Dose to nurses & other allied health staff
Dose to nurses and other allied health staff
2023
Due to its many benefits, fluoroscopy-guided intraoperative orthopedic surgery treatments are proliferating. However, during the fluoroscopic guided interventional (FGI) procedures, orthopedists were exposed to substantial radiation doses from primary and dispersed radiation.
This study aims to quantify the annual ionizing radiation exposure to personnel during orthopedic surgery operations. Twenty-eight employees in all the orthopedic departments were under observation, including 11 (39.5%) nurses and 17 (60.7%) orthopedic surgeons (one female and 16 males).
The yearly effective dosages were observed for two years in a row (2019 and 2020). Thermoluminecnt dosimeters(TLD-100: LiF: Mg, Ti) were utilized to assess the exposure levels of the staff. High-frequency generators and the ability to retain the last radiograph are features of C-arm machines.
Owing to the rise need for fluoroscopic guided intraoperative orthopedic surgery, nurses and medical doctors, including orthopedic surgeons, received yearly effective doses (Hp(10)) with averages, standard deviations, and ranges of 0.960 (0.4–1.48) and 0.810 (0.44–1.3), respectively. According to the current orthopedic surgery department practice, the study’s findings indicated that the personnel is adequately safeguarded.
Alsubaie A. Estimation of annual effective doses to orthopedic surgeons and nurses as a result of interventional procedures’. Radiation Physics and Chemistry. 2023; 202: 110520.
Nuclear medicine diagnostic procedures such as positron emission tomography (PET) scans and hybrid imaging using a combination of PET and computed tomography (CT), commonly referred to as PET-CT scanning. Hybrid imaging, which allows accurate visualization of internal anatomical structure and the consequent physiological processes simultaneously, is extensively used in oncology and other departments. Nevertheless, this exposes patients and medical personnel in such departments to significant doses of ionizing radiation, especially in hybrid imaging, where two sources of radiation (the radiopharmaceutical infusion and the CT scanner) are used. This necessitates strict compliance with international guidelines and regulations on radiation protection. Recent reports showed that occupational staff exposure might exceed the annual dose limits.
This study evaluated occupational exposure associated with diagnostic hybrid PET-CT imaging and the consequent risks. Twenty medical personnel: 5 physicists, ten technologists, two medical doctors, and three nurses are included in this study. The assessment includes measuring occupational ambient doses using calibrated optical stimulating-luminescent dosimeters (OSL) (Al2O3:C). These badges were read using an automatic OSL reader.
The results, displayed as (mean ± standard deviation): (range) of the effective dose (mSv) for the different personnel, can be summarized as follows(mean standard deviation and range). Physicists 0.72 ± 0.14 (0.49–0.83) mSv in 2019 and 0.67 ± 0.07 (0.59–0.78) in 2020; technologist 1.4 ± 0.96 (0–3.27) mSv in 2019 and 1.395 ± 1.27 (0.64–4.36) mSv; medical doctors 0.445 ± 0.42 (0.15–0.74) mSv in 2019 and 0.70 ± 0.04 (0.67–0.73) in 2020; and nurses 1.38 ± 0.25 (1.21–1.66) mSv in 2019 and 1.41 ± 0.17 (1.23–1.55) in 2020. The tube voltage of the scanner used in this study had a constant value of 120 kVp for all patients.
Staff working in PET or PET-CT departments receive significant doses from the radiopharmaceuticals and the energetic gamma rays from the CT scanners. Hence, optimizing the CT acquisition parameter is necessary to optimize the occupational doses and restrict them to acceptable dose limits.
Omer H, Salah H, Tamam N, et al. Assessment of occupational exposure from PET and PET/CT scanning in Saudi Arabia. Radiation Physics and Chemistry. 2023; 204: 110642.
Medical personnel working with ionizing radiation are exposed to significant radiation doses. Previously published studies reported increased incidence of induced cancer and cataracts among radiation workers in medical and industrial premises due to exposure to ionizing radiation. Therefore, an assessment of occupational exposure is recommended.
The purpose of this study is to estimate the radiation risk caused by staff exposure and ambient exposures during diagnostic radiography.
The study involved 46 staff members: 38 technologists, 8 Radiologists and 22 patients: 11 undergoing conventional radiology and 11 undergoing fluoroscopic radiology. Occupational and ambient doses were measured using calibrated optical stimulating-luminescent dosimeters (OSL) (Al2O3:C). These badges were read using an automatic OSL reader. Patients’ doses were calculated form the reading of the x-ray machines. Calculating the dose parameters for patients, the mean and standard deviation (SD) of the kVp, mAs, and patient doses in terms of Dose Area Product (DAP)were 113.1 ± 16.2, 7.5 ± 11.65, and 869.6, respectively. The mean and range of the annual effective dose (mSv) for technologists was (0.6 ± 0.36) (0–2.11). The mean and range of effective dose (mSv) for Radiologists were (0.48 ± 0.19) (0.17–0.74).
The occupational exposure in this study showed that radiology technologists and radiologists are exposed to a low dose according to the current workload. The staff dose reported in this study is lower than those available in most previous studies.
Tamam N, Salah H, Almogren KS, et al. Evaluation of patients’ and occupational radiation risk dose during conventional and interventional radiology procedures. Radiation Physics and Chemistry. 2023; 207: 110818.
Due to the extended localized fluoroscopy, many radiographic exposures, and multiple procedures that might result in tissue reaction, patients and personnel received a significant radiation dose during interventional cardiology (IR) procedures.
This study aims to calculate the radiation risk and assess patient and staff effective doses during IC procedures.
