical staff is exposed to X-rays scattered from the patient, so it is fundamental to wear personal protective equipment. In order to evaluate the effective dose, two dosimeters shall be used: one above the protective apron and one under the protective apron. Several algorithm have been developed to combine the readings of the dosimeters, currently there is no international consensus on which is the best one. In this work, typical interventional radiology procedures have been simulated in order to experimentally verify the accuracy of the algorithms. Material and methods Eight different irradiation conditions have been simulated in an angiographic room at Niguarda Hospital in Milano. The patient has been reproduced with two different RW3 slabs; the effective dose to personnel has been calculated by TLD inside a Rando-Alderson phantom. Personal dose equivalent (Hp(10)) have been measured by 17 dosimeters, placed on the phantom surface. The phantom has been equipped with a thyroid shield and a protective apron during two irradiations; in the other irradiations, corrections have been applied to dosimeters readings to take into account the effect of protective clothes. Results The majority of the algorithms tend to be too conservative, only the one proposed by the NCRP tend to underestimate the effective dose: the algorithms suggested in the ICRP draft seems to be the more reliable. However there are many factors which can affect the accuracy of the algorithms, so it is impossible to achieve a great precision in the evaluation of the effective dose. Conclusions The algorithms proposed by the ICRP draft shall be used to estimate the effective dose in interventional radiology; in case of risk to exceed the dose limit, it is better to further investigate the irradiation conditions. Download : Download high-res image (236KB) Download : Download full-size image

Radiation exposure during C-arm-guided (fluoroscopy) small animal orthopaedic surgery

The purpose of the current study was to investigate the radiation exposure level of surgeons performing C-arm guided small animal orthopaedic surgery using thermoluminescent dosimeters located inside and outside personnel shielding devices at major body parts. A prospective study was conducted to measure the radiation exposure dose of individuals in three positions (first assistant, operating surgeon and anaesthesiologist) using thermoluminescent dosimeters placed inside and outside protective devices. The lead equivalent protective devices included panorama mask, thyroid shield, apron and arm shield placed at five anatomic sites (eye, thyroid, breast, gonad and hand). Radiation exposure was measured during 12 surgical procedures with mean kVp of 51 and mean mAs of 1.6. The equivalent doses for thyroid, breast and gonad (outside/inside in mSv) were 1.75/0.58, 2.01/0.13 and 3.03/0.11, respectively, for the first assistant and 1.69/1.46, 4.82/0.35 and 5.25/0.22 for the operating surgeon. The dose of eye, thyroid, breast, gonad and arm for the anaesthesiologist were 0.61/0.51, 0.35/0.3, 0.67/0.34, 0.72/0.29 and 0.62/0.35, respectively. The exposure dose to gonads outside the lead protection showed the highest values in all participants. With lead protection, there was a significant reduction in the exposure dose to the gonads (first assistant, 96%; operating surgeon, 96%; anaesthesiologist, 60%). These results suggest that a radiation shield is essential in veterinary surgery with C-arms, particularly for gonad protection. In addition, these results demonstrate that exposure dose decreases with increasing distance from the C-arm machine.

PENGUJIAN KELAYAKAN ALAT PELINDUNG DIRI ( LEAD APRON DAN THYROID SHIELD)

Radiation Protection Tool in Radiology Departement Of RS PKU Muhammadiyah Yogyakarta there are four Lead Apron and Thyroid Shield. Maintance of Lead Apron and Thyroid Shield has not done well and has not been done by X-ray testing. This study aims to determine maintance of Lead Apron and Thyroid Shield, determine the results of Lead Apron and Thyroid Shield, to determine Lead Apron and Thyroid Shield tests are still feasible to use or not. The kind of research that used is descriptive quantitative research with survey approach. Data collection is done by direct observation, testing, measurement and documentation. The observations were conducted directly an four Lead Apron and Thyroid Shield in Radiology Departement Of RS PKU Muhammadiyah Yogyakarta. The testing was done with radiating all Lead Apron and Thyroid Shield and recorded with Computed Radiography. The data obtained are then analyzed. Appropriatness Lead Apron and Thyroid Shield are not feasible to use if the damage in the form a hole of 2 mm or area exceeds 3,14 mm2 and damage in the form of fault with a lenght exceeding 4 mm. The results of this research indicate that the maintance of Lead Apron and Thyroid Shield is not done well and correctly. Lead Apron and Thyroid Shield placed hung up, folded and placed not on a special cabinet. According the result Lead Apron and Thyroid Shield can be recognized that there is one Lead Apron is not feasible because it has hole damage in the form of 2 mm or area exceeds 3,14 mm2 and damage in the form of fault with a lenght exceeding 4 mm. But for Lead Apron A, B, D and Thyroid Shield although there are indentation and fractures but not exceeding the specified standart so it is still feasible to use.

