Non-angio dose
Occupational exposure to in non-angio procedures
2023
Percutaneous vertebral augmentation (PVA), which includes percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). Robot-assisted (RA) and fluoroscopy-assisted (FA) are important methods for treating osteoporotic vertebral compression fractures (OVCFs), though it is still unclear which is superior.
This analysis aimed to compare the efficacy and safety of RA and FA. PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure were systematically searched, the outcomes included surgical parameters (leakage rate, operation time, number of fluoroscopic, injection volume, inclination angle), and clinical indexes (hospital stays, Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, the midline height of vertebral). Thirteen articles involving 1094 patients were included.
RA group produced better results than the FA group in the leakage rate (OR = 0.27; 95% CI 0.17-0.42; P < 0.00001), number of fluoroscopic (WMD = – 13.88; 95% CI – 18.47 to – 9.30; P < 0.00001), inclination angle (WMD = 5.02; 95% CI 4.42-5.61; P < 0.00001), hospital stays (WMD = – 0.32; 95% CI – 0.58 to – 0.05; P = 0.02), VAS within 3 days (WMD = – 0.19; 95% CI – 0.26 to – 0.12; P < 0.00001), Cobb angle within 3 days (WMD = – 1.35; 95% CI – 2.56 to – 0.14; P = 0.003) and Cobb angle after 1 month (WMD = – 1.02; 95% CI – 1.84 to – 0.20; P = 0.01). But no significant differences in operation time, injection volume, ODI, the midline height of vertebral, and VAS score after 1 month.
Our analysis found that the RA group had lower cement leakage rates, number of fluoroscopic and hospital stays, a larger inclination angle, better short-term pain improvement, and Cobb angle improvement. It is worth acknowledging that robotic-assisted surgery holds promise for the development of spine surgery. The study was registered in the PROSPERO (CRD42023393497).
Keywords: Meta-analysis; Osteoporotic vertebral compression fractures; Percutaneous kyphoplasty; Percutaneous vertebroplasty; Robot-assisted.
Wang X, Zhu Y-h and Zhu Q-s. Efficacy and safety of robot-assisted versus fluoroscopy-assisted PKP or PVP for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. J Robot Surg. 2023.
Background
Radiofrequency catheter ablation (RFCA) of the slow pathway in atrioventricular nodal reentry tachycardia (AVNRT) is associated with high efficacy and low risk of total perioperative or late atrioventricular block. This study aimed to evaluate the efficacy, safety, and feasibility of slow-pathway RFCA for AVNRT using a zero-fluoroscopy approach.
Methods
Data were obtained from a prospective multicenter registry of catheter ablation from January 2012 to February 2018. Consecutive unselected patients with the final diagnosis of AVNRT were recruited. Electrophysiological and 3-dimensional (3D) electroanatomical mapping systems were used to create 3D maps and to navigate only 2 catheters from the femoral access. Acute procedural efficacy was evaluated using the isoproterenol and/or atropine test, with 15-min observation after ablation. Each case of recurrence or complication was consulted at an outpatient clinic during long-term follow-up.
Results
Of the 1032 procedures, 1007 (97.5%) were completed without fluoroscopy. Conversion to fluoroscopy was required in 25 patients (2.5%), mainly due to an atypical location of the coronary sinus (n = 7) and catheter instability (n = 7). The mean radiation exposure time was 1.95 ± 1.3 min for these cases. The mean fluoroscopy time for the entire study cohort was 0.05 ± 0.4 min. The mean total procedure time was 44.8 ± 18.6 min. There were no significant in-hospital complications. The total success rate was 96.1% (n = 992), and the recurrence rate was 3.9% (n = 40).
Conclusion
Slow-pathway RFCA can be safely performed without fluoroscopy, with a minimal risk of complications and a high success rate.
Świętoniowska-Mścisz A, Stec P, Stec S, et al. Efficacy and safety of zero-fluoroscopy approach for ablation of atrioventricular nodal reentry tachycardia: experience from more than 1000 cases. J Interv Card Electrophysiol. 2023; 66: 1231-42.
2022
Introduction
Direct anterior approach (DAA) for total hip arthroplasty (THA) frequently utilizes fluoroscopy. The purpose of this study is to assess the impact of using a novel, imageless THA navigation system on radiation exposure and acetabular cup placement consistency.
