Dose to extremities
Occupational exposure to extremities
2023
Background
Radiological neuro-interventions, especially endovascular stroke treatment (EST), are increasing in case numbers worldwide with increasing occupational radiation exposure. Aim of this study was to define the radiation exposure of neurointerventionalists (NI) during EST and to compare the accumulated dose reaching the left arm with the left temple.
Methods
This is a prospective observational study in a tertiary stroke center conducted between 11/2021 and 07/2022. Radiation exposure was measured using real time dosimetry with dosimeters being carried by the NI during EST simultaneously at the left temple and left arm. The effective dose [µSV] per dose area product (DAP) and potential influencing factors were compared in univariate analysis between the two dosimeter positions.
Results
In total, 82 ESTs were analyzed with a median DAP of 6179 µGy*m2 (IQR 3271 µGy*m2–11720 µGy*m2). The accumulated dose at the left arm and left temple correlated with the DAP and fluoroscopy time of the EST (DAP and arm: p = 0.01, DAP and temple: p = 0.006). The radiation exposure (RE) showed a wide range and did not differ between the two dosimeter positions (median, IQR arm 7 µSV, IQR 3.1–16.9 µSV, min. 0.3 µSV max. 64.5 µSV) vs. head 7 µSv, IQR 3.2–17.4 µSV, min. 0.38 µSV, max. 48.6 µSV, p = 0.94). Occupational RE depends on the number of thrombectomy attempts, but not the target vessel occlusion location or the NI’s body height.
Conclusion
Neurointerventionalists experience a generally low but very variable radiation exposure during EST, which depends on the intervention’s fluoroscopy time and dose area product as well as thrombectomy attempts but does not differ between left temple and left arm.
Weyland CS, Jesser J, Bourgart I, et al. Occupational radiation exposure of neurointerventionalists during endovascular stroke treatment. Eur J Radiol. 2023; 164: 110882.
Introduction
Percutaneous forefoot surgery has been associated with higher radiation exposure than the conventional approach. However, there is little data on forefoot surgery using a mini C-arm intensifier. We, therefore, conducted a prospective study to (1) evaluate the intraoperative radiation received by the surgeon during percutaneous forefoot surgery with a mini C-arm; (2) compare the radiation received by the surgeon with the guidelines for occupational exposure issued by the International Commission on Radiological Protection (ICRP) (20 millisieverts per year [mSv/year] for the whole body, 500 mSv/year for the hands, and 20 mSv/year for the lens of the eye); and (3) compare the radiation received during percutaneous forefoot surgery with that of the open approach, which has already been reported in the literature.
Hypothesis
The radiation received by the surgeon during percutaneous forefoot surgery with a mini C-arm is lower than the ICRP guidelines, and the findings reported in the literature.
Materials and methods
This prospective single-center study was conducted from September 2020 to May 2021. A total of 639 feet (i.e., 435 patients) were included. Of these 639 feet, 336 (52%) were hallux valgus repairs, 49 (8%) were stand-alone procedures of the lateral rays, and 124 (19%) were a combination of both. The radiation dose data was retrieved from the mini C-arm daily: dose-area product (DAP) in centigray per square centimeter (cGy/cm2) and radiation exposure duration in seconds. The doses received by the surgeon were collected every month by 4 passive dosimeters (hand, eye lens, and chest [on and under the lead apron]) and 2 active dosimeters (on and under the lead apron).
Results
The DAP emitted by the mini C-arm during an operating day was 0.10 ± 0.01 cGy/cm2 (range, 0.0–3.9), and the mean daily radiation duration was 34.7 ± 19.3 seconds (range, 0.7–226.8). There was a mean of 8 ± 8 (range, 1–18) elective procedures per operating day. The daily reading on the active dosimeter worn on the lead apron was 0.002 ± 0 microSv (range, 0–0.04), while the one worn under the apron was 0.001 ± 0 microSv (range, 0–0.03). The equivalent doses over the 7-month study period for the hand, eye lens, and chest (over and under the apron) were 0.14 mSv, 0 mSv, 0.22 mSv, and 0 mSv, respectively.