Not all lightweight lead aprons and thyroid shields are alike

ObjectiveWith the explosion of minimally invasive surgery, the use of fluoroscopy has significantly increased. Concurrently, there has been a demand for lighter weight aprons. The industry answered this call with the development of lightweight aprons. Our goal was to see whether lighter weight garments provide reduced protection. MethodsDry laboratory testing was performed in a standard X-ray room, using a standard fluoroscopy table and standard acrylic blocks. A commercial-grade pressurized ion chamber survey meter (Ludlum Model 9DP; Ludlum Measurements, Inc, Sweetwater, Tex) was used to detect gamma rays and X-rays above 25 keV. Nonlead aprons from several manufacturers were tested for scatter radiation penetration above the table at a fixed distance (3 feet) and compared with two standard 0.5-mm lead aprons of different manufacturers. ResultsScatter measurements were made at 60 kVp and 70 kVp for pure lead (0.5 mm), mixed, and nonlead protective garments. Scatter penetration for the nonlead blends and barium aprons was 292% and 258%, respectively, at 60 kVp compared with the pure lead apron. At the higher beam quality of 70 kVp, the scatter penetration was 214% and 233% for the blend and barium aprons, respectively, compared with the pure lead apron. Our measurements demonstrate a noticeable difference in scatter reduction between pure lead and nonlead garments. Pure barium aprons and nonlead aprons from certain companies demonstrated scatter penetration that is inconsistent with the 0.5 mm of lead equivalence as claimed on the label. In addition, there was an incidental finding of a handful of lightweight aprons with significant tears along the seams, leaving large gaps in protection. Our study also demonstrates that several companies rate their lightweight garments as 0.5 mm lead equivalent, when actually only a small area on the chest and abdomen where the garment overlapped was 0.5 mm, leaving the rest of the garment with half the protection at 0.25 mm. ConclusionsOur reliance on protective lead garments to shield us from the biologic effects of radiation exposure and the inferiority of some lightweight garments necessitate a streamlining of the testing methods and transparency in data reporting by manufacturers.

Radiation safety: a focus on lead aprons and thyroid shields in interventional pain management.

C-arm fluoroscopy is useful equipment in interventional pain management because it helps to guide correct needle targeting for the accurate injection and drug delivery. However, due to increased use of C-arm fluoroscopy in various pain procedures, the risk of radiation exposure is a significant concern for pain physicians. The harmful biological effects of ionizing radiation on the human body are well known. It is therefore necessary to strive to reduce radiation exposure. Lead aprons with thyroid shields are the most fundamental radiation protective devices for interventional procedures, and are very effective. However, the operator's radiation safety cannot be guaranteed because pain physicians seem to lack sufficient interest, knowledge, and awareness about radiation safety. Also, inappropriate care and use of radiation protective devices may result in a higher risk of radiation exposure. The purpose of this article was to review the literature on radiation safety with a focus on lead aprons and thyroid shields and present recommendations related to those devices during C-arm fluoroscopic-guided interventions by pain physicians.

Compliance With Radiation Protection Practices Among Radiologists

Radiologists are at higher risk of adverse health effects due to their occupational radiation exposure; therefore, applying protection techniques is imperative. Studies on radiologists' compliance in this regard are scarce. We aimed to assess compliance with radiation safety practices among radiologists. Questionnaires were distributed to radiologists in tertiary hospitals. The questionnaire was designed to assess compliance in three domains: using personal protective devices, using exposure-reduction techniques during fluoroscopic exposures, and using personal dose-monitoring devices. Descriptive analysis of the compliance was performed. Sixty-two radiologists were included in the analysis. Use of leaded aprons and thyroid shields was commonplace, whereas only 3.2% ever use leaded eyeglasses. About half of the radiologists always considered reducing the time of exposure and avoided exposure by the primary beam, and the other half did that sometimes. Most of the radiologists (66.1%) always complied with reducing the number of unnecessary exposures, and the rest only complied sometimes. Most of the radiologists (93.5%) always used single personal dose-monitoring devices, most commonly at the neck level over the collar. There was no difference in compliance between different sexes, position descriptions, hospital types, hospital sizes, or years of experience. Future compliance improvement strategies for radiologists should focus on use of thyroid shields and leaded eyeglasses and use of exposure-reduction techniques during fluoroscopic operations.

