OPtimising protection
Awareness & education
Staff radiation awareness & education
2023
In 2011, the International Commission on Radiological Protection (ICRP) recommended
a significant reduction in the lens-equivalent radiation dose limit, thus from an average of 150 to
20 mSv/year over 5 years. In recent years, the occupational dose has been rising with the increased sophistication of interventional radiology (IVR); management of IVR staff radiation doses has become more important, making real-time radiation monitoring of such staff desirable. Recently, the i3 real time occupational exposure monitoring system (based on RaySafeTM) has replaced the conventional i2 system.
Here, we compared the i2 and i3 systems in terms of sensitivity (batch uniformity), tube voltage dependency, dose linearity, dose-rate dependency, and angle dependency. The sensitivity difference (batch uniformity) was approximately 5%, and the tube-voltage dependency was <±20% between 50 and 110 kV. Dose linearity was good (R2 = 1.00); a slight dose-rate dependency (~20%) was evident at very high dose rates (250 mGy/h).
The i3 dosimeter showed better performance for
the lower radiation detection limit compared with the i2 system. The horizontal and vertical angle
dependencies of i3 were superior to those of i2. Thus, i3 sensitivity was higher over a wider angle
range compared with i2, aiding the measurement of scattered radiation.
Unlike the i2 sensor, the influence of backscattered radiation (i.e., radiation from an angle of 180◦) was negligible. Therefore,
the i3 system may be more appropriate in areas affected by backscatter. In the future, i3 will facilitate real-time dosimetry and dose management during IVR and other applications.
Keywords: radiation protection and safety; fluoroscopy; interventional radiology (IVR);
fluoroscopically guided interventional procedures; percutaneous coronary intervention (PCI);
eye lens dose; occupational radiation exposure; X-ray examination; real-time radiation sensor
Hattori K, Inaba Y, Kato T, et al. Evaluation of a New Real-Time Dosimeter Sensor for Interventional Radiology Staff. Sensors (Basel, Switzerland). 2023; 23: 512.
Highlights
- Evaluation of awareness and mitigation of hazards associated with radiological procedures for radiation workers.
- The healthcare workers’ radiation doses were reviewed to gauge their knowledge of radiation safety issues.
- In some hospitals, dose recording was high due to the low awareness of the need for radiation protection.
- Proper education in radiation protection safety and measures for healthcare professionals is required.
Background
Medical radiation workers account for 75% of the workers exposed to ionizing radiation worldwide. All registered radiation workers’ occupational exposure is monitored regularly to keep track of their doses. It is critical to track personnel’s radiation exposure and assess the characteristics that affect the total radiation burden.
Objective
The study aims to assess radiographers’ knowledge of radiation safety and their occupational exposure in the Southern Province of Saudi Arabia.
Materials and methods
Many random hospitals in the Asir region (Hospitals 1, 2, and 3), south of Saudi Arabia, were selected. The project’s analysis of the TLD readings for 200 radiography staff members was the first step. After that, radiology departments were surveyed about radiation exposure, and an electronic questionnaire was created to gauge radiographers’ awareness and understanding. The responses were then examined.
Results
More than half of the technicians whose average dose limit is more significant than one mSv, 20% are higher than 1.5 mSv. The CT rooms of Hospital 1 have a much higher effective dose than the rest of the hospitals’ CT rooms. Most radiographers do not wear radiation gowns during imaging when required. More than half of them reported that some protective tools are not available. The technicians demonstrated sound knowledge in answering questions about understanding and awareness of radiation protection.
Conclusion
The results are alert to a weakness in the radiation protection system within hospitals. This is reflected in the great dissatisfaction of technicians with the radiation protection units in their hospitals. Awareness answers and good knowledge do not correspond to reality.
Alasmari Y, Alnowami MR, Alkhateeb SM and Djouider F. Assessment of radiographers’ understanding of radiation safety and their occupational radiation exposure in the Asir region of Saudi Arabia. Radiation physics and chemistry (Oxford, England : 1993). 2023; 212: 111148.