Materials and methods
This was a retrospective, single-surgeon cohort study of a consecutive group of patients who underwent DAA THA for osteoarthritis. An optic-based imageless navigation system was used to determine intraoperative acetabular inclination and anteversion angles referenced off of a generic coronal and sagittal plane in 71 cases (study group). These were compared with 71 manual cases (control group) for fluoroscopy exposure, operative duration, and acetabular placement variation. Cohorts were similar in their distributions of sex, race, ethnicity, and body mass index. Comparisons between groups were made using independent samples t tests. Alpha error was 0.05.
Results
Study patients experienced significantly less fluoroscopy exposure time {3.59 [Standard Deviation (SD) 1.95] vs. 9.15 (SD 5.98) seconds; p < 0.001} and dosage (0.30 [SD 0.23] vs. 0.78 [SD 0.63] mGy; p < 0.001). Study and control patients had similar operative times [82.69 (SD 11.70) vs. 89.54 (SD 14.60) minutes; p = 0.09]. The study group had a significantly lower radiographic variation for inclination and anteversion, based on mean proximity to the centroid of each cohort [3.55 (SD 1.88) vs. 5.39 (SD 3.51); p < 0.001] and also a greater proportion of cases that fell within 1 SD of the mean cohort inclination and anteversion (40.8% vs. 21.1%; p = 0.009).
Conclusions
Use of a novel imageless navigation system for DAA THA significantly reduced fluoroscopic radiation exposure and improved consistency in acetabular cup placement.
Ong CB, Chiu Y-F, Premkumar A and Gonzalez Della Valle A. Use of a novel imageless navigation system reduced fluoroscopy exposure and improved acetabular positioning in anterior approach total hip arthroplasty: a case–control study. Arch Orthop Trauma Surg. 2023; 143: 2739-45.
2021
Background – Exposure to occupational radiation can lower the male-sex ratio. However, specific radiation exposure to the testes has not been evaluated.
Objective – This study aimed to examine the association between testicular radiation exposure andlower male sex ratio in children.
Methods – A comprehensive questionnaire survey was administered to 62 full-time male doctors with
children aged < 10 years at 5 hospitals. Based on the possibility of testicular radiation exposure 1 year before the child’s birth, participants were assigned to 3 groups as follows: RT (orthopedic surgery), RNT (cardiology/neurosurgery), and N (others). Intergroup differences in the proportion of female children were ascertained, and the female sex ratio (number of female/total number) of each group was compared against the standard value of 0.486. Multivariate logistic regression analysis with a generalized estimating equation was used to model the effects on the probability of female birth while controlling for the correlation
among the same fathers.
Results – The study population included 62 fathers and 109 children, 49 were female: 19/27, 11/30, and 19/52 in the RT, RNT, and N group, respectively; the RT group had the highest proportion of females (p = 0.009). The p values for comparisons with the standard sex ratio (0.486)
were 0.02, 0.19, and 0.08 for the RT, RNT, and N groups, respectively. Based on the N group, the adjusted odds ratios for the child to be female were 4.40 (95% confidence interval 1.60–2.48) and 1.03 (0.40–2.61) for the RT and RNT groups, respectively.
Conclusions – Our results imply an association between testicular radiation exposure and low male sex ratio of offspring. Confirmatory evidence is needed from larger studies which measure the
pre-conceptional doses accumulated in various temporal periods, separating out spermatogonial and spermatid effects.
Hijikata Y, Nakahara M, Kusumegi A, et al. Association between occupational testicular radiation exposure and lower male sex ratio of offspring among orthopedic surgeons. PLoS One. 2021; 16: e0262089-e.
Background: Fluoroscopic imaging involves exposure of the patients and the laboratory staff to ionizing radiation. One of the strategies that reduce such exposure in an electrophysiology laboratory is using a three-dimensional electroanatomic mapping (3D EAM) system for performing these procedures. In this analysis, we have analyzed the effect of fluoroscopy frame rate on the radiation exposure and in-hospital outcomes in ablation procedures performed under 3D EAM guidance.