Discussion/Conclusion
The radiation exposure in percutaneous forefoot surgery with a mini C-arm intensifier observed in our study was lower than the ICRP recommendations and literature findings during open surgery.
Duguay T, Housset V, Bouché PA, Hardy A and Bauer T. Prospective observational analysis of intraoperative radiation exposure with a mini C-arm intensifier in percutaneous forefoot surgery. Orthopaedics & Traumatology: Surgery & Research. 2023: 103705.
Background: The intensity of radiation scatter that emanates from the X-ray beam during fluoroscopically guided interventions is greater below the fluoroscopy table than above. Yet interventionalists’ lower legs are typically unshielded and table skirts are often positioned incorrectly. We sought to characterize the efficacy of the leg protector wraps (Leg Wraps, Burlington Medical Inc.) in reducing the radiation dose to the operator’s lower leg during fenestrated and branched endovascular aneurysm repair (F-BEVAR).
Methods: A prospective cohort study was performed evaluating the lower leg radiation dose reduction of one vascular surgeon during F/BEVAR using antimony/bismuth Enviro-Lite leg wraps (0.35 mm lead equivalency, 99.7% attenuation at 50 kVp; Burlington Medical, Hampton Roads, Virginia). Optically Stimulated Luminescence nanoDot detectors (microSTARii System, LANDAUER, Inc., Glenwood, Illinois) were placed over and under the left leg wrap at the anterior tibial tuberosity position to compare operator leg dose with and without this additional protection. The table-mounted lead skirt was used consistently in all cases. The nanoDot detectors were cross-calibrated with a survey meter (RaySafe X2 survey sensor, Fluke Biomedical, Cleveland, Ohio) by measuring scattered radiation at a position equivalent to an operator’s mid-tibia while performing digital acquisitions of a 25-cm thick, 30 cm × 30 cm acrylic phantom with a Philips FD20 fluoroscope (Philips Healthcare, Best, The Netherlands) with the table skirt removed. The measured radiation doses were converted to a Hp (0.07) skin dose, assuming an RQR6 beam spectrum (IEC-61267). Paired Wilcoxon test was performed to identify significant attenuation of radiation exposure.
Results: Leg dose measurements from 40 F-BEVARs were analyzed. The patients had a median (interquartile range) body mass index of 27 (24-32) kg/m2. Median procedure reference air kerma was 1,100 (728-1,601) mGy, kerma-area product was 127 (73-184) Gycm2, and fluoroscopy time was 69 (54-86) min. The median skin dose Hp (0.07) over the leg wraps (n = 40) was 54.2 (24-100) μSv and under the leg wraps (n = 40) was 2.7 μSv (1.0-5.8). The leg wraps attenuated the radiation dose by 95% (89-98%) (P < 0.001). The unprotected, Hp (0.07) per kerma-area product was determined to be 0.38 (0.30-0.55) μSv/Gycm2.
Conclusions: The 0.35-mm lead-equivalent leg wraps significantly decreased scattered radiation to the lower leg during F-BEVAR. Protective leg wraps should be recommended to operators performing complex fluoroscopically guided procedures.
Ramanan B, Pizano A, Timaran CH, et al. Operator Lower Leg Radiation Dose during Fluoroscopically Guided Interventions is Effectively Reduced by Wearing Lead-Equivalent Leg Wraps. Ann Vasc Surg. 2023; 89: 161-5.
2022
Purpose – To investigate the average fuoroscopy time, as well as the patient and surgical staf average radiation exposure in
the context of intraoperative fuoroscopy use during anterior total hip arthroplasty (THA).
Methods – PubMed, Cochrane, Embase, Web of Science and Scopus were systematically searched for studies pertaining to
intraoperative anterior THA fuoroscopy (PROSPERO ID 258049). The comprehensive literary search was conducted using
“THA,” “fluoroscopy” and “radiation exposure” as the search criteria, which resulted in 187 total papers. Of these 187 papers,
11 studies were included in this systematic review as they involved anterior THA and specifically contained data regarding
radiation exposure dose and/or time.
Results – Eleven studies were included, enrolling 1839 patients. The average fluoroscopy time was 21.4 (95% confidence
interval [CI] 16.6–26.1) seconds, whereas the average patient radiation dose was 1.8× 10–3 (95% CI 7.4× 10–4–2.9× 10–3) Gy.