2022
Japanese people experienced the Hiroshima and Nagasaki atomic bombings, the Japan Nuclear Fuel Conversion Co. criticality accident, it was found that many human resources are needed to respond to residents’ concerns about disaster exposure in the event of a radiation disaster. Medical radiologic technologists learn about radiation from the time of their training, and are engaged in routine radiographic work, examination explanations, medical exposure counseling, and radiation protection of staff. By learning about nuclear disasters and counseling, we believe they can address residents’ concerns. In order to identify items needed for training, we examined the perceptions of medical radiologic technologists in the case of different specialties, modalities and radiation doses.
In 2016, 5 years after the Fukushima Daiichi nuclear power plant accident, we conducted a survey of 57 medical radiologic technologists at two medical facilities with different specialties and work contents to investigate their attitudes toward radiation. 42 participants answered questions regarding sex, age group, presence of children, health effects of radiation exposure, radiation control, generation of X rays by diagnostic X ray equipment, and radiation related units.
In a comparison of 38 items other than demographic data, 14 showed no significant differences and 24 showed significant differences.
This study found that perceptions of radiation were different among radiology technologists at facilities with different specialties. The survey suggested the possibility of identifying needed training items and providing effective training.
Yashima S and Chida K. Awareness of Medical Radiologic Technologists of Ionizing Radiation and Radiation Protection. Int J Environ Res Public Health. 2022; 20: 497.
2021
Background – To assess awareness of ionizing radiation safety measures among Egyptian Urology Trainees and Urologists and see the effect of radiation safety courses on the adoption of these measures.
Methods – This Internet-based survey was conducted via https://www.surveymonkey.com/ after approval by the Egyptian Urological Association (EUA). It was sent to all EUA members via email during December 2019. Participation was voluntary and questions included participants’ demographics such as age, gender, years of experience, level of training and type of practice. Other questions assessed some domains such as whether the participant had radiation safety courses, and the extent to which she/he is adopting these measures during daily practice.
Results – A total of 142 Egyptian urology trainees and urologists responded to this electronic survey. The mean hours of fluoroscopy-guided endourologic procedures per week were 4.3 ± 2.1 h, and only 23% reported that they always wear protective lead aprons. In terms of the thyroid shield, X-ray protective gloves, eye googles, a total of 70% and 89% and 89% reported that they never wore it, respectively. The ALARA principle was known by only 24% of respondents. About 94% denied receiving any radiation safety courses. Participants who received radiation safety course reported significantly shorter FT during URS (p = 0.04), PCNL (p = 0.03) and JJ insertion (p = 0.04) and were significantly more compliant (p = 0.02). In addition, the number of years of experience (< 5y,5-10y,10-15y, > 15y) and the current job level (resident, specialist, consultant, professor) was significantly associated with higher compliance with lead aprons (p = 0.006, p < 0.001, respectively). On regression analysis, previous radiation safety awareness courses were the only predictor of good compliance with radiation safety measures (OR = 2 ± 0.73, p = 0.009).
Conclusion – There was a lack of awareness and implementation of radiation safety measures among all participants. Receiving radiation safety courses was the only predictor of good compliance with radiation safety measures.
Omar M, Desoky EEA, Elmohamady B, El-Shaer A and Noureldin YA. Awareness and implementation of lonizing radiation safety measures among urology community in Egypt: nationwide survey. African Journal of Urology. 2021; 27.
2020
We are all deeply conscious of radiation safety. We manage our collimation, dose, fluoroscopy time, and our lead, and our newest angiography suites have features that track patient and operator exposure. Our radiation protection culture seeks to protect the thyroid and torso. When we discuss our occupational risk from chronic low-dose ionizing radiation (LDIR) exposure, we focus on cataracts and long-term cancer risk. This article by Zhu et al, titled “Association between Radiation Exposure and Endothelium-Dependent Vasodilation: Results from Clinical and Experimental Studies,” reported an association between radiation exposure and cardiovascular disease.
Murphy, K. (2020). Comments on a Thought-Provoking Article about Occupational Radiation Injury. Journal of Vascular and Interventional Radiology, 31(1), 49–50. https://doi.org/10.1016/j.jvir.2019.10.008
2019
Purpose of Review – Radiation safety has been at the center of interest of both researchers and healthcare institutions. This review will summarize and shed light on the various techniques adapted to reduce staff exposure to ionizing radiation (IR) in the field of cardiac imaging.