Methods: We retrospectively analyzed all the ablation procedures performed under
3D EAM guidance at our institute from September 2015 to December 2018. The
procedures were divided into two groups based on whether the procedures were
performed before (pre) or after (post) January 26, 2018. After January 2018, fluoroscopy was used at a frame rate of 3.75 frames per second (fps). Radiation exposure
indices and in-hospital outcomes were compared between the two groups.
Results: Ablation procedures included in the analysis were ventricular arrhythmias
(n = 192), atrial flutter (115), atrial tachycardia (AT) (43), and atrial fibrillation (AF) (30).
Over the study period, there was a significant reduction in procedure time, fluoroscopy time, dose area product, and effective dose (ED) (P < .001). Except for AT and AF ablation procedures, there was a significant reduction in the radiation exposure indices when the “post” group was compared with the “pre” group (P ≤ .02). The decrease in the frame rate had no significant effect on in-hospital outcomes.
Conclusion: The use of 3D EAM combined with decreasing the fluoroscopy frame
rate significantly reduced the total radiation exposure without adversely affecting
in-hospital outcomes.
KEYWORDS
atrial flutter, effective dose, radiation exposure, three-dimensional electroanatomic mapping,
ventricular tachycardia
Ali M, Padmanabhan D, Kanjwal K, et al. Effect of fluoroscopy frame rate on radiation exposure and in‐hospital outcomes in three‐dimensional electroanatomic mapping guided procedures. Journal of arrhythmia. 2021; 37: 97-102.
2019
Introduction – Urologists are increasingly exposed to fluoroscopy as minimally invasive techniques continue to proliferate. Fluoroscopy, or electromagnetic radiation, can cause cellular damage. Appropriate knowledge of safety precautions for fluoroscopy are necessary and ideally should be taught to physicians in training.
Methods – A 20-question survey was created to assess radiation safety training, knowledge, behavior and attitudes. The survey was sent via REDCap™ to house staff routinely involved in fluoroscopic cases, including urology, orthopedic surgery, neurosurgery, radiology, general surgery, anesthesia, plastic surgery, cardiology, vascular surgery, and gastroenterology residents and fellows.
Results – Of 218 participants 61 (28%) responded during the 3-week study period. Overall 57% reported learning fluoroscopic radiation safety informally, with 28% receiving informal as well as formal education. Concerning directional x-ray travel and exposure only 20% answered correctly. In terms of conditions potentially related to radiation exposure 86% selected infertility, 87% cataracts, 87% leukemia and lymphoma, 59% central nervous system tumors and 71% birth defects. Twenty percent wear lead lined glasses, 23% dosimeters, 92% thyroid shields, 2% lead gloves, 92% lead apron, 48% lead shield and 1.6% nothing. Of the respondents 49% were unsure if the machine was set to continuous or pulse. Ninety-eight percent knew decreasing time and 100% knew wearing protective materials were ways to decrease exposure. However, concerning distance and exposure only 56% answered correctly. The majority of respondents believe radiation safety is important and would like more formal education.
Conclusions – Fluoroscopic radiation safety knowledge is low among house staff routinely exposed to fluoroscopy. Further study and likely increased formal education are warranted.
Harris, A., Loomis, J., Hopkins, M., & Bylund, J. (2019). Assessment of Radiation Safety Knowledge among House Staff Exposed to Fluoroscopic Radiation. Urology Practice, 6(2), 140–145. https://doi.org/10.1016/j.urpr.2018.05.002
Patients with structural heart disease (SHD) are more difficult to ablate than those with a structurally healthy heart. The reason may be technical problems. We compared periprocedural data in unselected patients (including SHD group) recruited for zero-fluoroscopy catheter ablation (ZF-CA) of supraventricular arrhythmias (SVTs).
Consecutive adult patients with atrioventricular nodal reentry tachycardia (AVNRT), accessory pathways (AP), atrial flutter (AFL), and atrial tachycardia (AT) were recruited. A 3-dimensional electroanatomical mapping system (Ensite Velocity, NavX, St Jude Medical, Lake Bluff, Illinois) was used to create electroanatomical maps and navigate catheters. Fluoroscopy was used on the decision of the first operator after 5 minutes of unresolved problems.
