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Kuriyama T, Moritake T, Nakagami K, Morota K, Hitomi G, Kitamura H. Background Factors Affecting the Radiation Exposure of the Lens of the Eye among Nurses in Interventional Radiology: A Quantitative Observational Study. NURSING REPORTS 2024; 14:413-427. [PMID: 38391077 PMCID: PMC10885035 DOI: 10.3390/nursrep14010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
With the International Commission on Radiological Protection's (ICRP) reduction in the radiation dose threshold for cataracts, evaluating and preventing radiation exposure to the lens of the eye among interventional radiology (IR) staff have become urgent tasks. In this study, we focused on differences in lens-equivalent dose (HT Lens) to which IR nurses in three hospitals were exposed and aimed to identify factors underlying these differences. According to analyses of time-, distance-, and shielding-related factors, the magnitude of the HT Lens dose to which IR nurses were exposed could be explained not by time or shielding but by the distance between the X-ray exposure field and the location of the IR nurse. This distance tended to be shorter in hospitals with fewer staff. The most effective means of reducing the exposure of the lenses of IR nurses' eyes to radiation is to position them at least two meters from the radiation source during angiography procedures. However, some hospitals must provide IR departments with comparatively few staff. In work environments where it is infeasible to reduce exposure by increasing distance, interventions to reduce time by managing working practices and investment in shielding equipment are also important. This study was not registered.
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Affiliation(s)
- Tomoko Kuriyama
- Department of Occupational and Community Health Nursing, School of Health Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu 807-8555, Japan
| | - Takashi Moritake
- Department of Radiation Regulatory Science Research, National Institute of Radiological Sciences, National Institute for Quantum Science and Technology, Chiba 263-8555, Japan
| | - Koichi Nakagami
- Department of Radiology, Hospital of the University of Occupational and Environmental Health, Japan, Kitakyushu 807-8556, Japan
| | - Koichi Morota
- Department of Radiology, Shinkomonji Hospital, Kitakyushu 800-0057, Japan
| | - Go Hitomi
- Department of Radiological Technology, Kawasaki Medical School Hospital, Kurashiki 701-0192, Japan
| | - Hiroko Kitamura
- Occupational Health Training Center, University of Occupational and Environmental Health, Japan, Kitakyushu 807-8555, Japan
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2
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Salah H, Sulieman A, Alkhorayef M, Alkhybari E, Bradley DA. Evaluation of personal dose equivalents during positron emission tomography and computed tomography imaging. Appl Radiat Isot 2024; 203:111078. [PMID: 37907054 DOI: 10.1016/j.apradiso.2023.111078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/02/2023]
Abstract
This study aimed to evaluate the annual occupational radiation exposure of technologists during PET/CT imaging in 2020 and 2021. Eleven nuclear medicine technologists were monitored at the PET/CT department. The personal dose equivalents (PDEs) for staff members, measured in terms of Hp (10) and Hp (0.07), were assessed annually, considering both deep and surface doses. PDEs were quantified using a thermoluminescent detector (LiF:Mg:Ti)). The average and range of PDEs and extremity doses (mSv) for the technologists were as follows: 4.5 (0.1-13.4) for Hp (10), 4.63 (0.1-13.9) for Hp (0.07), and 2.5 (0.2-17.5) for extremity, respectively. The results indicated that staff members are exposed to high-energy gamma rays while preparing radiopharmaceuticals, injections, and image acquisition. Therefore, proper handling of radiopharmaceuticals and patient management during the acquisition of parameters are crucial for maintaining the occupational dose within the defined limit.
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Affiliation(s)
- H Salah
- INAYA Medical Collage, Nuclear Medicine Department, Riyadh, Saudi Arabia.
| | - A Sulieman
- Prince Sattam Bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, Alkharj, Saudi Arabia
| | - M Alkhorayef
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - E Alkhybari
- Prince Sattam Bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, Alkharj, Saudi Arabia
| | - D A Bradley
- Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford, United Kingdom
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3
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Al-Choboq J, Mathis T, Restier-Verlet J, Sonzogni L, El Nachef L, Granzotto A, Bourguignon M, Foray N. The Radiobiological Characterization of Human and Porcine Lens Cells Suggests the Importance of the ATM Kinase in Radiation-Induced Cataractogenesis. Cells 2023; 12:2118. [PMID: 37626928 PMCID: PMC10453874 DOI: 10.3390/cells12162118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Studies about radiation-induced human cataractogenesis are generally limited by (1) the poor number of epithelial lens cell lines available (likely because of the difficulties of cell sampling and amplification) and (2) the lack of reliable biomarkers of the radiation-induced aging process. We have developed a mechanistic model of the individual response to radiation based on the nucleoshuttling of the ATM protein (RIANS). Recently, in the frame of the RIANS model, we have shown that, to respond to permanent endo- and exogenous stress, the ATM protein progressively agglutinates around the nucleus attracted by overexpressed perinuclear ATM-substrate protein. As a result, perinuclear ATM crowns appear to be an interesting biomarker of aging. The radiobiological characterization of the two human epithelial lens cell lines available and the four porcine epithelial lens cell lines that we have established showed delayed RIANS. The BFSP2 protein, found specifically overexpressed around the lens cell nucleus and interacting with ATM, may be a specific ATM-substrate protein facilitating the formation of perinuclear ATM crowns in lens cells. The perinuclear ATM crowns were observed inasmuch as the number of culture passages is high. Interestingly, 2 Gy X-rays lead to the transient disappearance of the perinuclear ATM crowns. Altogether, our findings suggest a strong influence of the ATM protein in radiation-induced cataractogenesis.
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Affiliation(s)
- Joëlle Al-Choboq
- INSERM U1296 Unit “Radiation: Defense, Health, Environment”, 28 Rue Laennec, 69008 Lyon, France; (J.A.-C.); (J.R.-V.); (L.S.); (L.E.N.); (A.G.); (M.B.)
| | - Thibaud Mathis
- Ophtalmology Department, Hospices Civils de Lyon, General University Hospital of Croix-Rousse, 103 Grande Rue Croix Rousse, 69004 Lyon, France;
- MATEIS Laboratory, CNRS UMR5510, INSA, Université Claude-Bernard Lyon 1, Campus de la Doua, 69100 Villeurbanne, France
| | - Juliette Restier-Verlet
- INSERM U1296 Unit “Radiation: Defense, Health, Environment”, 28 Rue Laennec, 69008 Lyon, France; (J.A.-C.); (J.R.-V.); (L.S.); (L.E.N.); (A.G.); (M.B.)
| | - Laurène Sonzogni
- INSERM U1296 Unit “Radiation: Defense, Health, Environment”, 28 Rue Laennec, 69008 Lyon, France; (J.A.-C.); (J.R.-V.); (L.S.); (L.E.N.); (A.G.); (M.B.)
| | - Laura El Nachef
- INSERM U1296 Unit “Radiation: Defense, Health, Environment”, 28 Rue Laennec, 69008 Lyon, France; (J.A.-C.); (J.R.-V.); (L.S.); (L.E.N.); (A.G.); (M.B.)
| | - Adeline Granzotto
- INSERM U1296 Unit “Radiation: Defense, Health, Environment”, 28 Rue Laennec, 69008 Lyon, France; (J.A.-C.); (J.R.-V.); (L.S.); (L.E.N.); (A.G.); (M.B.)
| | - Michel Bourguignon
- INSERM U1296 Unit “Radiation: Defense, Health, Environment”, 28 Rue Laennec, 69008 Lyon, France; (J.A.-C.); (J.R.-V.); (L.S.); (L.E.N.); (A.G.); (M.B.)
- Department of Biophysics and Nuclear Medicine, Université Paris Saclay Versailles St Quentin-en-Yvelines, 78035 Versailles, France
| | - Nicolas Foray
- INSERM U1296 Unit “Radiation: Defense, Health, Environment”, 28 Rue Laennec, 69008 Lyon, France; (J.A.-C.); (J.R.-V.); (L.S.); (L.E.N.); (A.G.); (M.B.)