Thirty-two patients underwent a Cath lab treatment in total. Ten Cath lab personnel, including six nurses, two cardiologists, and two X-ray technologists. Optical stimulating-luminescent dosimeters (OSL) (Al2O3:C) calibrated for this purpose were used to monitor both occupational and ambient doses. Using an automated OSL reader, these badges were scanned. The Air Kerma (mGy) and Kerma Area Products (KAP, mGy.cm2) have a mean and standard deviation (SD) of 371 ± 132 and 26052, respectively. The average personal dose equivalent (mSv) and its range for cardiologists, nurses and X ray technologists were 1.11 ± 0.21 (0.96–1.26), 0.84 ± 0.11 (0.68–1.16), and 0.68 ± 0.014 (0.12–0.13), respectively.
The current study findings showed that the annual effective dose for cardiologists, nurses, and X-ray technologists was lesser than the yearly occupational dose limit of 20 mSv recommended by national and international guidelines. The patients’ doses are comparable with some previously published studies and below the tissue reaction limits.
Sulieman A, Mahgoub O, Salah H, et al. Assessment of patient and occupational exposure and radiation risk from cath-lab procedure. Appl Radiat Isot. 2023; 202: 111071.
2022
Highlights
- For most Finnish interventionalists, eye lens doses are below legal limits.
- A small number of interventionalists may exceed the legal limits for eye lens dose.
- Nurses and radiographers are less exposed than interventionalists.
- For the majority of interventional workers, eye dosemeters are not required.
Purpose
The aim of this study was to investigate the eye lens and whole-body radiation doses to interventional radiology and cardiology staff in two Finnish hospitals.
Methods
Simultaneous measurements of personal dose equivalent quantities Hp(3) and Hp(10) were conducted in clinical conditions during different radiological and cardiological interventional procedures. In order to study the feasibility to estimate eye lens dose with Hp(10) measured over the protective apron or thyroid shield, the ratio between measured Hp(3) and Hp(10) was investigated.
Results and conclusions
Applying the obtained ratio on Hp(10) records from national dose register showed that only a small number of interventional radiologists and cardiologists in Finland may exceed eye lens equivalent dose levels of 20 mSv per year or 100 mSv in five consecutive years, but likely do not exceed 50 mSv in a single year. For the most Finnish interventionalists, the eye lens dose is well below 10 mSv per year. Nurses and radiographers assisting in interventions are, on average, less exposed than interventionalists, and will not exceed 20 mSv per year. Based on our results, Hp(10) measured over the protective apron or thyroid shield provides a conservative estimate of the eye lens dose for interventional radiologists and cardiologists, provided that appropriate protective glasses are used.
Pekkarinen A, Lindholm C, Kortesniemi M and Siiskonen T. Staff eye lens dose in interventional radiology and cardiology in Finland. Phys Med. 2022; 98: 1-7.
Occupational exposure to ionizing radiation of medical personnel is very common at radiology and nuclear medicine departments. Strict regulations and guidelines for the exposure of staff working in such departments were regulated by international authorities such as the International Atomic Energy Agency (IAEA), and the International Commission on Radiological Protection (ICRP) as well as national protocols. In order to reduce stochastic effects, for example, radiation induced carcinogenesis, the exposure of staff working at nuclear medicine department should be maintained at levels lower than 20 mSv per year or 100 mSv in five years.
The objective of this study is to measure staff radiation dose at four radiology departments in the south region of the Kingdom of Saudi Arabia. Exposures received by a total of 106 staff working at the radiology department were monitored for two consecutive years using calibrated Thermoluminecnt dosimeters (LiF:Mg:Ti (TLD-100). Exposure was then quantified in terms of deep dose: Hp (10). The TLD signal was obtained using an automatic TLD reader (Harshaw 6600).
The overall annual dose for staff was 1.4 ± 0.37 (0.67–8.74). The study revealed that the annual radiation exposure in the four-radiology department is below the annual dose limits. However, staff doses could be reduced if proper radiation protection are followed.
Johary YH, Aamry A, Albarakati S, et al. Staff radiation exposure at four radiology departments in the Aseer region of Saudi Arabia. Radiation Physics and Chemistry. 2022; 200: 110302.
2021
Ionising radiation damages DNA directly and indirectly through increased production of reactive oxygen species. Although telomereshave been reported as indicators of radiosensitivity, their maintenance in response to occupational exposure to low radiation doses is stilla matter of debate.
In this work we aimed to investigate telomere length and structure in hospital workers occupationally exposed to X-rays and to relate these findings to oxidation of biomolecules and chromosome aberrations. Blood samples of exposed participants and matching controls were taken during periodical check-ups.
Chromosome aberrations and telomere length and structure were analysed in peripheral blood lymphocytes using Q-FISH, whereas oxidative stress parameters [pro/antioxidant balance (PAB), lipid peroxidation,and 8-oxo-dG] were measured in plasma samples. Based on the CA findings we divided the exposed group into two subgroups, of whichone had chromosome aberrations in the first division metaphases and the other did not.
There was no significant difference in telomere length between any of the groups. However, both subgroups showed a significantly higher rate of fragile telomeres and higher lipid peroxidation product and 8-oxo-dG levels than controls. The rate of fragile telomeres significantly correlated with plasma levels of 8-oxo-dG, which suggests that continuous exposure to low radiation doses induces oxidative base damage of guanine resulting in telomere fragility.
Keywords: 8-oxo-dG; chromosome aberrations; lipid peroxidation; telomere fragility; telomere length; X-ray
Tričković JF, Šobot AV, Joksić I and Joksić G. Telomere fragility in radiology workers occupationally exposed to low doses of ionising radiation. Arh Hig Rada Toksikol. 2022; 73: 23-30.