Of the 1280 patients ablated with the intention to be treated with ZF approach, 174 (13.6%) patients with SHD (age: 58.2 ± 13.6; AVNRT: 23.9%; AP: 8.5%; AFL: 61.4%; and AT: 6.2%) were recruited. These patients were compared with the 1106 patients with nonstructural heart disease (NSHD) (age: 51.4 ± 16.4; AVNRT: 58.0%; AP: 17.6%; AFL: 20.7%; and AT: 3.7% P ≤ .001). Procedural time (49.9 ± 24.6 vs 49.1 ± 23.9 minutes, P = .55) and number of applications were similar between groups (P = 0.08). The rate of conversion from ZF-CA to fluoroscopy was slightly higher in SHD as compared to NSHD (13.2% vs 7.8%, P= .02) while the total time of fluoroscopy and radiation doses were comparable in the group of SHD and NSHD (P = .55; P = .48).
ZF-CA is feasible and safe in majority of patients with SHD and should be incorporated into a standard approach for SHD; however, the procedure requires sufficient experience.
Ali M, Padmanabhan D, Kanjwal K, et al. Effect of fluoroscopy frame rate on radiation exposure and in‐hospital outcomes in three‐dimensional electroanatomic mapping guided procedures. Journal of arrhythmia. 2021; 37: 97-102.
Aims: The use of electroanatomical mapping (EAM) systems can reduce radiation exposure (RX) and it can also completely eliminate the use of RX. Radiation exposure related to conventional radiofrequency ablation procedures can have a stochastic and deterministic effect on health. The main aim of this study was to evaluate the safety
and feasibility of an entirely nonfluoroscopic approach to catheter ablation (CA) using
EAM CARTO3.
Methods: In 2011 we started an RX‐minimization programme in all procedures using
the CARTO system with the deliberate intention to not resort to the aid of RX unless
strictly necessary. We divided procedures into two groups (group 1: from 2011 to
2013; group 2: from 2014 to 2017). The only exclusion criteria were the need for
transseptal puncture, and nonidiopathic ventricular tachycardia (VT).
Results: From a total of 525 procedures, we performed CA entirely without RX in
78.5% of cases. From 2011 to 2013, we performed CA without RX in 38.5% of cases;
from 2014 to 2017, we performed 96.2% of cases with zero RX. The use of RX was significantly reduced in group 2 (group 2: 1.4 ± 19.6 seconds vs group 1: 556.92 ± 520.76 seconds; P < .001). These differences were irrespective of arrhythmia
treatment. There were no differences between the two groups in acute success, complications, or duration of procedures.
Conclusion: CA of supraventricular tachycardia and VT entirely without RX, guided
by the CARTO system, is safe, feasible, and effective. After an adequate learning curve, CA can be performed entirely without RX.
KEYWORDS
catheter ablation, electroanatomic mapping without fluoroscopy, zero fluoroscopy
Santoro A, Di Clemente F, Baiocchi C, et al. From near‐zero to zero fluoroscopy catheter ablation procedures. J Cardiovasc Electrophysiol. 2019; 30: 2397-404.
2018
Orthopaedic surgeons are routinely exposed to intraoperative radiation and, therefore, follow the principle of “as low as reasonably achievable” with regard to occupational safety.
However, standardized education on the long-term health effects of radiation and the basis for current radiation exposure limits is limited in the field of orthopaedics. Much of orthopaedic surgeons’ understanding of radiation exposure limits is extrapolated from studies of survivors of the atomic bombings in Hiroshima and Nagasaki, Japan.
Epidemiologic studies on cancer risk in surgeons and interventional proceduralists and dosimetry studies on true radiation exposure during trauma and spine surgery recently have been conducted.
Orthopaedic surgeons should understand the basics and basis of radiation exposure limits, be familiar with the current literature on the incidence of solid tumors and cataracts in orthopaedic surgeons, and understand the evidence behind current intraoperative fluoroscopy safety recommendations.
Hayda RA, Hsu RY, DePasse JM and Gil JA. Radiation Exposure and Health Risks for Orthopaedic Surgeons. J Am Acad Orthop Surg. 2018; 26: 268.