Conclusions – Although several studies fail to report fluoroscopy time and radiation dose in THA patients, fluoroscopy-guided
THA has emerged as a safe procedure. Additional studies may analyze if radiation exposure during the surgeon’s THA learning curve is significantly higher, as well as what protocols may potentially reduce radiation exposure even further.
Keywords Intraoperative fluoroscopy · Total hip arthroplasty · Total hip replacement · Radiation exposure
Baksh N, Wei L, Ho ES, et al. Radiation exposure in fluoroscopy-guided anterior total hip arthroplasty: a systematic review. Eur J Orthop Surg Traumatol. 2022; 32: 891-7.
A two centre clinical study was performed to analyse exposure levels of cardiac physicians performing electrophysiology and haemodynamic procedures with the use of state of the art Zero-Gravity™ radiation protective system (ZG). The effectiveness of ZG was compared against the commonly used ceiling suspended lead shield (CSS) in a haemodynamic lab. The operator’s exposure was assessed using thermoluminescent dosimeters (TLDs) during both ablation (radiofrequency ablation (RFA) and cryoablation (CRYA)) and angiography and angioplasty procedures (CA/PCI). The dosimeters were placed in multiple body regions: near the left eye, on the left side of the neck, waist and chest, on both hands and ankles during each measurement performed with the use of ZG.
In total 29 measurements were performed during 105 procedures. To compare the effectiveness of ZG against CSS an extra 80 measurements were performed with the standard lead apron, thyroid collar and ceiling suspended lead shield during CA/PCI procedures. For ZG, the upper values for the average eye lens and whole body doses per procedure were 4 µSv and 16 µSv for the left eye lens in electrophysiology lab (with additionally used CSS) and haemodynamic lab (without CSS), respectively, and about 10 µSv for the remaining body parts (neck, chest and waist) in both labs.
The skin doses to hands and ankles non-protected by the ZG were 5 µSv for the most exposed left finger and left ankle in electrophysiology lab, while in haemodynamic lab 150 µSv and 17 µSv, respectively. The ZG performance was 3 times (p < 0.05) and at least 15 times (p < 0.05) higher for the eye lenses and thoracic region, respectively, compared to CSS (with dosimeters on the apron/collar). However, when only ZG was used slightly higher normalised doses were observed for the left finger compared to CSS (5.88e − 2 Sv/Gym2 vs. 4.31 e − 2 Sv/Gym2, p = 0.016).
The study results indicate that ZG performance is superior to CSS. It can be simultaneously used with the ceiling suspended lead shield to ensure the protection to the hands as long as this is not obstructive for the work.
Domienik-Andrzejewska J, Mirowski M, Jastrzębski M, et al. Occupational exposure to physicians working with a Zero-Gravity™ protection system in haemodynamic and electrophysiology labs and the assessment of its performance against a standard ceiling suspended shield. Radiat Environ Biophys. 2022; 61: 293-300.
This study aimed to decrease surgeon exposure to ionizing radiation through a new learning technique, “deliberate practice”, which consists in improving performance by setting goals with feedback. The hypothesis was that exposure to ionizing radiation during distal radius fracture surgery using the minimally invasive plate osteosynthesis (MIPO) technique decreased faster with “deliberate” practice than with “naïve” practice.
Radiographic dosimetry was measured in the first 30 fractures operated on by MIPO by 6 surgeons. The first 3 surgeons operated “naively” (Group 1) and the next 3 according to the “deliberate” procedure (Group 2). Group 2 received weekly feedback (number of exposed hands, number of fluoroscopic views, exposure duration, and X-ray dose). An expert, using fluoroscopic images and surgical videos, provided suggestions for improvement.
Mean number of exposed hands was 23.66 in Group 1 and 1.9 in Group 2. Mean number of fluoroscopic views was 78.31 and 35.0, respectively. Mean X-ray exposure time was 74.34 and 32.89 s, respectively. Mean dosimetry was 1.40 mGy (and 0.59 mGy, respectively. The hypothesis was thus confirmed: dosimetry decreased faster in Group 2 than in Group 1.