2021
Background – In interventional radiology attendant staff can be exposed to significant doses from the radiation scattered from the patient, giving rise to heterogeneous energy distribution, exposure occurring over extended periods of time. Protection of staff is a prime concern, also including reducing the risk of carcinogenesis. With only limited published studies available, as in for instance in regard to lens opacifications, further evaluation of staff exposures and assessment of radiation protection techniques and measures are crucial.
Aim – Present study has sought to evaluate staff radiation exposure in a radiology department that performs interventional procedures.
Methods – Annual occupational exposures were obtained for 32 personnel (6 females and 26 males) in a radiology department at a tertiary hospital. Personal dose equivalent Hp (d) was measured in terms of Hp (0.07) (shallow dose) and Hp (10) (deep dose). The measurements were made over a period of two consecutive years, 2017 and 2018, use being made of TLD-100 thermoluminescent dosimeters.
Results – In units of mSv, the corresponding average annual dose equivalent and range for Hp (10) and Hp (0.07) were 4.6 ± 7.0 (0.1–25.5) and 5.1 ± 7.3 (0.1–25.5). Notably, 16% of staff received doses that were greater than the annual dose limit. Since Hp (10) offers a conservative evaluation of effective dose, evaluation of the working environment is necessary in seeking to ensure dose values remain below annual dose limits.
Alkhorayef M, Al-Mohammed HI, Mayhoub FH, et al. Staff radiation dose and estimated risk in an interventional radiology department. Radiation Physics and Chemistry. 2021; 178: 108999.
Medical staff represent the largest group of workers occupationally exposed to ionizing
radiation (IR). Chronic exposure to low-dose IR may result in DNA damage and genotoxicity associated with increased risk of cancer.
This review aims to identify the genotoxicity biomarkers that are the most elevated in IR-exposed vs. unexposed health workers. A systematic review of the literature was performed to retrieve relevant studies with various biomarkers of genotoxicity.
Subsequent meta-analyses produced a pooled effect size for several endpoints. The search procedure yielded 65 studies. Chromosome aberrations (CA) and micronuclei (MN) frequencies were significantly different between IR-exposed and unexposed workers (θpooled = 3.19, 95% CI 1.46–4.93; and θpooled = 1.41, 95% CI 0.97–1.86, for total aberrant cells and MN frequencies, respectively), which was not the case for ring chromosomes and nucleoplasmic bridges. Although less frequently used, stable translocations, sister chromatid exchanges (SCE) and comet assay endpoints were also statistically
different between IR-exposed and unexposed workers. This review confirms the relevance of CA and MN as genotoxicity biomarkers that are consistently elevated in IR-exposed vs. unexposed workers.
Other endpoints are strong candidates but require further studies to validate their usefulness. The
integration of the identified biomarkers in future prospective epidemiological studies is encouraged.
Keywords: systematic review; meta-analysis; medical workers; ionizing radiation; cytogenetic
biomarkers; DNA integrity
Baudin C, Bernier M-O, Klokov D and Andreassi MG. Biomarkers of Genotoxicity in Medical Workers Exposed to Low-Dose Ionizing Radiation: Systematic Review and Meta-Analyses. Int J Mol Sci. 2021; 22: 7504.
2019
Purpose – Technological advancements have greatly expanded the field of cardiac electrophysiology, requiring greater demands on imaging systems and potentially delivering higher radiation doses to patients and operators. With little contemporary research on occupational and patient radiation risk in the electrophysiology laboratory, the aim of this study was to analyze radiation doses, including occupational fetal doses, over approximately the last decade. We benchmarked the occupational data to our patient radiation dose data to allow for comparison and to put into perspective the associated radiation risks.
Methods – Occupational radiation dosimetry analyzed included data from an 11-year period for physicians, a 7-year period for nurses, and a 9-year period for fetal doses. Patient-related dose metrics over an 8-year period were also analyzed.
Results – In the physician and nursing groups, there was a nearly 70% decrease in the average occupational radiation doses over the given periods. Within the electrophysiology department, the average fetal occupational doses were very low, close to 0 μSv. The average reference point air kerma per patient for all electrophysiology procedures decreased from nearly 600 mGy/procedure in 2010 to just over 100 mGy/procedure in 2017.
Conclusions – Patient and occupational radiation doses in our laboratories significantly decreased over the periods analyzed as a result of clinical and technical staff efforts as well as advances in imaging technology. The radiation-related risk to individuals working in our electrophysiology laboratories, including pregnant women, is very low. Data reported herein could be used by other institutions to evaluate their occupational and patient radiation safety practices.
Wunderle, K., Chung, M., Rayadurgam, S., Miller, M., Obuchowski, N., & Lindsay, B. (2019). Occupational and patient radiation doses in a modern cardiac electrophysiology laboratory. Journal of Interventional Cardiac Electrophysiology, 56(2), 183–190. https://doi.org/10.1007/s10840-018-0462-8
Background – Transesophageal echocardiography operators (TEEOP) provide critical imaging support for percutaneous structural cardiac intervention procedures. They stand close to the patient and the associated scattered radiation.
Objectives – This study sought to investigate TEEOP radiation dose during percutaneous structural cardiac intervention.
Methods – Key personnel (TEEOP, anesthetist, primary operator [OP1], and secondary operator) wore instantly downloadable personal dosimeters during procedures requiring TEE support. TEEOP effective dose (E) and E per unit Kerma area product (E/KAP) were calculated. E/KAP was compared with C-arm projections. Additional shielding for TEEOP was implemented, and doses were measured for a further 50 procedures. Multivariate linear regression was performed to investigate independent predictors of radiation dose reduction.