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4
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Sommer P, Sciacca V, Anselmino M, Tilz R, Bourier F, Lehrmann H, Bulava A. Practical guidance to reduce radiation exposure in electrophysiology applying ultra low-dose protocols: a European Heart Rhythm Association review. Europace 2023; 25:euad191. [PMID: 37410906 PMCID: PMC10365833 DOI: 10.1093/europace/euad191] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
Interventional electrophysiology offers a great variety of treatment options to patients suffering from symptomatic cardiac arrhythmia. Catheter ablation of supraventricular and ventricular tachycardia has globally evolved a cornerstone in modern arrhythmia management. Complex interventional electrophysiological procedures engaging multiple ablation tools have been developed over the past decades. Fluoroscopy enabled interventional electrophysiologist throughout the years to gain profound knowledge on intracardiac anatomy and catheter movement inside the cardiac cavities and hence develop specific ablation approaches. However, the application of X-ray technologies imposes serious health risks to patients and operators. To reduce the use of fluoroscopy during interventional electrophysiological procedures to the possibly lowest degree and to establish an optimal protection of patients and operators in cases of fluoroscopy is the main goal of modern radiation management. The present manuscript gives an overview of possible strategies of fluoroscopy reduction and specific radiation protection strategies.
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Affiliation(s)
- Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, ‘Citta della Salute e della Scienza di Torino’ Hospital, University of Turin, Torino, Italy
| | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center, Technical University, Munich, Germany
| | - Heiko Lehrmann
- Department of Cardiology and Angiology (Campus Bad Krozingen), University Hospital Freiburg, Bad Krozingen, Germany
| | - Alan Bulava
- Department of Cardiology, Ceske Budejovice Hospital and Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
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5
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Teng Z, Song M, Liu S, Ni N, Wei K, Liu Y, Hang Z, Geng X, Hu K, Li Q, Jia M, Li D. A NEW DOSE DETERMINATION METHOD FOR HP(3) AND DP LENS FOR BETA REFERENCE RADIATION QUALITIES. RADIATION PROTECTION DOSIMETRY 2023; 199:615-622. [PMID: 36929013 DOI: 10.1093/rpd/ncad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 05/05/2023]
Abstract
For the purpose of obtaining the smaller uncertainties for Hp(3) and Dp lens in 90Sr/90Y beta reference fields, a new dose determination method based on the Monte-Carlo simulation was proposed. The conversion coefficients from the absorbed dose in air, at the reference point of the extrapolation ionisation chamber, Dair, det to Hp(3; α) and the conversion factors from Dair, det to Dp lens(α) were calculated with EGSnrc, respectively, for the irradiation angles from 0° to 60°. Compared with the dose determination method in International Organization for Standardization (ISO) 6980 standard, the uncertainty reductions of 7.7-52.8% for Hp(3; α) and 7.9-55.0% for Dp lens(α) were achieved, respectively. In addition, for the conversion coefficients from the reference absorbed dose DR to Hp(3; α), the calculations were performed for more irradiation conditions, which are not included in the current ISO 6980 standard. For the calculations of the conversion factors from DR to Dp lens(α), the eye and head phantoms with Chinese characteristics were utilised, which makes the conversion factors more suitable for use in China.
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Affiliation(s)
- Zhongbin Teng
- National Key Laboratory for Metrology and Calibration Techniques, China Institute of Atomic Energy, Beijing 102413, China
| | - Mingzhe Song
- National Key Laboratory for Metrology and Calibration Techniques, China Institute of Atomic Energy, Beijing 102413, China
| | - Senlin Liu
- National Key Laboratory for Metrology and Calibration Techniques, China Institute of Atomic Energy, Beijing 102413, China
| | - Nin Ni
- National Key Laboratory for Metrology and Calibration Techniques, China Institute of Atomic Energy, Beijing 102413, China
| | - Kexin Wei
- National Key Laboratory for Metrology and Calibration Techniques, China Institute of Atomic Energy, Beijing 102413, China
| | - Yuntao Liu
- National Key Laboratory for Metrology and Calibration Techniques, China Institute of Atomic Energy, Beijing 102413, China
| | - Zhongbin Hang
- National Key Laboratory for Metrology and Calibration Techniques, China Institute of Atomic Energy, Beijing 102413, China
| | - Xuan Geng
- National Key Laboratory for Metrology and Calibration Techniques, China Institute of Atomic Energy, Beijing 102413, China
| | - Kaixuan Hu
- National Key Laboratory for Metrology and Calibration Techniques, China Institute of Atomic Energy, Beijing 102413, China
| | - Qiao Li
- National Key Laboratory for Metrology and Calibration Techniques, China Institute of Atomic Energy, Beijing 102413, China
| | - Minghan Jia
- National Key Laboratory for Metrology and Calibration Techniques, China Institute of Atomic Energy, Beijing 102413, China
| | - Dehong Li
- National Institute of Metrology, Beijing 100029, China
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6
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Igarashi T. [Recent Trends in Medical Radiation Protection]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:1265-1272. [PMID: 35989254 DOI: 10.6009/jjrt.2022-1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In recent years, the field of medical radiation protection has entered an era of drastic changes. In addition to international trends, it may also be related to the increased awareness of radiation and radiation effects among the Japanese people due to the Fukushima nuclear accident in March 2011. As a result, with the revision of laws and regulations, strict control is required for medical radiation safety management and management of radiation workers. As a recent movement on radiation protection, this article reviews the changes in the threshold dose and dose limit of the lens of the eye, medical radiation safety management due to revision of medical law enforcement regulations, diagnostic reference levels, domestic and international trends regarding gonad shielding during radiography, trends toward new ICRP recommendation, and risk communication from recent trends in medical radiation protection.
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Affiliation(s)
- Takayuki Igarashi
- Department of Radiological Technology, International University of Health and Welfare Narita Hospital
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7
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Assessment of occupational exposure from PET and PET/CT scanning in Saudi Arabia. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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8
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Kellermann F, Hödlmoser H, Leister I, Seidenbusch M, Treitl M, Wagner F, Militz M, Stuby F. [Radiation exposure of the eye lens in orthopedics and trauma surgery : A pilot study]. Unfallchirurg 2022; 126:399-404. [PMID: 35384465 DOI: 10.1007/s00113-022-01163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND On 27 June 2017 the Act on new regulation of the law for the protection against the harmful effects of ionizing radiation was passed. One of the main innovations in daily surgical practice in the now legally stipulated provisions is the lowering of the eye lens dose to 20 mSv/year (§§ 78, 212 Radiation Protection Act, StrlSchG). MATERIAL AND METHODS To estimate the level of exposure of the eye lens to ionizing radiation that is to be expected in the course of surgical interventions, the dose that surgeons receive during surgery was determined. For this, the radiation exposure adjacent to the eye lens was measured using a forehead dosimeter while performing surgical interventions over a period of 8 weeks in 2 different operating rooms. RESULTS As a result, a mean estimated eye lens radiation dose Hp (3) of 190 µSv could be determined during the 2‑month study period. Thus, the estimated cumulative radiation dose in 1 year of approximately 1.2 mSv was significantly below the threshold of 20 mSv/year. CONCLUSION By complying with the common radiation protection measures in the context of operative interventions in orthopedics and trauma surgery, the legal limit value of 20 mSv/year is generally not expected to be exceeded.
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Affiliation(s)
- F Kellermann
- Septische und Rekonstruktive Chirurgie, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland.