Teaching this deliberate practice should be generalized, to decrease the growth phase and increase the plateau phase of the learning curve.
Delbarre M, Hidalgo Diaz JJ, Xavier F, Meyer N, Sapa MC and Liverneaux P. Reduction in ionizing radiation exposure during minimally invasive anterior plate osteosynthesis of distal radius fracture: Naive versus deliberate practice. Hand Surgery and Rehabilitation. 2022; 41: 194-8.
2021
Abstract – A 70 year-old interventional cardiologist, who worked in the cardiac catheterization laboratory for >35 years, developed multiple skin cancers in regions not conventionally covered by protective lead apparel. The majority of lesions were left-sided, representing cutaneous regions in closest proximity to the radiation source. Although skin not covered by lead apparel often receives frequent sun exposure, a known risk factor for skin cancer, malignancies resulting exclusively from sun exposure would not in most cases be expected to have a left-sided predominance. Additional research is warranted to study the potential link between occupational radiation exposure and skin cancer risk.
Purohit E, Karimipour D and Madder RD. Multiple cutaneous cancers in an interventional cardiologist: Predominance in unprotected skin nearest the radiation source. Cardiovasc Revasc Med. 2021.
Introduction
Foot and ankle surgeons make daily use of mini-C-arm fluoroscopes. The present study aimed to quantify associated radiation doses.
Hypothesis
X-ray exposure for foot and ankle surgeons using a mini-C-arm fluoroscope is below the nuclear safety authority authorized doses of 20 mSv/year for the whole body and crystalline lens, 150 mSv/year for the thyroid and 500 mSv/year for the skin and limbs.
Material and methods
A single-center, single-surgeon prospective series was treated between February 2014 and December 2017. Doses emitted by the mini-C-arm (15 cm field) were recorded during 1,064 operations. Doses received by the surgeon were recorded by 3 passive dosimeters (thorax, eyes and hands) and 1 active dosimeter. The significance threshold was set at p < 0.05.
Results
A total of 64.4% of procedures concerned the forefoot, 35.3% the hindfoot and ankle, and 0.3% were strictly percutaneous. Mean dose-area product (DAP) per procedure was 3.9 cGy/cm2 ± 7: in forefoot surgery, 1.1 cGy/cm2 ± 0.9, and in hindfoot and ankle surgery 8.7 cGy/cm2 ± 9.7 (p < 0.05), for mean irradiation times of 7.6 s ± 5.3 and 36.7 s ± 35.5 respectively and image numbers 4.1 ± 2.7 and 18.7 ± 20.5. Total ankle replacement was associated with the highest doses: 20.1 cGy/cm2 ± 14.7. Mean daily active dosimetry was 2.2 μSv ± 1.4. Mean annual dose to the hand, crystalline lens and deep (Hp(10)) and shallow (Hp(0.07)) whole body was respectively 1.28 mSv, 0.6 mSv, 0.31 mSv and 0.19 mSv. The highest annual exposure was recorded for the hands: 2.68 mSv in 2015. There was a significant linear relationship between daily active dosimetry and daily emission: daily active dosimetry = (DAP × 0.11) + 0.54, for a correlation coefficient of 0.77.
Discussion/conclusion
The exposure of foot and ankle surgeons using mini-C-arms was well below threshold, and also lower than in the literature.
Guyonnet C, Mulliez A, Fessy M-H and Besse J-L. Prospective analysis of intraoperative radiation dose in foot and ankle surgery using mini-C-arm fluoroscopy. Continuous series of 1064 procedures. Orthopaedics & Traumatology: Surgery & Research. 2021; 107: 102994.
2020
Data were collected from 642 orthopaedic interventions during which the images produced by X-rays were recorded. By examining these images, it is possible to determine the time that the orthopaedic surgeons’ hands were exposed to the direct radiation beam. The procedures with greater exposure to the direct beam were those involving the hand (median 15 s) and the wrist (median 13 s).