Results – In the initial 98 procedures, median TEEOP E was 2.62 μSv (interquartile range [IQR]: 0.95 to 4.76 μSv), similar to OP1 E: 1.91 μSv (IQR: 0.48 to 3.81 μSv) (p = 0.101), but significantly higher than secondary operator E: 0.48 μSv (IQR: 0.00 to 1.91 μSv) (p < 0.001) and anesthetist E: 0.48 μSv (IQR: 0.00 to 1.43 μSv) (p < 0.001). Procedures using predominantly right anterior oblique (RAO) and steep RAO projections were associated with high TEEOP E/KAP (p = 0.041). In a further 50 procedures, with additional TEEOP shielding, TEEOP E was reduced by 82% (2.62 μSv [IQR: 0.95 to 4.76] to 0.48 μSv [IQR: 0.00 to 1.43 μSv] [p < 0.001]). Multivariate regression demonstrated shielding, procedure type, and KAP as independent predictors of TEEOP dose.
Conclusion – TEE operators are exposed to a radiation dose that is at least as high as that of OP1 during percutaneous cardiac intervention. Doses were higher with procedures using predominantly RAO projections. Radiation doses can be significantly reduced with the use of an additional ceiling-suspended lead shield.
Crowhurst, J., Scalia, G., Whitby, M., Murdoch, D., Robinson, B., Turner, A., … Walters, D. (2018). Radiation Exposure of Operators Performing Transesophageal Echocardiography During Percutaneous Structural Cardiac Interventions. Journal of the American College of Cardiology, 71(11), 1246–1254. https://doi.org/10.1016/j.jacc.2018.01.024
Aim – The study investigated the influence of genetic polymorphisms of the enzymes for DNA repair and detoxification of reactive intermediates on spontaneous and bleomycin-induced (BLM) genotoxic damage in 43 workers exposed to very low doses of ionizing radiation (IR) (mean cumulative dose 5.31 mSv) and 43 subjects with no occupational exposure to IR (controls).
Results – In all the subjects examined, the frequency of chromosome aberrations (CAs) and micronuclei (MN), both spontaneous and BLM-induced, the Comet assay parameters (tail intensity), the genotypic variants of the DNA repair enzymes XRCC1 (Arg194Trp, Arg280His, Arg399Gln), XRCC3 (Thr241Met), XPD (Lys751Gln), and of the detoxification enzymes GSTM1 and GSTT1 (null genotype) and BLMH (A1450G) were determined. Among the biomarkers considered, only the frequency of total CAs (p < 0.05), and in particular of chromosome breaks (p < 0.01), was found to be significantly higher in the exposed workers than the controls. The frequency of spontaneous MN was higher in subjects with at least one allelic variant in XRCC1 than in carriers of the wild-type, but again only in exposed workers (p = 0.046). Linear regression analysis showed a positive dependency of the frequency of spontaneous chromosome breaks on occupational exposure, and a dependency of the frequency of BLM-induced MN negative on occupational exposure and positive on alcohol consumption and the null GSTM1 genotype.
Conclusion – the frequency of chromosome breaks seems to be a useful cytogenetic biomarker for exposure to very low doses of IR, while only the combined effect of different gene variants or genetic, occupational, and lifestyle habits factors seems to be able to modulate the genotoxic effect of very low doses of IR.
Stufano A, Chiarappa P, Bagnulo R, et al. Influence of polymorphisms of DNA repair and GST genes on genotoxic damage and mutagen sensitivity in workers occupationally exposed to very low doses of ionizing radiation. Applied Sciences (Switzerland). 2019; 9.
2018
Highlights
Background
The impact of patient obesity on scrub technologist radiation dose during coronary angiography has not been adequately studied.
Methods
Real-time radiation exposure data were prospectively collected during consecutive coronary angiography cases. Patient radiation dose was estimated by dose area product (DAP). Technologist radiation dose was recorded by a dosimeter as the personal dose equivalent (Hp (10)). Patients were categorized according to their body mass index (BMI): <25.0, lean; 25.0–29.9, overweight; ≥30.0, obese. The study had two phases: in Phase I (N = 351) standard radiation protection measures were used; and in Phase II (N = 268) standard radiation protection measures were combined with an accessory lead shield placed between the technologist and patient.
Results
In 619 consecutive coronary angiography procedures, significant increases in patient and technologist radiation doses were observed across increasing patient BMI categories (p < 0.001 for both). Compared to lean patients, patient obesity was associated with a 1.7-fold increase in DAP (73.0 [52.7, 127.5] mGy × cm2 vs 43.6 [25.1, 65.7] mGy × cm2, p < 0.001) and a 1.8-fold increase in technologist radiation dose (1.1 [0.3, 2.7] μSv vs 0.6 [0.1, 1.6] μSv, p < 0.001). Compared to Phase I, use of an accessory lead shield in Phase II was associated with a 62.5% reduction in technologist radiation dose when used in obese patients (p < 0.001).
Conclusions
During coronary angiography procedures, patient obesity was associated with a significant increase in scrub technologist radiation dose. This increase in technologist radiation dose in obese patients may be mitigated by use of an accessory lead shield.
Eye lens doses have been widely explored for interventional clinicians, however, data for ancillary staff is limited. Eye doses have been measured using a headband technique for clinicians, specialist registrars, nurses and radiographers working in a cardiac catheterisation laboratory in a UK hospital. Workload was found to be significantly higher for ancillary staff, and consequently, despite the absolute monthly collar doses and other indicators such as eye dose/KAP and eye dose/procedure being highest for clinicians, our study found there was no significant difference in the monthly eye dose readings between the clinicians and nurses (p = 0.82), and clinicians and radiographers (p = 0.72). The average eye dose/collar dose ratios were 0.71 and 0.61 for cardiologists and SPRs, but ratios above one were found for nurses and radiographers. This work expands on the eye dose data available for ancillary staff and demonstrates that eye dosimetry for these workers should not be overlooked.