- , Professor-Küntscher-Straße 8, 82418, Murnau am Staffelsee, Deutschland.
| | - H Hödlmoser
- Auswertungsstelle für Strahlendosimeter München-Neuperlach, Mirion Technologies, München-Neuperlach, Deutschland
| | - I Leister
- ParaMove, Berufsgenossenschaftliche Unfallklinik Murnau und Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Deutschland
- Zentrum für Rückenmarkverletzte mit Neurourologie, Berufsgenossenschaftliche Unfallklinik, Murnau, Deutschland
- Institut für Molekulare Regenerative Medizin, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Deutschland
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Deutschland
| | - M Seidenbusch
- Abteilung Radiologie, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - M Treitl
- Abteilung Radiologie, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - F Wagner
- Septische und Rekonstruktive Chirurgie, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - M Militz
- Septische und Rekonstruktive Chirurgie, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - F Stuby
- Abteilung Unfallchirurgie, Orthopädie und Allgemeinchirurgie, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
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Erdem O, Ay M, Yalcin A, Bilgic S, Sanlıdilek U, Amasyalı B, Sancak T, Olgar T. PATIENT AND STAFF DOSES FOR VARIOUS INTERVENTIONAL RADIOLOGY AND CARDIOLOGY EXAMINATIONS IN TURKEY. RADIATION PROTECTION DOSIMETRY 2022; 198:158-166. [PMID: 35165744 DOI: 10.1093/rpd/ncac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
This study aims to determine the radiation doses of patients and staff during different interventional radiology and cardiology examinations. Dose measurements for interventional radiology examinations were performed in Ibn-i Sina Hospital of Ankara University using Siemens Artis-Zee medical imaging system. Patient dose measurement was carried out for interventional cardiology examinations in Cardiology Department of TOBB-ETU University, Medical Faculty Hospital using Philips Allura Centron interventional X-ray system. Patient doses were obtained in terms of kerma area product (KAP) and cumulative air kerma (CAK) from KAP meter attached to the angiography system. Performance tests of the angiography system were performed before patient dose measurements. Staff dose measurements were carried out with thermoluminescence dosimeters (TLD-100) placed in certain areas on the staff. Patient dose measurements were performed for 15 different interventional radiology examinations on a total of 431 patients and for four different cardiology examinations on a total of 299 patients. Monte Carlo based PCXMC 2.0 program was used to calculate patient effective doses. Lower extremity arteriography was the most common examination with a mean KAP value of 30 Gy cm2 and mean effective dose value of 1.2 mSv for total number of 194 patients. Mean KAP values calculated for coronary angiography, percutaneous coronary intervention, electrophysiological procedures and radiofrequency cardiac ablation examinations were 62.8, 162.8, 16.7 and 70.6 Gy cm2, respectively. Radiologist, nurse and technician effective dose normalised to the unit KAP of patient dose were 0.15, 0.11 and 0.14 μSv Gy-1 cm-2. Similarly, cardiologist, nurse and technician effective dose normalised to the unit KAP of patient dose were 0.22, 0.15 and 0.09 μSv Gy-1 cm-2. Measured KAP and CAK values vary depending on the type and complexity of the examination. The measured staff doses during cardiac examinations were higher when compared with that measured for interventional radiology as expected.
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Affiliation(s)
- Onur Erdem
- Ankara University, Institute of Nuclear Sciences, 06100 Ankara, Turkey
| | - Musa Ay
- Ankara University, Institute of Nuclear Sciences, 06100 Ankara, Turkey
| | - Asena Yalcin
- Ankara University, Institute of Nuclear Sciences, 06100 Ankara, Turkey
| | - Sadık Bilgic
- Ankara University, Faculty of Medicine, Department of Radiology, 06100 Ankara, Turkey
| | - Umman Sanlıdilek
- Ankara University, Faculty of Medicine, Department of Radiology, 06100 Ankara, Turkey
| | - Basri Amasyalı
- TOBB University of Economics and Technology Hospital, Department of Cardiology, 06510 Ankara, Turkey
| | - Tanzer Sancak
- TOBB University of Economics and Technology Hospital, Department of Radiology, 06510 Ankara, Turkey
| | - Turan Olgar
- Ankara University, Institute of Nuclear Sciences, 06100 Ankara, Turkey
- Ankara University, Faculty of Engineering, Department of Physics Engineering, 06100 Ankara, Turkey
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10
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Behr-Meenen C, von Boetticher H, Kersten JF, Nienhaus A. Radiation Protection in Interventional Radiology/Cardiology-Is State-of-the-Art Equipment Used? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13131. [PMID: 34948742 PMCID: PMC8700859 DOI: 10.3390/ijerph182413131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022]
Abstract
Interventional radiology/cardiology is one of the fields with the highest radiation doses for workers. For this reason, the International Commission on Radiological Protection (ICRP) published new recommendations in 2018 to shield staff from radiation. This study sets out to establish the extent to which these recommendations are observed in Germany. For the study, areas were selected which are known to have relatively high radiation exposure along with good conditions for radiological protection-interventional cardiology, radiology and vascular surgery. The study was advertised with the aid of an information flyer which was distributed via organisations including the German Cardiac Society (Deutsche Gesellschaft für Kardiologie- Herz- und Kreislaufforschung e. V.). Everyone who participated in our study received a questionnaire to record their occupational medical history, dosimetry, working practices, existing interventional installations and personal protective equipment. The results were compared with international recommendations, especially those of the ICRP, based on state-of-the-art equipment. A total of 104 respondents from eight German clinics took part in the survey. Four participants had been medically diagnosed with cataracts. None of the participants had previously worn an additional dosimeter over their apron to determine partial-body doses. The interventional installations recommended by the ICRP have not been fitted in all examination rooms and, where they have been put in place, they are not always used consistently. Just 31 participants (36.6%) stated that they "always" wore protective lead glasses or a visor. This study revealed considerable deficits in radiological protection-especially in connection with shielding measures and dosimetric practices pertaining to the head and neck-during a range of interventions. Examination rooms without the recommended interventional installations should be upgraded in the future. According to the principle of dose minimization, there is considerable potential for improving radiation protection. Temporary measurements should be taken over the apron to determine the organ-specific equivalent dose to the lens of the eye and the head.
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Affiliation(s)
- Christiane Behr-Meenen
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (J.F.K.); (A.N.)
| | - Heiner von Boetticher
- Division for Medical Radiation Physics, Faculty VI: Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26121 Oldenburg, Germany;
| | - Jan Felix Kersten
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (J.F.K.); (A.N.)
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (J.F.K.); (A.N.)
- Department of Occupational Medicine, Toxic Substances, Health Service Research, German Statuary Institution for Accident Insurance and Prevention for Health and Welfare Services (BGW), 22089 Hamburg, Germany
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11
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Alnaaimi M, Alduaij M, Shenawy F, Algaily M, Mohammedzein T, Shaaban M, Rehani MM. Assessment of eye doses to staff involved in interventional cardiology procedures in Kuwait. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:639-645. [PMID: 34351496 PMCID: PMC8339394 DOI: 10.1007/s00411-021-00929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/24/2021] [Indexed: 06/13/2023]
Abstract
In this study, which is the first of its kind in the gulf region, eye doses of interventional cardiologists and nurses were measured using active dosimeters for left and right eyes, in 60 percutaneous coronary interventions in three main hospitals in Kuwait. The dose given in terms of Hp(0.07) per procedure when ceiling suspended screens were used by main operators ranged from 18.5 to 30.3 µSv for the left eye and from 12.6 to 23.6 µSv for the right eye. Taking into account typical staff workload, the results show that the dose limit of 20 mSv/year to the eyes can be exceeded for interventional cardiologists in some situations, which demonstrates the need of using additional effective radiation protection tools, e.g. protective eye spectacles, in addition to the regular and proper use of ceiling suspended screens. With indications of increase in workload, the need for availability of a dedicated active dosimeter for the regular monitoring of eye doses is emphasized.