Purpose
To evaluate operator and patient irradiation during radiofrequency ablation (RFA) of common atrial flutter (AF) using three different fluoroscopy settings.
Material and method
A total of 38 patients who underwent RFA of AF with three different fluoroscopy settings (low dose, standard dose and collimated field) were included. Twelve patients (11 men, 1 woman; mean age, 67 ± 12 [SD] years) were included in the low dose group (3.75 frames per second), 13 patients (13 men; mean age, 66 ± 8 [SD] years) were included in the standard dose group (7.5 frames per second) and 13 patients (13 men; mean age, 71 ± 12 [SD] years) were included in the collimated field group (7.5 frames per second). Operator and patient exposure were compared between groups.
Result
No differences in procedure time and radiation exposure were found between the three groups. In the low dose group, mean operator X-ray exposures of eye-lens (4.7 ± 2.9 [SD] μSv/h; range: 0.9–10.5 μSv/h), whole body (1.6 ± 1.2 [SD] μSv/h; range 0.5–3.6 μSv/h) and hand skin (11.1 ± 10.8 [SD] μSv/h; range 2.4–35.4 μSv/h) were significantly lower than those in the standard dose group (P < 0.001). Significant patient dose reduction was found between low dose group (0.7 ± 0.4 [SD] Gy/h; range: 0.3–0.9 Gy/h) and standard (1.7 ± 0.5 [SD] Gy/h; range: 0.8 to 3.9 Gy/h) and collimated (1.8 ± 0.5 [SD] Gy/h; range: 0.7–3.0 Gy/h) groups (P < 0.01).
Conclusion
The use of a low dose setting (3.75 f/s) during fluoroscopy dramatically reduces operator’s irradiation during RFA of AF by a mean of 90%.
Zedira A, Greffier J, Brunet X, Pereira F, Winum PF and Granier M. Decreased operator X-ray exposure by optimized fluoroscopy during radiofrequency ablation of common atrial flutter. Diagnostic and interventional imaging. 2018; 99: 625-32.
2017
Highlights
- The eye lens exposure of the urology medical staff is assessed using OSL dosimeters.
- The relation between eye lens/chest dose and DAP for over-couch systems is discussed.
- The chest dose may be a non-conservative estimator of the eye lens dose for nurses and anaesthetist.
- The annual eye lens doses for physicians and instrumentalist nurses are above 6 mSv.
The purpose of this work was to estimate the eye lens radiation exposure of the medical staff during interventional urology procedures. The measurements were carried out for six medical staff members performing 33 fluoroscopically-guided procedures. All procedures were performed with the X-ray tube positioned over the couch. The dose equivalents (Hp(0.07)) were measured at the eye level using optically stimulated luminescent (OSL) dosimeters and at the chest level with OSL dosimeters placed over the protective apron. The ratio of the dose measured close to the eye lens and on the chest was determined. The annual eye lens dose was estimated based on the workload in the service. For the physician and the instrumentalist nurse, the eye to chest dose ratios were 0.9±0.4 and 2.6±1.6 (k = 2), respectively. The average doses per procedure received by the eye lens were 78±24 μSv and 38±18 μSv, respectively. The eye lens dose per DAP was 8.4±17.5 μSv/(Gy·cm2) for the physician and 4.1±8.7 μSv/(Gy·cm2) for the instrumentalist nurse. The results indicate that the eye lens to chest dose ratio greatly varies according to the staff function and that the dose equivalent measured by the personal dosimeter worn on the chest may underestimate the eye lens dose of some medical staff members.