Jupp, T., & Kamali-Zonouzi, P. (2018). Eye Lens dosimetry within the cardiac catheteristaion laboratory – are ancillary staff being forgotten? Radiation Protection Dosimetry, 178(2), 185–192. https://doi.org/10.1093/rpd/ncx088
2017
It is important to measure the radiation dose [3-mm dose equivalent, Hp(3)] in the eye. This study was to determine the current occupational radiation eye dose of staff conducting interventional cardiology procedures, using a novel direct eye dosimeter. We measured the occupational eye dose [Hp(3)] in physicians and nurses in a catheterization laboratory for 6-months. The eye doses [Hp(3)] of 12 physicians (9 with Pb glasses, 3 without), and 11 nurses were recorded using a novel direct eye dosimeter, the DOSIRISTM. We placed dosimeters above and under the glasses. We also estimated the eye dose [0.07-mm dose equivalent] using a neck personal dosimeter. The eye doses among interventional staff ranked in the following order: physicians without Pb glasses > physicians with Pb glasses > nurses. The shielding effect of the glasses (0.07-mm Pb) in a clinical setting was approximately 60%. In physicians who do not wear Pb glasses, the eye dose may exceed the new regulatory limit for IR staff. We found good correlations between the neck dosimeter dose and eye dosimeter dose (inside or outside glasses, R2 = 0.93 and R2 = 0.86, respectively) in physicians. We recommend that interventionae an eye dosimeter for correct evaluation of the lens dose.
In accordance with recommendations by the International Commission on Radiological Protection, the current European Basic Safety Standards has adopted a reduced occupational eye lens dose limit of 20 mSv yr-1. The radiation safety implications of this dose limit is of concern for clinical staff that work with relatively high dose x-ray angiography and interventional radiology. Presented in this work is a thorough assessment of the occupational eye lens dose based on clinical measurements with active personal dosimeters worn by staff during various types of procedures in interventional radiology, cardiology and neuroradiology. Results are presented in terms of the estimated equivalent eye lens dose for various medical professions. In order to compare the risk of exceeding the regulatory annual eye lens dose limit for the widely different clinical situations investigated in this work, the different medical professions were separated into categories based on their distinct work pattern: staff that work (a) regularly beside the patient, (b) in proximity to the patient and (c) typically at a distance from the patient. The results demonstrate that the risk of exceeding the annual eye lens dose limit is of concern for staff category (a), i.e. mainly the primary radiologist/cardiologist. However, the results also demonstrate that the risk can be greatly mitigated if radiation protection shields are used in the clinical routine. The results presented in this work cover a wide range of clinical situations, and can be used as a first indication of the risk of exceeding the annual eye lens dose limit for staff at other medical centres.
Omar A, Kadesjo N, Palmgren C, Marteinsdottir M, Segerdahl T, Fransson A. Assessment of the occupational eye lens dose for clinical staff in interventional radiology, cardiology and neuroradiology. Journal of Radiological Protection. 2017;37(1):145-159. doi: 10.1088/1361-6498/aa559c
2016
Digital subtraction angiography (DSA) is a type of fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment. The use of DSA procedures has been increased quite significantly in the Radiology departments in various cities in Indonesia. Various reports showed that both patients and medical staff received a noticeable radiation dose during the course of this procedure. A study had been carried out to measure these doses among interventionalist, nurse and radiographer. The results show that the interventionalist and the nurse, who stood quite close to the X-ray beams compared with the radiographer, received radiation higher than the others. The results also showed that the radiation dose received by medical staff were var depending upon the duration and their position against the X-ray beams. Compared tothe dose limits, however, the radiation dose received by all these three medical staff were still lower than the limits.
Nuraeni N, Hiswara E, Kartikasari D, Waris A, Haryanto F. Occupational radiation doses during interventional procedures. Journal of Physics: Conference Series. 2016;694(1).
2015
What is already known about the topic
- Nurses working in interventional radiology suites can incur large cumulative radiation doses.
- Feedback on traditionally measured personal doses can be delayed by weeks.
What this article adds
- Nurses can reduce personal radiation dose by using a real-time personal dosimeter
Dose reduction is greater for scout nurses than scrub nurses using a real-time personal dosimeter
Aim – Real-time radiation dosimeters can provide visual display of personal radiation dose as it occurs, potentially providing nurses working in radiation environments with more understanding about their personal radiation protection and safety strategies. This comparative observational study aimed to evaluate if the wearing of a real-time dosimeter with visual display by nurses working in interventional radiology would reduce their personal radiation dose.
Materials and methods – Personal dose data were collected from 10 nurses while working in two interventional radiology suites over two measurement periods. In the first measurement period, the nurses were not provided with any radiation dose information during the interventional procedures. In the second measurement period, the nurses were able to view their personal radiation dose in real time.
Results – Nurses working in interventional radiology suites reduced their personal radiology doses when using a real-time radiation dosimeter that provided a real-time display of their personal dose.
Conclusion – The results support the use of real-time radiation dosimeters as an occupational radiation protection strategy in interventional radiology suites.
Butcher RL, Gaggini R, Thoirs K. Does Wearing A Real-Time Visual Dosimeter Reduce the Personal Radiation Dose for Interventional Radiology Nurses? An Observational Comparative Study. Journal of Radiology Nursing. 2015;34(3):137-142. doi: https://doi.org/10.1016/j.jradnu.2015.06.006
Purpose – The purpose of this study is to evaluate a new device providing real-time monitoring on radiation exposure during fluoroscopy procedures intending to reduce radiation in an interventional radiology setting.