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Affiliation(s)
- Meshari Alnaaimi
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait.
| | - Mousa Alduaij
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Faisal Shenawy
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Musab Algaily
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Talal Mohammedzein
- Radiation Physics Department, Kuwait Cancer Control Centre (KCCC), Shuwaikh, Kuwait City, Kuwait
| | - Mohamed Shaaban
- Radiation Protection Department, Shuwaikh, Kuwait City, Kuwait
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12
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Alnaaimi M, Alduaij M, Algaily M, Shanawey F, Mohammedzein T, Alkandri F, Shaban M, Alenezi S. NATIONAL DIAGNOSTIC REFERENCE LEVELS FOR NUCLEAR MEDICINE IN KUWAIT. J Nucl Med Technol 2021; 50:54-59. [PMID: 34583955 DOI: 10.2967/jnmt.121.262175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/20/2021] [Indexed: 11/16/2022] Open
Abstract
The diagnostic reference level (DRL) is an optimization tool of patients exposure used to evaluate and provide guidance for radiation doses in medical imaging. In the past few decades, there has been a global increase in the number of diagnostic imaging procedures, including nuclear medicine procedures, and consequently the patient radiation exposure. This has encouraged international and national healthcare organizations to take actions and keep up with such changes to meet the expectations of an increasing use of ionizing radiation in medicine. The DRL in Kuwait was established by investigating the administered activity of radiopharmaceuticals and computed tomography (CT) radiation doses in hybrid imaging systems. The DRL were determined based on the 75th percentile of radiopharmaceuticals administered activity distribution as recommended by the international commission on radiation protection (ICRP). This study presents the establishment process and results of the first national DRLs for nuclear medicine procedures in Kuwait as a way to optimize radiation exposure. The DRLs determined in Kuwait are in good agreement with other published DRLs in Europe, Japan, Korea, Australia and the US.
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Affiliation(s)
| | | | | | | | | | | | - Mohamed Shaban
- Radiation Protection Department, Ministry of Health, Kuwait
| | - Saud Alenezi
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait
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13
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Mourtada F, Clement CH, Dauer LT, Baureus Koch C, Cosset JM, Doruff M, Damato A, Guedea F, Scalliet P, Thomadsen B, Pinillos-Ashton L, Small W. Occupational Radiological Protection in Brachytherapy. Ann ICRP 2021; 50:5-75. [PMID: 34503342 DOI: 10.1177/01466453211013514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Firas Mourtada
- Chief of Clinical Physics, ChristianaCare, Newark, Delaware.,President, American Brachytherapy Society
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14
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Ahmadi M, Barnard S, Ainsbury E, Kadhim M. Early Responses to Low-Dose Ionizing Radiation in Cellular Lens Epithelial Models. Radiat Res 2021; 197:78-91. [PMID: 34324666 DOI: 10.1667/rade-20-00284.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 07/06/2021] [Indexed: 11/03/2022]
Abstract
Cataract is the leading cause of visual impairment which can result in blindness. Cataract formation has been associated with radiation exposure; however, the mechanistic understanding of this phenomenon is still lacking. The goal of this study was to investigate mechanisms of cataract induction in isolated lens epithelial cells (LEC) exposed to ionizing radiation. Human LECs from different genetic backgrounds (SV40 immortalized HLE-B3 and primary HLEC cells) were exposed to varying doses of 137Cs gamma rays (0, 0.1, 0.25 and 0.5 Gy), at low (0.065 Gy/min) and higher (0.3 Gy/min) dose rates. Different assays were used to measure LEC response for, e.g., viability, oxidative stress, DNA damage studies, senescence and changes to telomere length/telomerase activity at two time points (1 h and 24 h, or 24 h and 15 days, depending on the type of assay and expected response time). The viability of cells decreased in a dose-dependent manner within 24 h of irradiation. Measurement of reactive oxygen species showed an increase at 1 h postirradiation, which was alleviated within 24 h. This was consistent with DNA damage results showing high DNA damage after 1 h postirradiation which reduced significantly (but not completely) within 24 h. Induction of senescence was also observed 15 days postirradiation, but this was not attributed to telomere erosion or telomerase activity reduction. Overall, these findings provide a mechanistic understanding of low-dose radiation-induced cataractogenesis which will ultimately help to inform judgements on the magnitude of risk and improve existing radiation protection procedures.
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Affiliation(s)
- Maryam Ahmadi
- Genomic Instability and Cell Communication Research Group, Department of Biological and Medical Science, Oxford Brookes University, Oxford, United Kingdom.,Kidney Genetics Group, Academic Unit of Nephrology, The Medical School, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Stephen Barnard
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Oxford, United Kingdom
| | - Elizabeth Ainsbury
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Oxford, United Kingdom
| | - Munira Kadhim
- Genomic Instability and Cell Communication Research Group, Department of Biological and Medical Science, Oxford Brookes University, Oxford, United Kingdom
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15
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McCarron RA, Barnard SGR, Babini G, Dalke C, Graw J, Leonardi S, Mancuso M, Moquet JE, Pawliczek D, Pazzaglia S, De Stefano I, Ainsbury EA. Radiation-Induced Lens Opacity and Cataractogenesis: A Lifetime Study Using Mice of Varying Genetic Backgrounds. Radiat Res 2021; 197:57-66. [PMID: 33984859 DOI: 10.1667/rade-20-00266.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/20/2021] [Indexed: 11/03/2022]
Abstract
Recent epidemiological findings and reanalysis of historical data suggest lens opacities resulting from ionizing radiation exposures are likely induced at lower doses than previously thought. These observations have led to ICRP recommendations for a reduction in the occupational dose limits for the eye lens, as well as subsequent implementation in EU member states. The EU CONCERT LDLensRad project was initiated to further understand the effects of ionizing radiation on the lens and identify the mechanism(s) involved in radiation-induced cataract, as well as the impact of dose and dose-rate. Here, we present the results of a long-term study of changes to lens opacity in male and female adult mice from a variety of different genetic (radiosensitive or radioresistant) backgrounds, including mutant strains Ercc2 and Ptch1, which were assumed to be susceptible to radiation-induced lens opacities. Mice received 0.5, 1 and 2 Gy 60Co gamma-ray irradiation at dose rates of 0.063 and 0.3 Gy min-1. Scheimpflug imaging was used to quantify lens opacification as an early indicator of cataract, with monthly observations taken postirradiation for an 18-month period in all strains apart from 129S2, which were observed for 12 months. Opacification of the lens was found to increase with time postirradiation (with age) for most mouse models, with ionizing radiation exposure increasing opacities further. Sex, dose, dose rate and genetic background were all found to be significant contributors to opacification; however, significant interactions were identified, which meant that the impact of these factors was strain dependent. Mean lens density increased with higher dose and dose rate in the presence of Ercc2 and Ptch1 mutations. This project was the first to focus on low (<1 Gy) dose, multiple dose rate, sex and strain effects in lens opacification, and clearly demonstrates the importance of these experimental factors in radiobiological investigations on the lens. The results provide insight into the effects of ionizing radiation on the lens as well as the need for further work in this area to underpin appropriate radiation protection legislation and guidance.
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Affiliation(s)
- R A McCarron
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, United Kingdom
| | - S G R Barnard
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, United Kingdom.,Durham University, School of Biosciences, Durham, United Kingdom
| | - G Babini
- Department of Physics, University of Pavia, Pavia, Italy.,Department of Woman and Child Health, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - C Dalke
- Helmholtz Zentrum München GmbH, German Research Centre for Environmental Health, Neuherberg, Germany
| | - J Graw
- Helmholtz Zentrum München GmbH, German Research Centre for Environmental Health, Neuherberg, Germany
| | - S Leonardi
- Laboratory of Biomedical Technologies, Agenzia Nazionale per le Nuove Tecnologie, l'Energia e lo Sviluppo Economico Sostenibile (ENEA), Rome, Italy
| | - M Mancuso
- Laboratory of Biomedical Technologies, Agenzia Nazionale per le Nuove Tecnologie, l'Energia e lo Sviluppo Economico Sostenibile (ENEA), Rome, Italy
| | - J E Moquet
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, United Kingdom
| | - D Pawliczek
- Helmholtz Zentrum München GmbH, German Research Centre for Environmental Health, Neuherberg, Germany
| | - S Pazzaglia
- Laboratory of Biomedical Technologies, Agenzia Nazionale per le Nuove Tecnologie, l'Energia e lo Sviluppo Economico Sostenibile (ENEA), Rome, Italy
| | - I De Stefano
- Laboratory of Biomedical Technologies, Agenzia Nazionale per le Nuove Tecnologie, l'Energia e lo Sviluppo Economico Sostenibile (ENEA), Rome, Italy
| | - E A Ainsbury
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, United Kingdom
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Radiological evaluation of lacrimal apparatus injury after functional endoscopic sinus surgery. The Journal of Laryngology & Otology 2021; 135:229-233. [PMID: 33641683 DOI: 10.1017/s0022215121000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the incidence of nasolacrimal duct injury after functional endoscopic sinus surgery radiologically, using computed tomography. METHODS Fifty patients of either sex who underwent functional endoscopic sinus surgery were evaluated for nasolacrimal duct injury by computed tomography. Computed tomography was conducted pre-operatively, and post-operatively at the end of four weeks, and nasolacrimal duct injury was analysed. RESULTS The prevalence of nasolacrimal duct injury dehiscence was 1.16 per cent, with a similar incidence of 1.16 per cent for nasolacrimal duct injury post-operatively. However, no cases of symptomatic nasolacrimal duct injury were recorded. CONCLUSION Computed tomography scan is an effective, non-invasive method to evaluate nasolacrimal duct injury following functional endoscopic sinus surgery, in accordance with evidence-based medicine.