Factors influencing the effective dose associated with CBCT: a systematic review.

Due to potential impact of the effects of ionizing radiation used in medical and dental examinations on public health in recent years, many studies are being conducted to quantify the radiation dose values, evaluate scanners, and indicate factors that could influence or reduce radiation doses. This study aimed to evaluate, by a systematic review, the factors that influence the effective radiation dose associated with cone beam computed tomography and respective effects, and compared the effective dose of different cone beam computed tomography (CBCT) scanners with similar exposure parameters. A search was conducted on five databases from 2007 to 2015. The search identified 741 abstracts, among which 44 eligible articles were retrieved in full text. Twenty-three studies met the inclusion criteria and were included. Additional copper filter was evaluated in one study, patient size in 2 studies, region of interest in 1 study, use of a thyroid shield in 2 studies, scan angle in 3 studies, exposure time in 10 studies, FOV diameter in 17 studies, FOV height in 17 studies, kV in 16 studies, mA in 18 studies, mAs in 13 studies, voxel in 8 studies, and resolution in 3 studies. When similar exposure parameters were evaluated, it was observed that CBCT scanner with lower effective dose was Kodak® 9000C 3D (mean 21.2μSv) in selected studies. Thirteen factors were related to changes in the effective dose emitted by different scanners. More studies are needed to identify the image quality requirements in addition to measure the radiation. Studies that give more information for professionals who request and interpret the exams and for technicians who perform 3D images about effective radiation dose associated with CBCT are necessary.

Radiation safety compliance: A closed loop audit of thyroid shield usage in urology

Radiation safety compliance: A closed loop audit of thyroid shield usage in urology

Effect of thyroid shielding during mammography: measurements on phantom and patient as well as estimation with Monte Carlo simulation

BackgroundDuring mammography, the thyroid is exposed to scattered radiation from breast tissue and the device. This may increase the risk of radiation induced thyroid cancer.MethodsWe investigated the scatter radiation exposition of the thyroid and the effect of a tailored thyroid protection in phantom and patient as well as by using Monte Carlo simulation (MCS). The protective effect of a modified thyroid protection, the relevance of the protective effect and acceptance by patients have been investigated.ResultsPhantom and patient measurements provided higher values for the surface dose at thyroid position than expected from MCS (phantom 0.32 mGy; patients 0.38 mGy; MCS 0.16 mGy). Phantom measurements indicated scatter contributions from both breast tissue and collimator/tube system. The value found in our patient study is within the range of the literature (0.22–0.39 mGy). The thyroid protection significantly reduced the surface dose but the dose (0.016 mGy) was higher than that expected from the lead equivalent value. However, the impact of the collar to the effective dose was small (< 4%). The collar was not visible on mammograms.ConclusionsScatter from the collimator/tube system contributed with 50% to the thyroid dose. Due to the relative small fraction of dose deposited in the thyroid when compared to the mean glandular dose to the breast, a collar is not mandatory in general. Not being associated with the risk of obscuring parts of mammograms, such a collar may be used for young women considering their higher radio sensitivity.

Radiation Exposure During Operative Fixation of Pediatric Supracondylar Humerus Fractures: Is Lead Shielding Necessary?