Materials and Methods – In one interventional suite, a new system providing a real-time radiation dose display and five individual wireless dosimeters were installed. The five dosimeters were worn by the attending, fellow, nurse, technician, and anesthesiologist for every procedure taking place in that suite. During the first 6-week interval the dose display was off (closed phase) and activated thereafter, for a 6-week learning phase (learning phase) and a 10-week open phase (open phase). During these phases, the staff dose and the individual dose for each procedure were recorded from the wireless dosimeter and correlated with the fluoroscopy time. Further subanalysis for dose exposure included diagnostic versus interventional as well as short (<10 min) versus long (>10 min) procedures.
Results – A total of 252 procedures were performed (n = 88 closed phase, n = 50 learning phase, n = 114 open phase). The overall mean staff dose per fluoroscopic minute was 42.79 versus 19.81 µSv/min (p < 0.05) comparing the closed and open phase. Thereby, anesthesiologists were the only individuals attaining a significant dose reduction during open phase 16.9 versus 8.86 µSv/min (p < 0.05). Furthermore, a significant reduction of total staff dose was observed for short 51 % and interventional procedures 45 % (p < 0.05, for both).
Conclusion – A real-time qualitative display of radiation exposure may reduce team radiation dose. The process may take a few weeks during the learning phase but appears sustained, thereafter.
Baumann F, Katzen BT, Carelsen B, Diehm N, Benenati JF, Peña CS. The Effect of Realtime Monitoring on Dose Exposure to Staff Within an Interventional Radiology Setting. CardioVascular and Interventional Radiology. 2015;38(5):1105-1111. DOI: 10.1007/s00270-015-1075-6
The optimisation and decision-making processes for radiological protection have been broadened by the introduction of re-examination or feedback after introducing protective measures. In this study, action research was used to reduce the occupational exposure of vascular interventional radiology (IR) nurses. Four radiological protection improvement measures were continuously performed in cooperation with the researchers, nurses and stakeholders, and the nurses’ annual effective doses were compared before and after the improvements. First, the dosimetry equipment was changed from one electronic personal dosimeter (EPD) to two silver-activated phosphate glass dosimeters (PGDs). Second, the nurses were educated regarding maintaining a safe distance from the sources of scattered and leakage radiation. Third, portable radiation shielding screens were placed in the IR rooms. Fourth, the x-ray units’ pulse rates were reduced by half. On changing the dosimetry method, the two PGDs recorded a 4.4 fold greater dose than the single EPD. Educating nurses regarding radiological protection and reducing the pulse rates by half decreased their effective doses to one-third and two-fifths of the baseline dose, respectively. No significant difference in their doses was detected after the placement of the shielding screens. Therefore, the action research effectively decreased the occupational doses of the vascular IR nurses.
Mori H. Action research regarding the optimisation of radiological protection for nurses during vascular interventional radiology. Journal of Radiological Protection. 2015;35(2):457-466. doi: 10.1088/0952-4746/35/2/457
Background – Thermoluminescent dosimeter badges currently utilized to monitor occupational radiation exposures are limited in their ability to provide timely feedback, restricting workers’ ability to identify unnecessary exposure. New real time radiation monitoring systems provide an opportunity for workers to immediately identify and alter problematic behaviors in the neuroangiography suite, decreasing unnecessary exposures, lowering risk, and maximizing safety efforts.
Methods – Real time radiation monitoring was performed for 120 diagnostic cerebral angiography procedures. Data were collected in two phases, for procedures performed by two physician participants (30 procedures per physician per phase). Workers were blinded to their real time dose in phase I, and unblinded in phase II. Individual exposures (Sv) and the incidence of red events (exposure rates ≥2.0 mSv/h) were collected for each assigned participating role (physician A, physician B, nurse, scrubbed technologist, and circulating technologist). The dose area product was collected for each procedure to standardize against variations in procedure duration or intensity.
Results – In phase II, significant decreased radiation exposure was observed for all roles except physician A. Physician B decreased most from 24.3×10(-8) to 6.9×10(-8) Sv/Gy-cm(2) (p<0.0001). Rates of red events decreased similarly for all roles except physician A, and were significant for all roles except the nurse role.
Conclusions – Real time radiation dose monitoring during diagnostic cerebral angiography may help to reduce occupational radiation exposures for healthcare workers.
James RF, Wainwright KJ, Kanaan HA, et al. Analysis of occupational radiation exposure during cerebral angiography utilizing a new real time radiation dose monitoring system. Journal of Neurointerventional Surgery. 2015;7(7):503-508. DOI: 10.1136/neurintsurg-2014-011215
Purpose – The aim of the study was to evaluate the radiation exposure to operating room personnel and to assess determinants for high personal doses during endovascular aortic repair.
Materials and Methods – Occupational radiation exposure was prospectively evaluated during 22 infra-renal aortic repair procedures (EVAR), 11 thoracic aortic repair procedures (TEVAR), and 11 fenestrated or branched aortic repair procedures (FEVAR). Real-time over-lead dosimeters attached to the left breast pocket measured personal doses for the first operators (FO) and second operators (SO), radiology technicians (RT), scrub nurses (SN), anesthesiologists (AN), and non-sterile nurses (NSN). Besides protective apron and thyroid collar, no additional radiation shielding was used. Procedural dose area product (DAP), iodinated contrast volume, fluoroscopy time, patient’s body weight, and C-arm angulation were documented.