Two surgeons wore a ring to measure the absorbed dose at the fingers: one on the dominant hand and the other on the non-dominant hand. The two surgeons performed 34 and 48 operations, respectively, in 14 months. The total doses measured with the rings were 2.30 and 1.04 mSv, respectively. The images of the interventions were examined, determining how much each individual hand was exposed. The interventional reference point (IRPeff (left or right)) was calculated by comparing the doses at the IRP with the exposure times of the right or the left hand.
Summing the IRPeff of the two surgeons in 14 months, it is obtained the maximum values of 2.87 mGy for the left hand of one and 6.74 mGy for the right hand of the other, which are of the order of 1/100 of the annual dose limit for the extremities.
Giordano C, Monica I, Quattrini F, Villaggi E, Gobbi R and Barbattini L. EVALUATION OF THE RADIATION DOSE TO THE HANDS OF ORTHOPAEDIC SURGEONS DURING FLUOROSCOPY USING STORED IMAGES. Radiation Protection Dosimetry. 2020; 189: 157-62.
2019
There are two major challenges for personal dosimetry in healthcare. The implications for interventional clinicians of the reduction in eye dose limit in the European Basic Safety Standards and UK regulations, and the large dose gradients across the hands of nuclear medicine staff who manipulate radionuclides. Guidelines on personal dosimetry have been prepared to address these and other issues. Collar dosemeters are recommended for assessment of eye doses for the majority of staff working with x-rays and, for interventional operators, dosemeters under their lead aprons to monitor effective dose together with eye dosemeters. When a dedicated eye dosemeter is worn together with lead glasses a correction might be required to allow for the protection provided. A dosemeter worn on the chest should provide an indication of eye dose for nuclear medicine workers. Finger doses for interventional clinicians can be monitored with ring dosemeters, but radionuclide workers may need to wear finger stalls if doses to fingertips are likely to be over 100 mSv. If only ring dosemeters are used, ratios for doses to the tip and base of the finger should be established. Guidance is given on levels where dose monitoring would be required and methods to predict dose levels based on local practices.
Martin, C., Temperton, D., Jupp, T., & Hughes, A. (2019). Ipem topical report: personal dose monitoring requirements in healthcare. Physics in Medicine and Biology, 64(3), 13. https://doi.org/10.1088/1361-6560/aafa3f
Objectives – The purpose of this study was to determine the radiation exposure of primary interventionalist’s diferent body parts during endovascular aneurysm repair (EVAR) procedures and aortoiliac percutaneous transluminal angioplasty (PTA) procedures and to evaluate the efficacy of a radioprotective drape.
Methods – Occupational doses for 36 consecutive aortoiliac PTA procedures and 17 consecutive EVAR procedures were estimated using thermoluminescence dosimetry (TLD) chips (TLD-200, Hashaw, Solon, OH). Effective dose (ED) was calculated using the Niklason algorithm. For the evaluation of a 0.25 mm Pb equivalent drape (Ecolab, Saint Paul, Minnesota, USA), experiments were performed using two physical anthropomorphic phantoms (Rando-Alderson Research Labs, CA, USA).
Results – Median ED for a typical EVAR and PTA procedure was 4.7±1.4 μSv and 4.4±3.6 μSv, respectively. The highest radiation doses were measured for the operator’s hands in both procedures. Moreover, considerable doses were measured to the operator’s head, eye lenses and thyroid. Due to the use of the drape, radiation exposure of primary operator’s abdominal area, genitals, thyroid and eye lenses was reduced by an average of 59%, 60%, 65% and 59%, respectively. However, dose area product (DAP) and peak skin dose (PSD) were increased by 20% when part of the drape was placed into the X-ray field.
Conclusion – During EVAR and PTA procedures, primary operator’s organs are exposed to considerable radiation doses. Occupational radiation exposure can be reduced signifcantly with the proper use of a radioprotective drape. Keywords Occupational radiation exposure · Radioprotective drapes · Fluoroscopy · Dosimetry · EVAR · PTA
Tzanis, E., Tsetis, D., Kehagias, E., Ioannou, C., & Damilakis, J. (n.d.). Occupational exposure during endovascular aneurysm repair (EVAR) and aortoiliac percutaneous transluminal angioplasty (PTA) procedures. La Radiologia Medica, 124(6), 539–545. https://doi.org/10.1007/s11547-018-00985-8
2017
Objectives – The purpose of this study was to determine the radiation exposure of primary interventionalist’s diferent body parts during endovascular aneurysm repair (EVAR) procedures and aortoiliac percutaneous transluminal angioplasty (PTA) procedures and to evaluate the efficacy of a radioprotective drape.