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Arellano RS, Yang K, Rehani MM. Analysis of patients receiving ≥ 100 mSv during a computed tomography intervention. Eur Radiol 2020; 31:3065-3070. [PMID: 33180164 DOI: 10.1007/s00330-020-07458-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/27/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify a patient cohort who received ≥ 100 mSv during a single computed tomography (CT)-guided intervention and analyze clinical information. MATERIALS AND METHODS Using the dose-tracking platform Radimetrics that collects data from all CT scanners in a single hospital, a patient-level search was performed retrospectively by setting a threshold effective dose (E) of 100 mSv for the period from January 2013 to December 2017. Patients who received ≥ 100 mSv in a single day during a single CT-guided intervention were then identified. Procedure types were identified, and medical records were reviewed up to January 2020 to identify patients who developed short- and/or medium-term (up to 8 years) medical consequences. RESULTS Of 8952 patients with 100 mSv+, there were 33 patients who underwent 37 CT-guided interventions each resulting in ≥ 100 mSv. Procedures included ablations (15), myelograms (8), drainages (7), biopsies (6), and other (1). The dose for individual procedures was 100.2 to 235.5 mSv with mean and median of 125.7 mSv and 111.8 mSv, respectively. Six patients (18 %) were less than 50 years of age. During the study period of 0.2 to 7 years, there were no deterministic or stochastic consequences identified in this study cohort. CONCLUSIONS While infrequent, CT-guided interventions may result in a single procedure dose of ≥ 100 mSv. Awareness of the possibility of such high doses and potential for long-term deleterious effects, especially in younger patients, and consideration of alternative imaging guidance and/or further dose optimization should be strongly considered whenever feasible. KEY POINTS • Although not so frequent, CT-guided interventions may result in a single procedure dose of ≥ 100 mSv • Procedures with potential for high dose includes ablations, myelograms, drainages, and biopsies.
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Affiliation(s)
- Ronald S Arellano
- Radiology Department, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Kai Yang
- Radiology Department, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Madan M Rehani
- Radiology Department, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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Vassileva J, Zagorska A, Karagiannis A, Petkova K, Sabuncu K, Saltirov I, Sarica K, Skolarikos A, Stavridis S, Trinchieri A, Tzelves L, Ulus I, Yuruk E. Radiation Exposure of Surgical Team During Endourological Procedures: International Atomic Energy Agency-South-Eastern European Group for Urolithiasis Research Study. J Endourol 2020; 35:574-582. [PMID: 32791856 DOI: 10.1089/end.2020.0630] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction: Fluoroscopy-guided endourology procedures require proper radiation protection to minimize radiation risk. This multicenter study aimed at investigating radiation protection practice and related radiation exposure of operating team members. Materials and Methods: Six endourology centers from the South-Eastern European Group for Urolithiasis Research answered questionnaires and collected data of 315 procedures performed within a 3-months period, with simultaneous measurement of dose to staff and dose area product (DAP) to patient. A pair of calibrated personal dosimeters, one for body and one for eye-lens dose, was worn by all key staff members. Dosimeters were centrally calibrated, measured, and analyzed. Results: The annual workload ranged from 173 to 865 procedures per center. Practice of personal dose monitoring and use of radiation protection shielding was found to be inconsistent. Lead aprons and thyroid collars were used by all, whereas protective eyewear was used in only half of centers. Due to the regular use of protective aprons, the whole-body dose of all 44 monitored staff members was safely below the regulatory dose limits. Eye-lens dose of 17 (14 urologists and 3 assisting staff) was above the dosimeter detection level, and dose per procedure varied from <10 to 63 μSv. The highest annual eye-lens dose of 13.5 mSv was found for the surgeon in the busiest department by using an over-the-couch X-ray tube without a ceiling suspended screen. Working closer to patient body with no protection resulted in a six-time higher eye-lens dose per DAP for a surgeon compared with others in the same center. Lower eye-dose per procedure was associated with lower DAP to patient and with the use of an under-the-couch tube, lower fluoroscopy pulse rate, collimation, fluoroscopy time, and acquired images. Conclusions: The study results call for the need to establish standard protocols about use of fluoroscopy during endourology procedures and to increase radiation protection knowledge and awareness of surgical staff.
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Affiliation(s)
- Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Anna Zagorska
- Second Nuclear Medicine Department, Acibadem City Clinic UMHAT, Sofia, Bulgaria
| | - Andreas Karagiannis
- Second Department of Urology, Sismanoglio Hospital, Athens, Greece.,Department of Urology, Athens Euroclinic Hospital, Athens, Greece
| | - Kremena Petkova
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Kubilay Sabuncu
- Department of Urology, Karacabey State Hospital, Bursa, Turkey
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey
| | | | - Sotir Stavridis
- Medical Faculty Skopje, University Clinic of Urology, Skopje, North Macedonia
| | - Alberto Trinchieri
- Department of Urology, Manzoni Hospital, Lecco, Italy.,Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Lazaros Tzelves
- Second Department of Urology, Sismanoglio Hospital, Athens, Greece
| | - Ismail Ulus
- Department of Urology, BHT Clinic Istanbul Tema Hospital, Istanbul, Turkey
| | - Emrah Yuruk
- Department of Urology, BHT Clinic Istanbul Tema Hospital, Istanbul, Turkey
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20
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[Effect of X-ray protective visors on the eye lens dose during ureteroscopy]. Urologe A 2020; 59:1231-1236. [PMID: 32377765 DOI: 10.1007/s00120-020-01208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Eye lens radiation exposure during fluoroscopy-guided interventional procedures may result in occupational radiation-induced cataracts. We evaluated the eye lens radiation doses and the protective effect of X‑ray protective visors during ureteroscopic procedures. MATERIALS AND METHODS Eye lens doses were measured in front of and behind X‑ray protective visors using eye lens dosemeters during ureteroscopic procedures done by 4 different endourologic surgeons within a 12-week period. Background radiation dose, simultaneously measured with transport dosemeters, was subtracted. Measured eye lens doses below the detection limit of the eye lens dosemeters were adjusted to the detection limit of 0.028 mSv. Correlating the eye lens doses (ELD) to the dose-area-product (DAP) an ELD/DAP ratio was calculated. Applying this ELD/DAP ratio the potential reduction of the eye lens radiation dose was retrospectively calculated for all ureteroscopic procedures done within one year. RESULTS Within the 12-week period 76 ureteroscopies were done by the 4 endourologic surgeons. The accumulated eye lens radiation dose was 0.796 mSv in front of the X‑ray protective visors, and 0.338 mSv behind the X‑ray protective visors. Thus, the eye lens radiation exposure was reduced to at least 42% by using X‑ray protective visors. Considering the 215 documented ureteroscopies in our clinic in the year before starting the study, occupational radiation exposure to the eye lens would have been reduced by X‑ray protective visors from 4.090 to 1.737 mSv. CONCLUSION X‑ray protective visors can effectively reduce the radiation exposure to the eye lens during fluoroscopy-guided endourologic procedures and should be used especially by high-volume endourologic surgeons.