Factors that impact radiation exposure during operative fixation of pediatric supracondylar humerus (SCH) fractures have been investigated; however, no studies have measured the equivalent dose at the patient's radiosensitive organs. Our hypothesis was that intraoperative fluoroscopy exposes pediatric patients to a significant radiation load and lead shielding of radiosensitive organs is important. The goal of the study was to quantify the patient's radiation exposure during the procedure by measuring the radiation load at the thyroid and gonads. A prospective quality improvement project of radiation exposure during percutaneous fixation of isolated SCH fractures was performed over a 4-week period. The c-arm image intensifier was used as the operating table and radiation dosimeters were positioned over the thyroid and gonadal lead shields. Fluoroscopy times were recorded, doses were calculated, and the dosimeters were analyzed. To assure that the prospective cohort was representative of a larger population of SCH fractures, demographics and fluoroscopy time of the prospective cohort were compared with a 12-month retrospective cohort in which dosimetry was not performed. Prospective cohort-18 patients with type 2 (8) and type 3 (10) fractures were prospectively studied with intraoperative measurement of thyroid and gonadal radiation equivalent doses. Mean age was 4.9 years (1.9 to 9.5 y) and mean weight was 21.4 kg (13.1 to 33.5 kg). Mean fluoroscopy time was 65.0 seconds (25.3 to 168.4 s), and absorbed skin dose at the elbow was 0.47 mGy (0.18 to 1.21 mGy). The radiation dosimeters overlying the thyroid and gonads measured minimal radiation indicating equivalent doses of <0.01 mSv for all patients in the prospective cohort.Retrospective cohort-163 patients with type 2 (60) and type 3 (103) fractures were retrospectively studied. The mean age was 5.5 years (0.02 to 13.7 y) and weight was 21.6 kg (2.0 to 71.9 kg). Mean fluoroscopy time was 74.1 seconds (10.2 to 288.9 s), and absorbed skin dose at the elbow was 0.53 mGy (0.07 to 2.07 mGy).There were no statistically significant differences between the cohorts. The smaller prospective cohort had fluoroscopy times and radiation doses that were not statistically different from the larger retrospective cohort, suggesting that the dosimeter measurements are representative of intraoperative radiation exposure during fixation of pediatric SCH fractures. The equivalent dose to the thyroid and gonads was minimal and approximates daily background radiation. Shielding of radiosensitive organs is appropriate when practical to minimize cumulative lifetime radiation exposure, particularly in smaller patients and when longer fluoroscopy times are anticipated. Level 2.

Evaluation of the radiation dose in the thyroid gland using different protective collars in panoramic imaging.

The value for the use of thyroid shield is one of the issues in radiation protection of patients in dental panoramic imaging. The objective of this research is to investigate the attenuation characteristics of some models of thyroid shielding in dental panoramic examinations. The effects of five different types of lead and lead-free (Pb-equivalent) shields on dose reduction of thyroid gland were investigated using implanted Thermoluminescence Dosemeters (TLDs) in head-neck parts of a Rando phantom. The results show that frontal lead and Pb-equivalent shields can reduce the thyroid dose around 50% and 19%, respectively. It can be concluded that the effective shielding area is an important parameter in thyroid gland dose reduction. Lead frontal collars with large effective shielding areas (>~300 cm2 but not necessarily very large) are appropriate for an optimized thyroid gland dose reduction particularly for the critical patients in dental panoramic imaging. Regardless of the shape and thickness, using the Pb-equivalent shields is not justifiable in dental panoramic imaging.

MP02-15 ASSESSMENT OF RADIATION SAFETY KNOWLEDGE AMONG HOUSE STAFF REVEALS APPROPRIATE PRECAUTIONS BUT DEFICIENT KNOWLEDGE