Patients and Methods – Occupational doses for 36 consecutive aortoiliac PTA procedures and 17 consecutive EVAR procedures were estimated using thermoluminescence dosimetry (TLD) chips (TLD-200, Hashaw, Solon, OH). Effective dose (ED) was calculated using the Niklason algorithm. For the evaluation of a 0.25 mm Pb equivalent drape (Ecolab, Saint Paul, Minnesota, USA), experiments were performed using two physical anthropomorphic phantoms (Rando-Alderson Research Labs, CA, USA).
Results – Median ED for a typical EVAR and PTA procedure was 4.7±1.4 μSv and 4.4±3.6 μSv, respectively. The highest radiation doses were measured for the operator’s hands in both procedures. Moreover, considerable doses were measured to the operator’s head, eye lenses and thyroid. Due to the use of the drape, radiation exposure of primary operator’s abdominal area, genitals, thyroid and eye lenses was reduced by an average of 59%, 60%, 65% and 59%, respectively. However, dose area product (DAP) and peak skin dose (PSD) were increased by 20% when part of the drape was placed into the X-ray field.
Conclusion – During EVAR and PTA procedures, primary operator’s organs are exposed to considerable radiation doses. Occupational radiation exposure can be reduced signifcantly with the proper use of a radioprotective drape. Keywords Occupational radiation exposure · Radioprotective drapes · Fluoroscopy · Dosimetry · EVAR · PTA
Tzanis, E., Tsetis, D., Kehagias, E., Ioannou, C., & Damilakis, J. (n.d.). Occupational exposure during endovascular aneurysm repair (EVAR) and aortoiliac percutaneous transluminal angioplasty (PTA) procedures. La Radiologia Medica, 124(6), 539–545. https://doi.org/10.1007/s11547-018-00985-8
Background – Radiation exposure during fluoroscopically guided interventions such as endovascular aortic repair (EVAR) is a growing concern for operators. This study aimed to measure DNA damage/repair markers in operators perfoming EVAR.
Methods – Expression of the DNA damage/repair marker, γ-H2AX and DNA damage response marker, phosphorylated ataxia telangiectasia mutated (pATM), were quantified in circulating lymphocytes in operators during the peri-operative period of endovascular (infrarenal, branched, and fenestrated) and open aortic repair using flow cytometry. These markers were separately measured in the same operators but this time wearing leg lead shielding in addition to upper body protection and compared with those operating with unprotected legs. Susceptibility to radiation damage was determined by irradiating operators’ blood in vitro.
Results – γ-H2AX and pATM levels increased significantly in operators immediately after branched endovascular aortic repair/fenestrated endovascular aortic repair (P<0.0003 for both). Only pATM levels increased after infrarenal endovascular aortic repair (P<0.04). Expression of both markers fell to baseline in operators after 24 hours (P<0.003 for both). There was no change in γ-H2AX or pATM expression after open repair. Leg protection abrogated γ-H2AX and pATM response after branched endovascular aortic repair/fenestrated endovascular aortic repair. The expression of γ-H2AX varied significantly when operators’ blood was exposed to the same radiation dose in vitro (P<0.0001).
Conclusion – This is the first study to detect an acute DNA damage response in operators performing fluoroscopically guided aortic procedures and highlights the protective effect of leg shielding. Defining the relationship between this response and cancer risk may better inform safe levels of chronic low-dose radiation exposure.
El-Sayed ST, Patel SA, Cho AJ, et al. Radiation Induced DNA Damage in Operators Performing Endovascular Aortic Repair. Circulation. 2017; 136.
Exposure to ionizing radiation in the operating room is governed by practical prevention and protection measures on the international, national and local levels.