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Use of Artificial Intelligence to Reduce Radiation Exposure at Fluoroscopy-Guided Endoscopic Procedures. Am J Gastroenterol 2020; 115:555-561. [PMID: 32195731 DOI: 10.14309/ajg.0000000000000565] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Exposure to ionizing radiation remains a hazard for patients and healthcare providers. We evaluated the utility of an artificial intelligence (AI)-enabled fluoroscopy system to minimize radiation exposure during image-guided endoscopic procedures. METHODS We conducted a prospective study of 100 consecutive patients who underwent fluoroscopy-guided endoscopic procedures. Patients underwent interventions using either conventional or AI-equipped fluoroscopy system that uses ultrafast collimation to limit radiation exposure to the region of interest. The main outcome measure was to compare radiation exposure with patients, which was measured by dose area product. Secondary outcome was radiation scatter to endoscopy personnel measured using dosimeter. RESULTS Of 100 patients who underwent procedures using traditional (n = 50) or AI-enabled (n = 50) fluoroscopy systems, there was no significant difference in demographics, body mass index, procedural type, and procedural or fluoroscopy time between the conventional and the AI-enabled fluoroscopy systems. Radiation exposure to patients was lower (median dose area product 2,178 vs 5,708 mGym, P = 0.001) and scatter effect to endoscopy personnel was less (total deep dose equivalent 0.28 vs 0.69 mSv; difference of 59.4%) for AI-enabled fluoroscopy as compared to conventional system. On multivariate linear regression analysis, after adjusting for patient characteristics, procedural/fluoroscopy duration, and type of fluoroscopy system, only AI-equipped fluoroscopy system (coefficient 3,331.9 [95% confidence interval: 1,926.8-4,737.1, P < 0.001) and fluoroscopy duration (coefficient 813.2 [95% confidence interval: 640.5-985.9], P < 0.001) were associated with radiation exposure. DISCUSSION The AI-enabled fluoroscopy system significantly reduces radiation exposure to patients and scatter effect to endoscopy personnel (see Graphical abstract, Supplementary Digital Content, http://links.lww.com/AJG/B461).
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Choi EJ, Go G, Han WK, Lee PB. Radiation exposure to the eyes and thyroid during C-arm fluoroscopy-guided cervical epidural injections is far below the safety limit. Korean J Pain 2020; 33:73-80. [PMID: 31888321 PMCID: PMC6944368 DOI: 10.3344/kjp.2020.33.1.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/05/2022] Open
Abstract
Background The aim of this study was to evaluate radiation exposure to the eye and thyroid in pain physicians during the fluoroscopy-guided cervical epidural block (CEB). Methods Two pain physicians (a fellow and a professor) who regularly performed C-arm fluoroscopy-guided CEBs were included. Seven dosimeters were used to measure radiation exposure, five of which were placed on the physician (forehead, inside and outside of the thyroid protector, and inside and outside of the lead apron) and two were used as controls. Patient age, sex, height, and weight were noted, as were radiation exposure time, absorbed radiation dose, and distance from the X-ray field center to the physician. Results One hundred CEB procedures using C-arm fluoroscopy were performed on comparable patients. Only the distance from the X-ray field center to the physician was significantly different between the two physicians (fellow: 37.5 ± 2.1 cm, professor: 41.2 ± 3.6 cm, P = 0.03). The use of lead-based protection effectively decreased the absorbed radiation dose by up to 35%. Conclusions Although there was no difference in radiation exposure between the professor and the fellow, there was a difference in the distance from the X-ray field during the CEBs. Further, radiation exposure can be minimized if proper protection (thyroid protector, leaded apron, and eyewear) is used, even if the distance between the X-ray beam and the pain physician is small. Damage from frequent, low-dose radiation exposure is not yet fully understood. Therefore, safety measures, including lead-based protection, should always be enforced.
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Affiliation(s)
- Eun Joo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gwangcheol Go
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woong Ki Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Pyung-Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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Roslee MAAM, Shuaib IL, Napi AFM, Razali MASM, Osman ND. Cumulative organ dose and effective dose in adult population underwent repeated or multiple head CT examination. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Santos MF, Cassola V, Kramer R, Costa JV, Andrade MEA, Asfora VK, Khoury HJ, Barros VSM. Development of a realistic 3D printed eye lens dosemeter using CAD integrated with Monte Carlo simulation. Biomed Phys Eng Express 2019; 6:015009. [PMID: 33438597 DOI: 10.1088/2057-1976/ab57bf] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recent epidemiological studies suggested to lower the threshold dose for radiation induced cataract in the eye lens. Therefore, eye lens radiation protection became to play a more important role in personal dosimetry. The main objective of this work is to propose a new methodology for prototyping and benchmarking of an eye lens dosimter based on the equivalent dose to the sensitive part of the eye lens, using CAD Software and Geant4 Monte Carlo simulations with mesh modelling and 3D printing. A 3D printed dosemeter was type tested based on IEC 62387:2012, in terms of energy and angular dependence for the measurements of Hp(3). The results show that the methodology employed is suitable for the development of new eye lens dosemeters.
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Affiliation(s)
- M F Santos
- Department of Nuclear Energy, Federal University of Pernambuco, Recife, Brazil
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Masterson M, Cournane S, McWilliams N, Maguire D, McCavana J, Lucey J. Relative response of dosimeters to variations in scattered X-ray energy spectra encountered in interventional radiology. Phys Med 2019; 67:141-147. [DOI: 10.1016/j.ejmp.2019.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/10/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022] Open
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Lee J, Yoon JS, Kim JS, Koom WS, Cho J, Suh CO. Long-term outcome, relapse patterns, and toxicity after radiotherapy for orbital mucosa-associated lymphoid tissue lymphoma: implications for radiotherapy optimization. Jpn J Clin Oncol 2019; 49:664-670. [PMID: 31505651 DOI: 10.1093/jjco/hyz044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/15/2019] [Accepted: 03/05/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Although mucosa-associated lymphoid tissue lymphoma (MALToma) is sensitive to radiation therapy (RT), the optimal RT dose and treatment volumes have not been established. This study aimed to assess the relapse patterns and outcomes of patients with orbital MALToma who underwent RT and to suggest implications for optimized RT. METHODS We reviewed 212 patients (246 orbits) diagnosed with orbital MALToma who received RT between 1993 and 2013. Median RT dose was 25.2 Gy. Generally, conjunctival and eyelid lesions were irradiated with electrons, whereas retrobulbar and lacrimal gland lesions with photons. Lens shielding was used for 70% of treated eyes, mainly conjunctival and eyelid tumors. RESULTS Relapse occurred in 29 patients. Among 11 patients with local relapse (LR), 4 were attributed to insufficient dose (n = 2) and improper RT volume (n = 2). The 10-year LR, contralateral orbit relapse, and distant relapse rates were 8.6%, 12.8% and 4.9%, respectively. Twelve patients died of disease-specific causes (n = 1) and intercurrent diseases (n = 11). The 10-year relapse-free survival, overall survival, and cause-specific survival rates were 69.7%, 88.2% and 98.8%, respectively. Grade 3 cataracts and nasolacrimal duct obstruction were observed in 27 and 4 orbits, respectively. CONCLUSION Low-dose RT with proper lens shielding is an appropriate treatment for orbital MALToma in terms of high disease control rate and acceptable morbidity. However, lower RT dose may be attempted to further reduce toxicity while maintaining excellent outcomes.
