[Reduction of radiation exposure for patient and investigator in interventional radiography]

Interventional Angiography: Radiation Protection for the Examiner by using Lead-free Gloves

INTRODUCTION

The radiation exposure to unprotected parts of the body requires special attention for the interventional radiologist. During angiographic procedures, hands are exposed to the direct X-ray beam and scattered radiation.

AIM

The aim of the study was to evaluate the radiation exposure of examiners hand with the use of lead-free X-ray protective gloves in clinical practice in terms of shielding and sense of touch. The aim of the study was to evaluate the radiation exposure of examiners hand with the use of lead-free X-ray protective gloves in clinical practice in terms of shielding and sense of touch.

MATERIALS AND METHODS

Phantom measurements were conducted in the direct X-ray beam and the area of scattered radiation with and without shielding. Examiner measurements were determined in interventional angiographies in clinical routine of the lower limb in antegrade puncture technique through the femoral artery. In 24 out of 50 interventions, an elastic natural rubber latex glove with lead-free metal shielding against radiation was used. All measurements were performed with a direct dosimeter. After the intervention, an opinion of the examiner was requested for evaluation of the sense of touch.

RESULTS

Phantom measurements; when using the protective glove in the direct X-ray beam, a significant increase of the Dose Area Product (DAP) (1084.2-1603.8 mGy*cm²; 67.6%; p<0.001) as well of the examiner's hand dose (143-221.8 μSv; 64.5%; p<0.001) was observed. A significant reduction of the examiner's hand dose was verifiable for scattered radiation (1.76-0.75 μSv; 42.6%; p<0.001). Examiner measurements; if protective gloves were used, a significant increase of the DAP (6183.2-10462.9 mGy*cm²; 59.1%; p<0.05) and decrease of the average dose rate (0.76-0.43 mSv/h; 56.6%) for the entire procedure was determined. The tactile sensitivity was assessed as not restricted (18/24).

CONCLUSION

The new generation of protective gloves is characterized by a shielding effect against X-ray scattered radiation, without restricting the sense of touch. A significant reduction in radiation doses to the examiner can be accomplished with these gloves in the area of scattered radiation only. If the gloves were used in the direct X-ray beam, especially while the artery puncture was performed, a significant increase of the dose values was observed.

Effect of a one-session versus two-session procedure on different parameters of interventional therapy for peripheral arterial occlusive disease: results of a retrospective cohort study

PURPOSE

To compare the effects of a one-session procedure (ie, diagnostic angiography immediately followed by intervention) versus a two-session procedure (ie, diagnostic angiography and intervention in two separate sessions) on interventional therapy in patients with peripheral arterial occlusive disease (PAOD).

MATERIALS AND METHODS

Interventional therapy was performed immediately after diagnostic angiography in one session in 228 patients (group 1) and in a chronologically separate, later session in another 43 patients (group 2). The retrospectively captured parameters were Fontaine stage, TransAtlantic InterSociety Consensus II criteria, angiographic severity, type, technical success and complication rates, examination times, volume of contrast media, radiation exposure, and fluoroscopy time for intervention.

RESULTS

There were no between-group differences in clinical and interventional parameters. In group 1 there were 340 interventions performed, and there were 61 in group 2 with an interval before intervention of 1-55 days. The groups showed comparable success rates (92.6% vs 91.8%; P = .79) and complication rates (5.7% vs 4.65%; P = 1.0). The examination times were similar at 82.6 minutes +/- 40.5 and 91.3 minutes +/- 69.9, respectively (P = .92). Volume of contrast media (301.7 mL +/- 81.3 vs 459.2 mL +/- 123.7) and radiation exposure (140.5 Gy/cm(2) +/- 152.1 vs 304.7 Gy/cm(2) +/- 217.4) were significantly lower in group 1 (P < .001 each). Fluoroscopy times trended lower in group 1.

CONCLUSIONS

In patients with PAOD, interventional therapy of iliac and femoropopliteal artery lesions performed in the same session as diagnostic angiography yields technical success and complication rates comparable to those seen with a two-session procedure, but is associated with significantly less contrast media use and radiation exposure.

Radiation exposure of medical staff from interventional x-ray procedures: a multicentre study

The purpose of this study was to analyse the radiation exposure of medical staff from interventional x-ray procedures. Partial-body dose measurements were performed with thermoluminescent dosimeters (TLD) in 39 physicians and nine assistants conducting 73 interventional procedures of nine different types in 14 hospitals in Germany. Fluoroscopy time and the dose-area product (DAP) were recorded too. The median (maximum) equivalent body dose per procedure was 16 (2,500) microSv for an unshielded person; the partial-body dose per procedure was 2.8 (240) microSv to the eye lens, 4.1 (730) microSv to the thyroid, 44 (1,800) microSv to one of the feet and 75 (13,000) microSv to one of the hands. A weak correlation between fluoroscopy time or DAP and the mean TLD dose was observed. Generally, the doses were within an acceptable range from a radiation hygiene point of view. However, relatively high exposures were measured to the hand in some cases and could cause a partial-body dose above the annual dose limit of 500 mSv. Thus, the use of finger dosimeters is strongly recommended.