We evaluated the equivalent dose to the hand of an orthopedic surgeon over 13 months. An orthopedic surgeon wore a ring dosimeter on the ring finger of his right hand for all surgical procedures requiring intraoperative fluoroscopy between March 2014 and April 2015. Monthly doses were evaluated by the IRSN over the study period. The number and type of procedures were compiled as well as the type of fluoroscopy unit used. Four hundred procedures were performed during this period, including 182 with fluoroscopy. The equivalent cumulative dose at the hand was 4.75 mSv. No correlation was found with the type of procedure or type of fluoroscopy unit (conventional or mini C-arm). Equivalent doses were below the annual regulatory limit in France of 500 mSv.
These results are consistent with those reported in the literature. However, recent studies have noted that both younger surgeons in training and more experienced surgeons must remember to use radiation protection measures.
Loisel F, Menu G, Boyer E, Pluvy I and Obert L. Radiation exposure and the orthopedic surgeon’s hand: Measurement of the equivalent dose over 13 months. Hand Surgery and Rehabilitation. 2017; 36: 97-101.
2014
Objective -Occupational radiation doses from fluoroscopic procedures are some of the highest doses of exposure amongst medical staff using radiography. Protective equipment and dose monitoring are used to minimize and control the risk from these occupational doses. Other studies have considered the effectiveness of this protection, but this study further considers whether protection is adequate for the lower leg and foot and the extent to which these doses can be reduced.
Methods – Scatter air kerma profiles at toe level were measured with an ionization chamber. Thermoluminescent dosemeters and lower extremity phantoms were used to estimate the dose variation with the height of patient couch. A 7-week period of in situ toe dose monitoring of four radiologists was also undertaken.
Results – The use of protective curtains effectively reduced the exposure to most of the lower extremities. Toe doses were found to be high and increased with increase in couch height. In situ monitoring indicated annual toe doses of 110 mSv for two of the four radiologists monitored.
Conclusion – Protective curtains should be used, but they might have limitations with respect to toe doses. Annual toe doses approaching the classification threshold of 150 mSv were measured for two radiologists. Caution should be exercised when there is a gap below curtains and, when possible, staff should step back from the couch. Lower legs and toes should be included in local radiation protection programmes.
Advances in knowledge – Toe doses in interventional radiology may be higher than expected and may have to be included in radiation protection programmes.
Artschan, R., Brettle, D., Chase, K., Fender, A., Howells, P., & Buchan, S. (2014). An investigation of the radiation doses to the lower legs and feet of staff undertaking interventional procedures. The British Journal of Radiology, 87(1038), 20130746. https://doi.org/10.1259/bjr.20130746
2011
Objectives – The aim of this study was to determine occupational dose levels in interventional radiology and cardiology procedures.
Methods – The study covered a sample of 25 procedures and monitored occupational dose for all laboratory personnel. Each individual wore eight thermoluminescent dosemeters next to the eyes, wrists, fingers and legs during each procedure. Radiation protection shields used in each procedure were recorded.
Results – The highest doses per procedure were recorded for interventionists at the left wrist (average 485 μSv, maximum 5239 μSv) and left finger (average 324 μSv, maximum 2877 μSv), whereas lower doses were recorded for the legs (average 124 μSv, maximum 1959 μSv) and the eyes (average 64 μSv, maximum 1129 μSv). Doses to the assisting nurses during the intervention were considerably lower; the highest doses were recorded at the wrists (average 26 μSv, maximum 41 μSv) and legs (average 18 μSv, maximum 22 μSv), whereas doses to the eyes were minimal (average 4 μSv, maximum 16 μSv). Occupational doses normalised to kerma area product (KAP) ranged from 11.9 to 117.3 μSv/1000 cGy cm² and KAP was poorly correlated to the interventionists’ extremity doses.
Conclusion – Calculation of the dose burden for interventionists considering the actual number of procedures performed annually revealed that dose limits for the extremities and the lenses of the eyes were not exceeded. However, there are cases in which high doses have been recorded and this can lead to exceeding the dose limits when bad practices are followed and the radiation protection tools are not properly used.
Efstathopoulos EP, Pantos I, Andreou M, et al. Occupational radiation doses to the extremities and the eyes in interventional radiology and cardiology procedures. British Journal of Radiology. 2011;84(997):70-77. doi: 10.1259/bjr/83222759