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety I1 Apr 2018MP02-15 ASSESSMENT OF RADIATION SAFETY KNOWLEDGE AMONG HOUSE STAFF REVEALS APPROPRIATE PRECAUTIONS BUT DEFICIENT KNOWLEDGE Andrew Harris, Marilyn Hopkins, John Loomis, and Jason Bylund Andrew HarrisAndrew Harris More articles by this author , Marilyn HopkinsMarilyn Hopkins More articles by this author , John LoomisJohn Loomis More articles by this author , and Jason BylundJason Bylund More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.141AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urologists, as well as other specialties, are increasingly exposed to fluoroscopy as minimally invasive techniques continue to become more widespread. Fluoroscopy, or electromagnetic radiation, can be harmful due to cellular damage. Appropriate knowledge of and safety precautions concerning fluoroscopy are necessary and ideally should be taught in training. METHODS A 20 question survey was constructed to assess radiation safety training, attitudes, knowledge, and behavior. The survey was sent via REDCap to house staff routinely involved fluoroscopic cases, which included urology, orthopedic surgery, neurosurgery, radiology, general surgery, anesthesia, plastic surgery, cardiology, vascular surgery, and gastroenterology. RESULTS 61 of 218 (28%) participants responded during the 2 week study period. 57% have received fluoroscopic radiation safety education informally, with 28% receiving both informal and formal education. When asked about directional X-travel and exposure, only 20% answered correctly with 25% being unsure, 18% stating no difference, and 38% choosing flow originating below the patient exposes the operator to more radiation. When asked about conditions potentially related to radiation exposure, 86% believe infertility is potentially related to exposure, 87% cataracts, 87% leukemia and lymphoma, 59% central nervous system tumors, 71% birth defects, and 3% diabetes. When asked about protection, 20% wear lead lined glasses, 23% dosimeters, 92% thyroid shields, 2% lead gloves, 92% lead apron, 48% lead shield, and 1.6% nothing. When asked about fluoroscopy machine settings, 12% knew the machine used was set to continuous, 39% pulse, and 49% were unsure. 64% were aware of the directional travel concerning the machine routinely used. When asked about safety techniques, 98% knew decreasing time and 100% knew wearing protective materials were ways to decrease exposure. When asked about distance and exposure, only 56% answered correctly. The majority of respondents believe radiation safety is important (87%) and would like more formal education (52.5%). Concerning items, see Figure 1. CONCLUSIONS Fluoroscopic radiation safety knowledge is low among house staff routinely using fluoroscopy. Further study and likely increased formal education is warranted. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e17-e18 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Andrew Harris More articles by this author Marilyn Hopkins More articles by this author John Loomis More articles by this author Jason Bylund More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Restrainer exposure to scatter radiation in practical small animal radiography measured using thermoluminescent dosimeters

This study was aimed at estimating restrainer exposure to scatter radiation in veterinary radiography using thermoluminescent dosimeters (TLDs) in different positions, and at different anatomic regions. A prospective study was conducted to measure exposure dose of two restrainers: A (cathode side) and B (anode side), and an observer C (at a 1-meter distance from the X-ray table) over two months. Protective devices included panorama mask, thyroid shield and arm shield. TLDs were placed on the inside and outside of the protective gear at five different anatomic sites (eye, thyroid, breast, gonad and arm). The study data consisted of 778 exposures, 82 patients (78 dogs, four cats), a mean kVp of 58.7 and a mean mAs of 11.4. The doses (outside the shield/inside the shield, in mSv) measured by restrainers A, B and C were eye (3.04/0.42), (2.29/0.17), (0.55/0.01), thyroid (2.93/0.01), (1.97/0.01), (0.19/0.01), breast (1.01/0.04), (0.73/0.01), (0.32/0.01), gonad (0.07/0.01), (0.01/0.01), (0.16/0.01) and arm (2.81/1.43), (1.17/0.01), (0.08/0.01), respectively. This study describes the extent of occupational radiation exposure in small animal radiography. The exposure dose for eyes outside lead protection showed the highest value in all participants. With lead protection, the reduction in the exposure dose of eyes was significant (A: 86%, B: 93%, C: 98%), and the highest reduction was 99% in the thyroid region. These results suggest the necessity of radiation shields in manual restraint, particularly for eye protection.

What Leads to Lead: Results of a Nationwide Survey Exploring Attitudes and Practices of Orthopaedic Surgery Residents Regarding Radiation Safety.