Results – Average procedural FO dose was significantly higher during FEVAR (0.34 ± 0.28 mSv) compared to EVAR (0.11 ± 0.21 mSv) and TEVAR (0.06 ± 0.05 mSv; p = 0.003). Average personnel doses were 0.17 ± 0.21 mSv (FO), 0.042 ± 0.045 mSv (SO), 0.019 ± 0.042 mSv (RT), 0.017 ± 0.031 mSv (SN), 0.006 ± 0.007 mSv (AN), and 0.004 ± 0.009 mSv (NSN). SO and AN doses were strongly correlated with FO dose (p = 0.003 and p < 0.001). There was a significant correlation between FO dose and procedural DAP (R = 0.69, p < 0.001), iodinated contrast volume (R = 0.67, p < 0.001) and left-anterior C-arm projections >60° (p = 0.02), and a weak correlation with fluoroscopy time (R = 0.40, p = 0.049).
Conclusion – Average FO dose was a factor four higher than SO dose. Predictors for high personal doses are procedural DAP, iodinated contrast volume, and left-anterior C-arm projections greater than 60°.
Sailer AM, Schurink GWH, Bol ME, et al. Occupational Radiation Exposure During Endovascular Aortic Repair. CardioVascular and Interventional Radiology. 2015;38(4):827-832. doi:10.1007/s00270-014-1025-8
2014
Purpose – To compare radiation exposure of nurses when performing nursing tasks associated with interventional procedures depending on whether or not the nurses called out to the operator before approaching the patient.
Materials and Methods – In a prospective study, 93 interventional radiology procedures were randomly divided into a call group and a no-call group; there were 50 procedures in the call group and 43 procedures in the no-call group. Two monitoring badges were used to calculate effective dose of nurses. In the call group, the nurse first told the operator she was going to approach the patient each time she was about to do so. In the no-call group, the nurse did not say anything to the operator when she was about to approach the patient.
Results – In all the nursing tasks, the equivalent dose at the umbilical level inside the lead apron was below the detectable limit. The equivalent dose at the sternal level outside the lead apron was 0.16 μSv ± 0.41 per procedure in the call group and 0.51 μSv ± 1.17 per procedure in the no-call group. The effective dose was 0.018 μSv ± 0.04 per procedure in the call group and 0.056 μSv ± 0.129 per procedure in the no-call group. The call group had a significantly lower radiation dose (P = .034).
Conclusions – Radiation doses of nurses were lower in the group in which the nurse called to the operator before she approached the patient.
Komemushi A, Suzuki S, Sano A, et al. Radiation Dose of Nurses during IR Procedures: A Controlled Trial Evaluating Operator Alerts before Nursing Tasks. Journal of Vascular and Interventional Radiology. 2014;25(8):1195-1199. doi: 10.1016/j.jvir.2014.03.021
Purpose – To measure and compare individual staff radiation dose levels during interventional radiologic (IR) procedures with and without real-time feedback to evaluate whether it has any impact on staff radiation dose.
Materials and Methods – A prospective trial was performed in which individuals filling five different staff roles wore radiation dosimeters during all IR procedures during two phases: a 12-week “closed” phase (measurements recorded but display was off, so no feedback was provided) and a 17-week “open” phase (display was on and provided real-time feedback). Radiation dose rates were recorded and compared by Mann-Whitney U test.
Results – There was no significant difference in median procedure time, fluoroscopy time, or patient dose (dose-area product normalized to fluoroscopy time) between the two phases. Overall, the median staff dose was lower in the open phase (0.56 µSv/min of fluoroscopy time) than in the closed phase (3.01 µSv/min; P < .05). The IR attending physician dose decreased significantly for procedures for which the physicians were close to the patient, but not for ones for which they were far away.
Conclusions – A radiation dose monitoring system that provides real-time feedback to the interventional staff can significantly reduce radiation exposure to the primary operator, most likely by increasing staff compliance with use of radiation protection equipment and dose reduction techniques.
Racadio J, Nachabe R, Carelsen B, et al. Effect of Real-Time Radiation Dose Feedback on Pediatric Interventional Radiology Staff Radiation Exposure. Journal of Vascular and Interventional Radiology. 2014;25(1):119-126. doi: 10.1016/j.jvir.2013.08.015
2013
Optimisation of radiological protection for operators working with fluoroscopically guided procedures has to be performed during the procedure, under varying and difficult conditions. The aim of the present study was to evaluate the impact of a system for real-time visualisation of radiation dose rate on optimisation of occupational radiological protection in fluoroscopically guided procedures. Individual radiation dose measurements, using a system for real-time visualisation, were performed in a cardiology laboratory for three cardiologists and ten assisting nurses. Radiation doses collected when the radiation dose rates were not displayed to the staff were compared to radiation doses collected when the radiation dose rates were displayed. When the radiation dose rates were displayed to the staff, one cardiologist and the assisting nurses (as a group) significantly reduced their personal radiation doses. The median radiation dose (Hp(10)) per procedure decreased from 68 to 28 μSv (p = 0.003) for this cardiologist and from 4.3 to 2.5 μSv (p = 0.001) for the assisting nurses. The results of the present study indicate that a system for real-time visualisation of radiation dose rate may have a positive impact on optimisation of occupational radiological protection. In particular, this may affect the behaviour of staff members practising inadequate personal radiological protection.
Sandblom V, Mai T, Almén A, et al. Evaluation of the impact of a system for real-time visualisation of occupational radiation dose rate during fluoroscopically guided procedures. Journal of Radiological Protection. 2013;33(3):693-702. doi: 10.1088/0952-4746/33/3/693
Objective – Interventional radiology tends to involve long procedures (i.e., long fluoroscopic times). Therefore, radiation protection for interventional radiology staff is an important issue. This study describes the occupational radiation dose for interventional radiology staff, especially nurses, to clarify the present annual dose level for interventional radiology nurses.
Materials and Methods – We compared the annual occupational dose (effective dose and dose equivalent) among interventional radiology staff in a hospital where 6606 catheterization procedures are performed annually. The annual occupational doses of 18 physicians, seven nurses, and eight radiologic technologists were recorded using two monitoring badges, one worn over and one under their lead aprons.