Medici, S., Pitzschke, A., Cherbuin, N., Boldini, M., Sans-Merce, M., & Damet, J. (2017). Eye lens radiation exposure of the medical staff performing interventional urology procedures with an over-couch X-ray tube. Physica Medica, 43, 140–147. https://doi.org/10.1016/j.ejmp.2017.11.002
2014
Occupational radiation dose monitoring is a method of ensuring that radiation levels are within the regulatory limits. Our objective in this study was to evaluate the radiation doses experienced by personnel at a radiology facility between 2001 and 2010. Overall, 2418 annual dose records for workers who were categorized into four occupational groups were analyzed. The groups included: (1) radiologists, (2) radiologic technologists, (3) nurses, and (4) other workers, who belong to other hospital departments, but who participate partially in some radiologic procedures. The dose distribution was found to be skewed, with 76 % of personnel having received no measurable doses and almost 2 % having received doses of more than 2 mSv. The weighted-average annual doses ranged from 0.13 to 0.57, 0.9 to 2.12, 0.01 to 0.19, and 0.01 to 0.09 mSv for the radiologists, radiologic technologists, nurses, and the other workers, respectively. The radiologic technologists received the highest radiation exposure among the four groups. It was found that the average annual doses were decreasing over time for the radiologists, radiologic technologists, and others, whereas they were increasing for the nurses. Nurses play an important role in assisting radiologists and patients during various radiologic procedures, which might have increased their average annual dose. During the 10-year period of this study, there was no incidence of a dose exceeding the annual dose limit of 20 mSv. Furthermore, there was no detectable neutron exposure.
Almasri HY, Kakinohana Y, Yogi T. Occupational radiation monitoring at a large medical center in Japan. Radiological Physics and Technology. 2014;7(2):271-276. doi: 10.1007/s12194-014-0262-5
2013
Measurements of doses to hands, legs and eyes are reported for operators in four different hospitals performing vertebroplasty or kyphoplasty. The results confirm that occupational doses can be high for interventional spine procedures. Extremity and eye lens doses were measured with thermoluminescent dosimeters positioned on the ring fingers, wrists, legs and near the eyes of interventional radiologists and neurosurgeons, over a period of 15 months. Doses were generally larger on the left side for all positions monitored. The median dose to the left finger was 225 μSv per procedure, although a maximum of 7.3 mSv was found. The median dose to the right finger was 118 μSv, but with an even higher maximum of 7.7 mSv. A median left eye dose of 34 μSv (maximum 836 μSv) was found, while the legs received the lowest doses with a median of 13 μSv (maximum 332 μSv) to the left leg. Annual dose to the hand assessed by the cumulated doses almost reached the annual dose limit of 500 mSv, while annual dose to the eyes exceeded the eye lens dose limit of 20 mSv yr−1. Different x-ray systems and radiation protection measures were tested, like the use of lead gloves and glasses, tweezers, cement delivery systems and a magnetic navigation system. These measurements showed that doses can be significantly reduced. The use of lead glasses is strongly recommended for protection of the eyes.
Struelens, L., Schoonjans, W., Schils, F., De Smedt, K., & Vanhavere, F. (2013). Extremity and eye lens dosimetry for medical staff performing vertebroplasty and kyphoplasty procedures. Journal of Radiological Protection, 33(3), 635–645. https://doi.org/10.1088/0952-4746/33/3/635
Objective – Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure that combines the use of X-ray fluoroscopy and endoscopy for examination of the bile duct. Published data on ERCP doses are limited, including staff eye dose from ERCP. Occupational eye doses are of particular interest now as the International Commission on Radiological Protection (ICRP) has recommended a reduction in the dose limit to the lens of the eye. The aim of this study was to measure occupational eye doses obtained from ERCP procedures.
Methods – A new eye lens dosemeter (EYE-D(™), Radcard, Krakow, Poland) was used to measure the ERCP eye dose, H(p)(3), at two endoscopy departments in Ireland. A review of radiation protection practice at the two facilities was also carried out.
Results – The mean equivalent dose to the lens of the eye of a gastroenterologist is 0.01 mSv per ERCP procedure with an undercouch X-ray tube and 0.09 mSv per ERCP procedure with an overcouch X-ray tube. Staff eye dose normalised to patient kerma area product is also presented.
Conclusion – Staff eye doses in ERCP have the potential to exceed the revised ICRP limit of 20 mSv per annum when an overcouch X-ray tube is used. The EYE-D dosemeter was found to be a convenient method for measuring lens dose. Eye doses in areas outside of radiology departments should be kept under review, particularly in light of the new ICRP eye dose limit.
Advances in knowledge – Occupational eye lens doses from ERCP procedures have been established using a new commercially available dedicated H(p)(3) dosemeter.