Recent Findings – In the last years, with the advance of awareness and the development of new technologies, there have been several tools and techniques adapted. The breakthrough of several technologies to lower radiation dose and shorten the duration of diagnostic tests associated with IR, the use of protection devices by staff members, and mostly the awareness of exposure to IR are the hallmark of these advances. Using all these measures has led to a significant decrease in staff exposure to IR.
Summary – Reducing staff exposure to meet the “As Low As Reasonably Achievable” principle is feasible. This review introduces the most important strategies applied in cardiac imaging.
Massalha, S., Almufleh, A., Small, G., Marvin, B., Keidar, Z., Israel, O., & Kennedy, J. (2019). Strategies for Minimizing Occupational Radiation Exposure in Cardiac Imaging. Current Cardiology Reports, 21(8), 1–6. https://doi.org/10.1007/s11886-019-1157-1
Purpose – To evaluate conditions for minimizing staff dose in interventional radiology, and to provide an achievable level for radiation exposure reduction.
Materials and Methods – Comprehensive phantom experiments were performed in an angiography suite to evaluate the effects of several parameters on operator dose, such as patient body part, radiation shielding, x-ray tube angulation, and acquisition type. Phantom data were compared with operator dose data from clinical procedures (n = 281), which were prospectively acquired with the use of electronic real-time personal dosimeters (PDMs) combined with an automatic dose-tracking system (DoseWise Portal; Philips, Best, The Netherlands). A reference PDM was installed on the C-arm to measure scattered radiation. Operator exposure was calculated relative to this scatter dose.
Results – In phantom experiments and clinical procedures, median operator dose relative to the dose-area product (DAP) was reduced by 81% and 79% in cerebral procedures and abdominal procedures, respectively. The use of radiation shielding decreased operator exposure up to 97% in phantom experiments; however, operator dose data show that this reduction was not fully achieved in clinical practice. Both phantom experiments and clinical procedures showed that the largest contribution to relative operator dose originated from left-anterior-oblique C-arm angulations (59%–75% of clinical operator exposure). Of the various x-ray acquisition types used, fluoroscopy was the main contributor to procedural DAP (49%) and operator dose in clinical procedures (82%).
Conclusions – Achievable levels for radiation exposure reduction were determined and compared with real-life clinical practice. This generated evidence-based advice on the conditions required for optimal radiation safety.
Sailer, A., Paulis, L., Vergoossen, L., Wildberger, J., & Jeukens, C. (2019). Optimizing Staff Dose in Fluoroscopy-Guided Interventions by Comparing Clinical Data with Phantom Experiments. Journal of Vascular and Interventional Radiology, 30(5), 701–708.e1. https://doi.org/10.1016/j.jvir.2018.11.019
2018
This review describes the basic concepts and methods for optimization of occupational dose in the interventional suite. In fluoroscopy, the source of virtually all radiation exposure to the operator is scattered radiation from the patient. All other things being equal, reducing patient radiation dose will reduce operator and staff dose. Most tools and methods of occupational radiation protection are entirely operator dependent. These methods must be used routinely and properly to be effective. Your occupational dose depends on how well you follow good radiation protection practices and on the kinds of procedures you do. The only way to know your own occupational dose is to wear your dosimeters for every case. If proper protection practices are followed and appropriate protection tools are used, annual effective dose for an interventionalist should be well below 10 mSv/y, and will more likely be in the range of 2-4 mSv/y. However, if proper protection practices and tools are not used, annual effective doses may be much higher. You should review your own doses periodically.
Miller, D. (2018). Make Radiation Protection a Habit. Techniques in Vascular and Interventional Radiology, 21(1), 37–42. https://doi.org/10.1053/j.tvir.2017.12.008
2017
Background – One goal of increasing awareness of radiation dose is to encourage personal and technical modifications in order to reduce the radiation exposure of patients and staff.
Objective – To analyze the radiation doses incurred during diagnostic cerebral angiography and the angiographic techniques practiced over a 4-year period, in order to demonstrate the effectiveness of implementing radiation dose reduction strategies.