Excessive radiation to health-care providers has been linked to risks of cancer and cataracts, but its negative effects can be substantially reduced by lead aprons, thyroid shields, and leaded glasses. Hospitals are required to provide education and proper personal protective equipment, yet discrepancies exist between recommendations and compliance. This article presents the results of a survey of U.S. orthopaedic surgery residents concerning attitudes toward radiation exposure and personal protective equipment behavior. An invitation to participate in a web-based, anonymous survey was distributed to 46 U.S. allopathic orthopaedic surgery residency programs (1,207 potential resident respondents). The survey was conceptually divided into the following areas: demographic characteristics, training and attitudes concerning occupational hazards, personal protective equipment provision and use, and general safety knowledge. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated for the association between these characteristics and compliance with thyroid shield or lead gown wear. In this study, 518 surveys were received, with 1 survey excluded because of insufficient response, leaving 517 surveys for analysis (42.8% response rate). Ninety-eight percent of residents believed that personal protective equipment should be provided by the hospital or residency program. However, provision of personal protective equipment was not universal, with 33.8% reporting none and 54.2% reporting provision of a gown and thyroid shield. The prevalence of leaded glasses usage was 21%. Poor lead gown compliance and thyroid shield wear were associated with difficulty finding the corresponding equipment: PR, 2.51 (95% CI, 1.75 to 3.62; p < 0.001) for poor lead gown compliance and PR, 2.14 (95% CI, 1.46 to 3.16; p < 0.0001) for poor thyroid shield wear. Not being provided with personal protective equipment was also significantly associated with low compliance with both lead gowns (PR, 1.47 [95% CI, 1.04 to 2.08]; p = 0.03) and thyroid shields (PR, 1.69 [95% CI, 1.18 to 2.41]; p = 0.004). Respondents from the Southeast, West, or Midwest had lower compliance with lead gown usage. Forgetting was the number 1 reason to not wear a lead apron (42%). Radiation exposure is associated with increased risk of serious health problems. Our findings identified that the availability of lead personal protective equipment leads to increased compliance among residents surveyed. In addition to yearly occupational hazard training specific to orthopaedic surgery, greater efforts by residency programs and hospitals are needed to improve access to lead personal protective equipment and compliance for orthopaedic residents.

Radiation Exposure to the Urologist Using an Overcouch Radiation Source Compared With an Undercouch Radiation Source in Contemporary Urology Practice

To compare radiation dosage to the urologist using an overcouch system, x-ray tube over table, and an undercouch system, x-ray tube under table. Urologists continue to perform more endoscopic surgery requiring fluoroscopy. Fluoroscopy, or electromagnetic radiation, can cause cellular damage when passing through tissues. These systems are compared with respect to radiation dosage to the urologist. A single urologic surgeon utilized a dosimeter badge while using an overcouch system. The dosimeter exposure was higher than expected and an undercouch system was then employed. Dosimeter exposure levels between the overcouch and the undercouch systems were examined and compared. Over the 4 months reviewed for the overcouch system, radiation doses to the body averaged 3.63 mSv, those to the eye averaged 3.73 mSv, and those to the extremities averaged 3.72 mSv. The 3-month averages for the undercouch system exposure to the body, the eye, and the extremities were 0.31, 0.35, and 0.35 mSv, respectively. The difference in radiation exposure between the 2 systems was significant (P ≤.001). The average number of radiation cases between the 2 systems was not significantly different (P = .37). The average fluoroscopy time for the procedures between the 2 systems was not significantly different (P = .24). Overcouch fluoroscopy systems expose the urologist to significantly higher, potentially dangerous levels of radiation. Urologists using an overcouch system should strongly consider as low as reasonably achievable precautions and proper utilization of lead aprons, thyroid shields, and lead glasses. Radiation safety training should be considered.

Occupation-associated health hazards for the gastroenterologist/endoscopist.

Advances in the field of endoscopy have allowed gastroenterologists to obtain detailed imaging of anatomical structures and to treat gastrointestinal diseases with endoscopic therapies. However, these technological developments have exposed endoscopists and staff to hazards such as musculoskeletal injuries, exposure to infectious agents, and ionizing radiation. We aimed to review the occupational hazards for the gastroenterologist and endoscopist. Using PubMed, Medline, Medscape, and Google Scholar, we identified peer-reviewed articles with the keywords “occupational hazards,” “health hazards,” “occupational health hazards,” “endoscopy,” “gastroenterologist,” “infectious agents,” “musculoskeletal injuries,” and “radiation.” Strategies for reducing exposure to infectious agents, radiation, and the risk of musculoskeletal injuries related to gastroenterology include compliance with established standard measures, the use of thyroid shields and radioprotective eyewear, and ergonomic practices. We conclude that educating endoscopic personnel and trainees in these practices, in addition to further research in these areas, will likely lead to the development of more efficient and user-friendly workspaces that are safer for patients and personnel.

Use of personal protective equipment in a radiology room at a veterinary teaching hospital.