O’Connor U, Gallagher A, Malone L, O’Reilly G. Occupational radiation dose to eyes from endoscopic retrograde cholangiopancreatography procedures in light of the revised eye lens dose limit from the International Commission on Radiological Protection. British Journal of Radiology. 2013;86(1022):20120289. doi: 10.1259/bjr.20120289
2011
Objective – Exposure of surgeons and nurses to radiation during endoscopic retrograde cholangiopancreatography (ERCP) has not been studied in our locality. Recently, data suggest that cataracts can occur at doses far lower than the permissible occupational limits. The present study is to determine the amount of radiation absorbed by surgeons and nurses while carrying out ERCP.
Methods – We prospectively recorded the radiation absorption of three surgeons and two nurses during all ERCP procedures for 6 months. Radiation absorption was measured by wearing thermoluminescent dosimeters specifically for measuring eye lens, finger and whole‐body dose. Results were compared with standards set by the International Commission on Radiation Protection. The difference in absorbed radiation to different parts of the body among each individual was evaluated. The number of ERCP procedures a surgeon can tolerate before reaching the occupational limit was determined. Ways to minimise radiation exposure are discussed.
Results – Three surgeons carried out a total of 134 ERCP, while two nurses assisted in 255 ERCP over a period of 6 months. The mean yearly whole‐body, eyes and fingers‐absorbed dose for surgeons were 0.19 mSv, 0.25 mSv and 0.62 mSv, respectively; whereas those for nurses were 0.1 mSv, 0.84 mSv and 1.07 mSv, respectively. They were all well below the international occupational limit. Among the whole‐body dose, eye lens dose and fingers dose, eye lens dose was the first factor that reached the occupational limit.
Conclusion – The current radiation safety practice in our endoscopy suite is satisfactory. Human eyes are more vulnerable to radiation damage when compared with the rest of the body. Wearing lead‐eyeglasses during ERCP is mandatory.
Lo I, Lau SHY, Kwok K-H, Kao S-S, Cheung M-T. Ionizing radiation absorption of surgeons and endoscopy nurses during endoscopic retrograde cholangiopancreatography: Radiation absorption during ERCP. Surgical Practice. 2011;15(3):70-78. doi.org/10.1111/j.1744-1633.2011.00546.x
2010
An increasing number of medical specialists are using fluoroscopy outside imaging departments, but there has been general neglect of radiological protection coverage of fluoroscopy machines used outside imaging departments. Lack of radiological protection training of those working with fluoroscopy outside imaging departments can increase the radiation risk to workers and patients. Procedures such as endovascular aneurysm repair, renal angioplasty, iliac angioplasty, ureteric stent placement, therapeutic endoscopic retrograde cholangio-pancreatography, and bile duct stenting and drainage have the potential to impart skin doses exceeding 1 Gy. Although tissue reactions among patients and workers from fluoroscopy procedures have, to date, only been reported in interventional radiology and cardiology, the level of fluoroscopy use outside imaging departments creates potential for such injuries.
A brief account of the health effects of ionising radiation and protection principles is presented in Section 2. Section 3 deals with general aspects of the protection of workers and patients that are common to all, whereas specific aspects are covered in Section 4 for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology, gastroenterology and hepatobiliary system, and anaesthetics and pain management. Although sentinel lymph node biopsy involves the use of radio-isotopic methods rather than fluoroscopy, performance of this procedure in operating theatres is covered in this report as it is unlikely that this topic will be addressed in another ICRP publication in coming years. Information on radiation dose levels to patients and workers, and dose management is presented for each speciality.
Issues connected with pregnant patients and pregnant workers are covered in Section 5. Although ICRP has recently published a report on training, specific needs for the target groups in terms of orientation of training, competency of those who conduct and assess specialists, and guidelines on the curriculum are provided in Section 6.
This report emphasises that patient dose monitoring is essential whenever fluoroscopy is used.
It is recommended that manufacturers should develop systems to indicate patient dose indices with the possibility of producing patient dose reports that can be transferred to the hospital network, and shielding screens that can be effectively used for the protection of workers using fluoroscopy machines in operating theatres without hindering the clinical task.
Radiological Protection in Fluoroscopically Guided Procedures Performed Outside the Imaging Department. In: 117 ICoRPIP, ed. Annals of the ICRP. Vol 40. London, England: Elsevier Ltd; 2010:1-102.