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Affiliation(s)
- Jeongshim Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Radiation Oncology, Inha University Hospital, Incheon, Republic of Korea
| | - Jin Sook Yoon
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Seok Kim
- Division of Hemato-oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
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Castilho AVB, Szjenfeld D, Nalli D, Fornazari V, Moreira AC, Medeiros RB. A Study of Radiation Doses to the Patient and Medical Team at Embolization Procedures. ACTA ACUST UNITED AC 2019. [DOI: 10.14407/jrpr.2019.44.3.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Poon R, Badawy MK. Radiation dose and risk to the lens of the eye during CT examinations of the brain. J Med Imaging Radiat Oncol 2019; 63:786-794. [DOI: 10.1111/1754-9485.12950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/11/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Rebekah Poon
- Department of Medical Imaging and Radiation Sciences School of Primary and Allied Health Care Faculty of Medicine, Nursing and Health Sciences Monash University Clayton Victoria Australia
| | - Mohamed K Badawy
- Department of Medical Imaging and Radiation Sciences School of Primary and Allied Health Care Faculty of Medicine, Nursing and Health Sciences Monash University Clayton Victoria Australia
- Monash Imaging Monash Health Clayton Victoria Australia
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Lin KT, Lee SY, Liu SC, Tsao CC, Hsu SD, Chien WC, Chung CH, Chang WK, Chen YW, Lin CS. Risk of ocular complications following radiation therapy in patients with nasopharyngeal carcinoma. Laryngoscope 2019; 130:1270-1277. [PMID: 31441954 DOI: 10.1002/lary.28254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/14/2019] [Accepted: 08/07/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the risk of ocular complications following radiotherapy in patients with nasopharyngeal carcinoma (NPC). METHODS We adopted 1:1 propensity score matching and identified an NPC cohort (n = 736) and a comparison cohort (n = 736) that comprised non-NPC head and neck cancer patients who received radiotherapy in the National Health Insurance Research Database from 1997 to 2010. The follow-up period was terminated upon developing ocular complications (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]360-379) or on December 31, 2010. RESULTS After adjusting for the confounding factors of the study, the NPC cohort had a higher adjusted hazard ratio (HR) for developing ocular complications than the comparison cohort (adjusted HR = 2.786, 95% confidence interval [CI] = 1.805-4.112, P < 0.001). The NPC cohort was associated with a significantly higher risk of developing ocular complications compared with the comparison cohort within 12 and after 24 months of follow-up (P < 0.05). The most common associated ocular complications were optic nerve disorder and retinopathy. CONCLUSIONS Patients with NPC might be at higher risk of developing ocular complications after radiotherapy than non-NPC head and neck cancer patients in Taiwan. Either further investigation or routine assessments by ophthalmological physician is recommended. LEVEL OF EVIDENCE NA Laryngoscope, 130:1270-1277, 2020.
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Affiliation(s)
- Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
| | - Shih-Yu Lee
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shao-Cheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Chih-Cheng Tsao
- Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
| | - Sheng-Der Hsu
- Division of Traumatic and General Surgery, Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Yuan-Wu Chen
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei, Taiwan.,School of Dentistry, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
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Hoedlmoser H, Greiter M, Bandalo V, Mende E, Brönner J, Kleinau P, Haninger T, Furlan M, Schmid M, Esser R, Scheubert P, Figel M. New eye lens dosemeters for integration in radiation protection glasses. RADIAT MEAS 2019. [DOI: 10.1016/j.radmeas.2019.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alkhorayef M, Sulieman A, Alonazi B, Alnaaimi M, Alduaij M, Bradley D. Estimation of radiation-induced cataract and cancer risks during routine CT head procedures. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2018.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Eye lens monitoring programme for medical staff involved in fluoroscopy guided interventional procedures in Switzerland. Phys Med 2019; 57:33-40. [DOI: 10.1016/j.ejmp.2018.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 10/18/2018] [Accepted: 12/05/2018] [Indexed: 11/15/2022] Open
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Sulieman A, Yousif E, Alkhorayef M, Mattar E, Babikir E, Bradley D. Lens dose and radiogenic risk from 99mTc nuclear medicine examinations. J Radioanal Nucl Chem 2018. [DOI: 10.1007/s10967-018-6178-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Angsuwatcharakon P, Janjeurmat W, Krisanachinda A, Ridtitid W, Kongkam P, Rerknimitr R. The difference in ocular lens equivalent dose to ERCP personnel between prone and left lateral decubitus positions: a prospective randomized study. Endosc Int Open 2018; 6:E969-E974. [PMID: 30083586 PMCID: PMC6070372 DOI: 10.1055/a-0599-5917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 03/05/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed in a prone or left lateral decubitus (LLD) position. The ocular lens equivalent doses between the two positions may be different because in the LLD position the tube voltage will automatically increase to maintain the image quality, and the increased distance between the image intensifier and the X-ray tube may result in more scattered radiation. We aimed to compare the ocular lens equivalent doses of ERCP personnel between the two different positions. PATIENTS AND METHODS Fifty-five patients with ERCP indications were randomized to either prone or LLD positions. One patient in an LLD position was excluded due to technical reasons. Indications for ERCP, patients' vertical thicknesses, fluoroscopy parameters, patients' skin dose rates, and the ocular-lens equivalent doses of ERCP personnel were compared. RESULTS Baseline characteristics were no different except for vertical thickness, which was significantly higher in the LLD group. The ocular lens equivalent doses (prone vs. LLD) of the primary endoscopist (19.2 vs. 30.7 µSv, P = 0.035), and the nurse anesthetist (17.3 vs. 42.2 µSv, P = 0.002) were significantly lower in the prone group than in the LLD group. The calculated annual number of procedures not to exceed the exposure allowance in prone and LLD positions were 1,042 and 651 procedures for the primary endoscopist and 1,157 and 473 procedures for the nurse anesthetist, respectively. CONCLUSIONS Ocular-radiation exposure to ERCP personnel was one-third lower in the prone than in LLD position. Therefore, more annual ERCPs could be performed by the personnel.
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Affiliation(s)
- Phonthep Angsuwatcharakon
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Department of Anatomy, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Worawarut Janjeurmat
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Anchali Krisanachinda
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Wiriyaporn Ridtitid
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pradermchai Kongkam
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Corresponding author Rungsun Rerknimitr, MD, FRCP (London), Professor of Medicine Division of Gastroenterology, Department of Medicine, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital1873 Rama 4 Road, PatumwanBangkok 10330Thailand+ 6622564356
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Tsapaki V, Balter S, Cousins C, Holmberg O, Miller DL, Miranda P, Rehani M, Vano E. The International Atomic Energy Agency action plan on radiation protection of patients and staff in interventional procedures: Achieving change in practice. Phys Med 2018; 52:56-64. [PMID: 30139610 DOI: 10.1016/j.ejmp.2018.06.634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/22/2018] [Accepted: 06/15/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The International Atomic Energy Agency (IAEA) organized the 3rd international conference on radiation protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session. MATERIAL AND METHODS The IAEA conference was conducted as a series of plenary sessions followed by various thematic sessions. "Radiation protection of patients and staff in interventional procedures" session keynote speakers presented information on: 1) Risk management of skin injuries, 2) Occupational radiation risks and 3) RP for paediatric patients. Then, a summary of the session-related papers was presented by a rapporteur, followed by an open question-and-answer discussion. RESULTS Sixty-seven percent (67%) of papers came from Europe. Forty-four percent (44%) were patient studies, 44% were occupational and 12% were combined studies. Occupational studies were mostly on eye lens dosimetry. The rest were on scattered radiation measurements and dose tracking. The majority of patient studies related to patient exposure with only one study on paediatric patients. Automatic patient dose reporting is considered as a first step for dose optimization. Despite efforts, paediatric IP radiation dose data are still scarce. The keynote speakers outlined recent achievements but also challenges in the field. Forecasting technology, task-specific targeted education from educators familiar with the clinical situation, more accurate estimation of lens doses and improved identification of high-risk professional groups are some of the areas they focused on. CONCLUSIONS Manufacturers play an important role in making patients safer. Low dose technologies are still expensive and manufacturers should make these affordable in less resourced countries. Automatic patient dose reporting and real-time skin dose map are important for dose optimization. Clinical audit and better QA processes together with more studies on the impact of lens opacities in clinical practice and on paediatric patients are needed.
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Affiliation(s)
- V Tsapaki
- Konstantopoulio General Hospital, Agias Olgas 3-5, 14233 Nea Ionia, Greece.
| | - S Balter
- Department of Radiology and Medicine, Columbia University, New York, USA.
| | - C Cousins
- FRCP, FRCR, Chair ICRP, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada.
| | - O Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna International Center, Vienna, Austria.
| | - D L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA.
| | - P Miranda
- Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile.
| | - M Rehani
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - E Vano
- Radiology Department, Medical School, Complutense University, 28040 Madrid, Spain.