Methods – A retrospective review of the first 50 consecutive adult and pediatric patients undergoing diagnostic cerebral angiography each year from 2010 to 2013 was performed. Angiograms and procedure examination protocols were reviewed for patient age, gender, diagnosis, angiography techniques, fluoroscopy time, reference point air kerma (Ka,r in mGy), and kerma-area product (PKA in μGym2).
Results – From January 2010 to June 2013, a total of 231 diagnostic cerebral angiograms were reviewed (200 adults, 31 children). Adult patients were aged from 19 to 94 years and included 77 men and 123 women. Pediatric patients were aged from 2 to 18 years and comprised 11 boys and 20 girls. Median Ka,r and PKA significantly decreased from 2010 to 2013 in adults (1867 mGy; 21 231 µGym2 vs 653 mGy; 7860 µGym2) and children (644 mGy; 6495 µGym2 vs138 mGy; 1465 µGym2), (p<0.001).
Conclusions – Increased awareness and implementation of dose reduction strategies resulted in decreased radiation doses for diagnostic cerebral angiography both in adult and pediatric patients. The use of lower and variable digital subtraction angiography frame rates and tailored examinations contributed significantly to the reduced radiation doses observed during diagnostic cerebral angiography.
Schneider T, Wyse E, Pearl MS. Analysis of radiation doses incurred during diagnostic cerebral angiography after the implementation of dose reduction strategies Journal of NeuroInterventional Surgery 2017;9:384-388. doi: 10.1136/neurintsurg-2015-012204
2016
Introduction – There is growing interest in improving radiation safety in the cardiac catheterization laboratory for both patients and operators.
Methods – We developed and administered an online survey on practices and perceptions on radiation safety to physicians working in the catheterization laboratory both in the United States and internationally.
Results – A total of 570 responses were collected from the United States (77.9%), Asia (7.9%), Europe (6.8%), Canada (2.8%), Mexico and Central America (2.1%). Most (73%) respondents were interventional cardiologists, while 23.3% were electrophysiologists. Participants were in clinical practice for 14.4 ± 10.2 years. Of the respondents 75.4% did not know how much radiation they had received during the past year, 21.2% had never attended a radiation safety course, and 17.7% attended annual refresher courses. 43.0% reported back pain related to lead use and 6.3% had health problems potentially related to radiation exposure, i.e. cataracts and malignancies. More frequent attendance of radiation safety courses was associated with more frequent awareness about personal annual dose (p=0.0002), patient radiation dose thresholds (p<0.0001) and use of the fluoro store function (p<0.0001) and under-table shields (p=0.0012). When comparing US with non-US operators, US operators were more likely to attend radiation safety courses, wear a dosimeter, and use the fluoro store function (Figure). In addition, US operators were more likely to use under-table shields (p=0.0016) and disposable radiation shields (p=0.0016). US operators were more concerned about chronic radiation exposure, but non-US operators were more likely to know their annual personal radiation dose (p<0.0001).
Conclusions – Radiation safety in the catheterization laboratory is a concern for many operators, however there is a significant variability in current practices around the world.
Menon, A., Patel, V., Karatasakis, S., Danek, S., Karacsonyi, S., Rangan, S., … Brilakis, S. (2016). Abstract 19741: Current Perspectives and Practices on Radiation Safety in the Catheterization Laboratory. Circulation, 134(Suppl_1 Suppl 1), A19741–A19741.
Objective – Cardiac interventional radiology (IR) can cause radiation injury to the staff who administer it as well as to patients. Although education in the basic principles of radiation is required for nurses, their level of radiation safety knowledge is not known. The present study used a questionnaire protocol to assess the level of radiation safety knowledge among hospital nurses.
Methods and Results – A questionnaire to assess the level of training and current understanding of radiation safety was administered to 305 nurses in 2008 and again to 359 nurses in 2010. Our study indicates that nurses had insufficient knowledge about radiation safety, and that a high percentage of nurses were concerned about the health hazards of radiation. Moreover, more than 80% of the nurses expressed an interest in attending periodic radiation safety seminars. Annual radiation protection training for hospital staff (including nurses) is important.