The use of personal protective equipment by veterinary workers during radiographic imaging is inconsistent. While the self-reported use of leaded aprons and thyroid shields approaches 100% in some studies, the use of leaded gloves and eyeglasses is much lower. Previous studies describing personal protective equipment use are based on self-reporting. Objectives of this prospective, observational study were to describe use of leaded personal protective equipment during radiographic imaging by veterinary workers, and to compare observed use with self-reported use. Use of leaded personal protective equipment during radiographic imaging by veterinary workers was observed over a 10week period using two motion-triggered video cameras, and a questionnaire was then completed by workers on their use of personal protective equipment. Workers restrained the animal during 91.8% (753/820) of exposures. An apron and a securely closed thyroid shield were worn for>99% of studies. Gloves were used correctly for 43.6% (156/358) of radiographic studies. Leaded eyeglasses were worn for 1.7% (6/358) of studies. Correct glove use was more frequent during regular working hours than after-hours for both veterinarians (odds ratio 32.7, P=0.001) and veterinary students (odds ratio 75.1, P<0.001). The number of workers in the room was lower when animals were sedated (P=0.002) or anesthetized (P=0.017). Workers overestimated their frequency of glove use (P<0.001). In conclusion, workers use personal protective equipment less frequently in an unsupervised environment, and overestimate their use of personal protective equipment. Use of sedation or anesthesia decreases worker exposure to ionizing radiation.

Health Care Workers’ Use and Cleaning of X-Ray Aprons and Thyroid Shields

We evaluated the use and cleaning of x-ray aprons and thyroid shields by surveying rural hospital system health care workers who wear x-ray aprons and thyroid shields. One hundred fifty-five of the 173 respondents were RNs (89.6%), and 94 respondents were from inpatient or outpatient surgical settings (54.3%). One hundred thirty-five respondents (78.0%) reported soiled x-ray aprons or thyroid shields, and 52 (30.1%) reported shield odors. Eighty-three participants (48.0%) indicated they never spot cleaned. Standard department cleaning never occurred for 37 x-ray aprons or thyroid shields (21.4%); and 114 x-ray aprons or thyroid shields (65.9%) contacted a patient or patient item 1 to 10 times per shift. Twenty-six participants (15%) specified there were policies and procedures for cleaning x-ray aprons and thyroid shields. Use of evidence-based cleaning guidelines and manufacturer’s requirements for effective spot and standard cleaning of the protective aprons and thyroid shields are warranted.

The use of a thyroid shield for intraoral anterior oblique occlusal views-a risk-based approach.

To estimate the radiation dose reduction to the thyroid for an anterior oblique occlusal view from the use of a thyroid shield, compare this with the variation in thyroid dose resulting from differences in examination positioning and discuss the additional considerations associated with the use of a thyroid shield before making a recommendation on their routine use for this examination. Doses to the oral mucosa, the salivary glands, the thyroid, the extrathoracic airways, the oesophagus and the lungs were directly measured for anterior oblique occlusal X-rays of a Rando phantom with and without a thyroid shield using strips of calibrated XRQA Gafchromic film. The examination was also simulated using Monte Carlo software for the without thyroid shield case for a comparison of the dose and to evaluate the dosimetric effect of suboptimal examination positioning. A 36% reduction in thyroid dose was measured as a result of thyroid shield use; the effective dose reduction is of the order of 22%. Suboptimal positioning was found to increase thyroid dose by a far more significant amount. Despite the reduction in thyroid dose, cost-benefit considerations mean that the purchase of a thyroid shield is only recommended where a very high number of anterior oblique occlusal views are undertaken. Optimization efforts for this examination are better focussed on training in examination positioning.

Thyroid shield during brain CT scan: dosereduction and image quality evaluation

Introduction: The aim of this study was to investigate the dose reduction to the thyroid gland during routine brain CT examinations. Also, the study compares the quality of the images before and after applying the thyroid shields. Material and methods: An experimental study utilizing head attenuation phantom and multi-slice 16 CT scanner. Dose measurement conducted by thermoluminescent dosimeter (TLD). A circumferential thyroid shielding was used during pre and post scan, images from scan qualitatively assessed for quality parameters such as grayscale, noise, soft tissue, bone details and overall image quality. Results: An average of 45% reduction in the entrance skin dose to the thyroid area was reported. 40-60% dose reduction was achieved at different points along thyroid region. The results of the image quality comparisons between scans done with and without shielding showed that quality of the images was not affected. Significant reduction in the scatter radiation dose to the thyroid during CT head scan when shielding applied. The study proved that application of thyroid shielding would not affect the quality of the images. Therefore, it is highly recommended to be used during brain scan whenever it is possible.