Results – The annual mean ± SD effective dose (range) to the physicians, nurses, and radiologic technologists using two badges was 3.00 ± 1.50 (0.84-6.17), 1.34 ± 0.55 (0.70-2.20), and 0.60 ± 0.48 (0.02-1.43) mSv/y, respectively. Similarly, the annual mean ± SD dose equivalent range was 19.84 ± 12.45 (7.0-48.5), 4.73 ± 0.72 (3.9-6.2), and 1.30 ± 1.00 (0.2-2.7) mSv/y, respectively. The mean ± SD effective dose for the physicians was 1.02 ± 0.74 and 3.00 ± 1.50 mSv/y for the one- and two-badge methods, respectively (p < 0.001). Similarly, the mean ± SD effective dose for the nurses (p = 0.186) and radiologic technologists (p = 0.726) tended to be lower using the one-badge method.
Conclusions – The annual occupational dose for interventional radiology staff was in the order physicians > nurses > radiologic technologists. The occupational dose determined using one badge under the apron was far lower than the dose obtained with two badges in both physicians and nonphysicians. To evaluate the occupational dose correctly, we recommend use of two monitoring badges to evaluate interventional radiology nurses as well as physicians.
Chida K, Kaga Y, Haga Y, et al. Occupational dose in interventional radiology procedures. American Journal of Roentgenology. 2013;200(1):138-141. doi: 10.2214/AJR.11.8455
Abstract
Objective – To characterize radiation exposure to patients and operating room personnel during fluoroscopic procedures.
Methods – Patient dose information was collected from the imaging equipment. Real-time dosimetry was used to measure doses to the operators, scrub nurse, radiologic technologist (RT), and anesthesiologist in 39 cases of endovascular thoracoabdominal aortic aneurysm repair using fenestrated endografts. Overall equivalent doses and dose rates at time points of interest were noted and compared with the corresponding patient doses.
Results – The dosimeter on the anesthesia equipment received 143 μSv (38-247) more radiation per case than the average operator, and the scrub nurse and RT received 106 μSv (66-146) and 100 μSv (55-145) less, respectively. Adjusting for protective lead aprons by the Webster methodology, the average operator received an effective dose of 38 μSv. Except for the RT, personnel doses were well correlated with patient dose as measured by kerma area product (KAP) (r = .82 for average operator, r = .85 for scrub nurse, and r = .86 for anesthesia; all P < .001) but less well correlated with fluoroscopy time or cumulative air kerma (CAK). When preoperative cone beam computed tomography was performed, the equivalent dose to the RT was 1.1 μSv (0.6-1.5) when using shielding and 37 μSv (22-53) when unshielded. Digital subtraction acquisitions accounted for a large fraction of all individuals’ doses. Decreasing field size (and thus, increasing magnification) was associated with decreased KAP (r = .47; P < .001) and increased CAK (r = -.56; P < .001). The square of the field size correlated strongly with the KAP/CAK ratio (r = .99; P < .001). Increased lateral angulation of the C-arm increased both CAK and KAP (at field size, 22 cm; r = .54 and r = .44; both P < .001) and the average dose rate to an operator was 1.78 (1.37-2.31) times as high in a lateral projection as in a posterior-anterior projection.
Conclusions – Personnel doses were best correlated with KAP and less well correlated with fluoroscopy time or CAK. The dosimeter on the anesthesia equipment recorded the highest doses attributable to ineffective shielding. Operators can reduce the effective dose to themselves, the patient, and other personnel by minimizing the use of digital subtraction acquisitions, avoiding lateral angulation, using higher magnification levels when possible, and being diligent about the use of shielding during fluoroscopy cases.
Mohapatra A, Greenberg RK, Mastracci TM, Eagleton MJ, Thornsberry B. Radiation exposure to operating room personnel and patients during endovascular procedures. Journal of Vascular Surgery. 2013;58(3):702-709. doi: 10.1016/j.jvs.2013.02.032
2012
The aim of this study was to estimate radiation doses patients and staff are exposed to during interventional procedures (IPs), compare them with the international diagnostic reference levels and to develop initial National Diagnostic Reference Levels. The IP survey was undertaken as the initial task of which, retrospective data were collected from the only four Kenyan hospitals carrying out interventional radiology and cardiology procedures at the time of the study. Real-time measurement of radiation dose to patients and staff during these procedures was done. To the patients, kerma-area product (KAP) and fluoroscopy time measurements were done using an in-built KAP meter, while peak skin dose (PSD) was measured using slow Extended Dose Range (EDR2(®)) radiographic films. The staff occupational doses were measured using individual thermoluminescence dosemeters. The maximum and minimum KAP values were found to be 137.1 and 4.2 Gy cm(2), while the measured PSD values were 740 and 52 mGy, respectively. The fluoroscopic time range was between 3.3 and 70 min. The staff doses per procedure ranged between 0.05 and 1.41 mSv for medical doctors, 0.03 and 1.16 mSv for nurses, 0.04 and 0.78 mSv for radiographers and 0.04 and 0.88 mSv for clinical staff. The measured patient PSDs were within the threshold limit for skin injuries. However, with the current few IP specialists, an annual increase in workload as determined in the study will result in the International Commission on Radiation Protection annual eye lens dose limit being exceeded by 10 %. A concerted effort is required to contain these dose levels through use of protective gear, optimisation of practice and justification.
Korir GK, Ochieng BO, Wambani JS, Korir IK, Jowi CY. Radiation exposure in interventional procedures. Radiation Protection Dosimetry. 2012;152(4):339-344. doi: 10.1093/rpd/ncs072
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.