Conclusions – Our results suggest that nurses do not have sufficient knowledge of radiation safety and should receive appropriate radiation safety training. Many had a minimal understanding of radiation and thus had significant concerns about the safety of working with radiation. Periodic radiation safety education/training for nurses is essential.
Morishima Y, Chida K, Katahira Y, Seto H, Chiba H, Tabayashi K. Need for radiation safety education for interventional cardiology staff, especially nurses. Acta cardiologica. 2016;71(2):151-155. doi: 10.2143/AC.71.2.3141844
2014
Despite the advent of non-fluoroscopic technology, fluoroscopy remains the cornerstone of imaging in most interventional electrophysiological procedures, from diagnostic studies over ablation interventions to device implantation. Moreover, many patients receive additional X-ray imaging, such as cardiac computed tomography and others. More and more complex procedures have the risk to increase the radiation exposure, both for the patients and the operators. The professional lifetime attributable excess cancer risk may be around 1 in 100 for the operators, the same as for a patient undergoing repetitive complex procedures. Moreover, recent reports have also hinted at an excess risk of brain tumours among interventional cardiologists. Apart from evaluating the need for and justifying the use of radiation to assist their procedures, physicians have to continuously explore ways to reduce the radiation exposure. After an introduction on how to quantify the radiation exposure and defining its current magnitude in electrophysiology compared with the other sources of radiation, this position paper wants to offer some very practical advice on how to reduce exposure to patients and staff. The text describes how customization of the X-ray system, workflow adaptations, and shielding measures can be implemented in the cath lab. The potential and the pitfalls of different non-fluoroscopic guiding technologies are discussed. Finally, we suggest further improvements that can be implemented by both the physicians and the industry in the future. We are confident that these suggestions are able to reduce patient and operator exposure by more than an order of magnitude, and therefore think that these recommendations are worth reading and implementing by any electrophysiological operator in the field.
Heidbuchel, H., Wittkampf, F., Vano, E., Ernst, S., Schilling, R., Picano, E., … Femenia, F. (2014). Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures. Europace, 16(7), 946–964. https://doi.org/10.1093/europace/eut409
2013
Concerns about ionizing radiation during interventional cardiology have been increased in recent years as a result of rapid growth in interventional procedure volumes and the high radiation doses associated with some procedures. Noncancer radiation risks to cardiologists and medical staff in terms of radiation-induced cataracts and skin injuries for patients appear clear potential consequences of interventional cardiology procedures, while radiation-induced potential risk of developing cardiovascular effects remains less clear. This paper provides an overview of the evidence-based reviews of concerns about noncancer risks of radiation exposure in interventional cardiology. Strategies commonly undertaken to reduce radiation doses to both medical staff and patients during interventional cardiology procedures are discussed; optimisation of interventional cardiology procedures is highlighted.
Sun, Z., AbAziz, A., & Khairuddin Md Yusof, A. (2013). Radiation-Induced Noncancer Risks in Interventional Cardiology: Optimisation of Procedures and Staff and Patient Dose Reduction. BioMed Research International, 2013, 11. https://doi.org/10.1155/2013/976962
2011
In order to establish an efficient training program of radiation safety for nurses, studies have been carried out on the basis of questionnaires. Collaboration of nurses, who are usually standing closest to the patient, is necessary in order to offer safe radiological diagnostics/treatment. The authors distributed the questionnaire to 134 nurses in five polyclinic hospitals in Japan. Important questions were: fear of radiation exposure, knowledge on the radiation treatment, understanding the impact on pregnancy, and so on. Most of the nurses feel themselves uneasy against exposure to radiation. They do not have enough knowledge of radiological treatment. They do not know exactly what is the impact of the radiation on pregnant women. Such tendency is more pronounced, when nurses spend less time working in the radiological department. Nurses play important roles in radiological diagnostics/treatment. Therefore, a well-developed education system for radiation safety is essential. The training for the radiation safety in medicine should be done in the context of general safety in medicine. Education programs in undergraduate school and at the working place should be coordinated efficiently in order to ensure that both nurses and patients are informed about the meaning of radiation safety.
Ohno K, Kaori T. Effective education in radiation safety for nurses. Radiation Protection Dosimetry. 2011;147(1-2):343-345. doi: 10.1093/rpd/ncr342