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Badel AE, Rico-Mesa JS, Gaviria MC, Arango-Isaza D, Hernández Chica CA. Radiación ionizante: revisión de tema y recomendaciones para la práctica. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Eye lens dosimetry and the study on radiation cataract in interventional cardiologists. Phys Med 2017; 44:232-235. [DOI: 10.1016/j.ejmp.2017.10.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/30/2017] [Accepted: 10/14/2017] [Indexed: 11/18/2022] Open
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Alnaaimi M, Alkhorayef M, Omar M, Abughaith N, Alduaij M, Salahudin T, Alkandri F, Sulieman A, Bradley D. Occupational radiation exposure in nuclear medicine department in Kuwait. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2017.02.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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41
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Kim MJ, Kim JH. Radiation exposure and protection for eyes in pain management. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.4.297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Min Jung Kim
- Department Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Rose A, Rae WID, Chikobvu P, Marais W. A multiple methods approach: radiation associated cataracts and occupational radiation safety practices in interventionalists in South Africa. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2017; 37:329-339. [PMID: 28253201 DOI: 10.1088/1361-6498/aa5eee] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ionising radiation is a modality used in diagnostic and therapeutic medicine. The technology has improved and resulted in lower dose exposure but there has been an escalation in the quantity of procedures, their duration and complexity. These factors have meant increased occupational radiation exposure for interventionalists. Ionising radiation exposure can have detrimental health effects and includes radiation skin burns, various carcinomas, genetic and chromosomal aberrations and cataractogenesis of the lenses of the eye. The lenses of the eye are of the most radiosensitive organs and the risk of cataracts is high despite low radiation dose exposures. The use of personal protective equipment (PPE) is a method that can be used to mitigate the risk for developing lens opacifications. The consistent and effective utilisation of PPE is marred by availability, proper fit and ease of use when performing procedures. Radiation safety training is imperative to enforce a culture of radiation safety among interventionalists. The aim of this study was to quantify and describe cataracts among South African interventionalists and to understand their radiation safety practices. For this purpose, a cross sectional study was designed using multiple methods. A survey was conducted to determine the demographics and the risk factors of doctors exposed to radiation to doctors not exposed. The radiation workload and radiation safety practices of interventionalists were explored. Both groups had slit lamp examinations. The data were analysed analytically and a regression model developed looking at the outcomes and the risk factors. Qualitative in-depth interviews and group interviews were conducted to explore the perceptions of interventionalists regarding radiation safety. Deductive and inductive thematic analysis was done. Interdisciplinary research is challenging but offers tremendous opportunity for exploring and tackling complex issues related to securing a safe radiation work environment.
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Affiliation(s)
- A Rose
- Department of Community Health, University of the Free State, South Africa
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Cho YI, Kim JM, Kim JH. OCULAR ORGAN DOSE ASSESSMENT OF NUCLEAR MEDICINE WORKERS HANDLING DIAGNOSTIC RADIONUCLIDES. RADIATION PROTECTION DOSIMETRY 2017; 175:209-216. [PMID: 27765833 DOI: 10.1093/rpd/ncw287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Indexed: 06/06/2023]
Abstract
The dose distribution in the ocular organs of nuclear medicine workers during the handling of diagnostic radionuclides was assessed via simulation in virtual space. The cornea and lenses received the highest dose, and the dose distribution tended to be proportional to the gamma-ray energy emitted from the radiation source being handled. Moreover, calculations on the dose-reduction effects of eyewear protectors for the eyes of the workers showed that the effects were inversely proportional to the emitted gamma-ray energy, with the dose-reduction effect decreasing in the order of 201Tl, 123I, 99mTc, 67Ga, 111In and 18F. Among the considered sources, the dose-reduction effect was significant for sources that emit relatively less energy, namely 123I, 201Tl and 99mTc, while it was lower for the remaining sources, namely 18F, 111In and 67Ga.
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Affiliation(s)
- Yong In Cho
- Department of Nuclear Medicine, Dongnam Institute of Radiological and Medical Science, 40Jwadong-gil, Jangan-eup, Gijang-gun, Busan, Republic of Korea
| | - Ja Mee Kim
- Major of Computer Science Education, Graduate School of Education, Korea University, 145Anam-ro, Seoul, Republic of Korea
| | - Jung Hoon Kim
- Department of Radiological Science, College of Health Sciences, Catholic University of Pusan, 57Oryundae-ro, Geumjeong-gu, Busan, Republic of Korea
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Jowhari F, Hopman WM, Hookey L. A simple ergonomic measure reduces fluoroscopy time during ERCP: A multivariate analysis. Endosc Int Open 2017; 5:E172-E178. [PMID: 28299352 PMCID: PMC5348293 DOI: 10.1055/s-0043-102934] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and study aims Endoscopic retrograde cholangiopancreatgraphy (ERCP) carries a radiation risk to patients undergoing the procedure and the team performing it. Fluoroscopy time (FT) has been shown to have a linear relationship with radiation exposure during ERCP. Recent modifications to our ERCP suite design were felt to impact fluoroscopy time and ergonomics. This multivariate analysis was therefore undertaken to investigate these effects, and to identify and validate various clinical, procedural and ergonomic factors influencing the total fluoroscopy time during ERCP. This would better assist clinicians with predicting prolonged fluoroscopic durations and to undertake relevant precautions accordingly. Patients and methods A retrospective analysis of 299 ERCPs performed by 4 endoscopists over an 18-month period, at a single tertiary care center was conducted. All inpatients/outpatients (121 males, 178 females) undergoing ERCP for any clinical indication from January 2012 to June 2013 in the chosen ERCP suite were included in the study. Various predetermined clinical, procedural and ergonomic factors were obtained via chart review. Univariate analyses identified factors to be included in the multivariate regression model with FT as the dependent variable. Results Bringing the endoscopy and fluoroscopy screens next to each other was associated with a significantly lesser FT than when the screens were separated further (-1.4 min, P = 0.026). Other significant factors associated with a prolonged FT included having a prior ERCP (+ 1.4 min, P = 0.031), and more difficult procedures (+ 4.2 min for each level of difficulty, P < 0.001). ERCPs performed by high-volume endoscopists used lesser FT vs. low-volume endoscopists (-1.82, P = 0.015). Conclusions Our study has identified and validated various factors that affect the total fluoroscopy time during ERCP. This is the first study to show that decreasing the distance between the endoscopy and fluoroscopy screens in the ERCP suite significantly reduces the total fluoroscopy time, and therefore radiation exposure to patients and staff involved in the procedure.
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Affiliation(s)
- Fahd Jowhari
- Gastrointestinal Diseases Research Unit, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada
| | - Wilma M. Hopman
- Clinical Research Centre, Kingston General Hospital, and Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Lawrence Hookey
- Gastrointestinal Diseases Research Unit, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada,Corresponding author Lawrence Hookey, MD, FRCPC Division of GastroenterologyHotel Dieu Hospital166 Brock StreetKingston, ON K7L 5G2
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Wang ML, Hoffler CE, Ilyas AM, Kirkpatrick WH, Beredjiklian PK, Leinberry CF. Hand Surgery and Fluoroscopic Eye Radiation Dosage: A Prospective Pilot Comparison of Large Versus Mini C-Arm Fluoroscopy Use. Hand (N Y) 2017; 12:21-25. [PMID: 28082838 PMCID: PMC5207279 DOI: 10.1177/1558944716643279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The purpose of this study is to (1) perform a prospective pilot comparison of the impact of large versus mini C-arm fluoroscopy on resultant eye radiation exposure and (2) test the hypothesis that the use of either modality during routine hand surgery does not exceed the current recommended limits to critical eye radiation dosage. Methods: Over a 12-month period, eye radiation exposure was prospectively measured by a board-certified hand surgeon using both large and mini C-arm fluoroscopy. For each modality, accumulated eye radiation dosage was measured monthly, while fluoroscopic radiation output was recorded, including total exposure time and dose rate. Results: A total of 58 cases were recorded using large C-arm and 25 cases using mini C-arm. Between the 2 groups, there was not a significant difference with total exposure time (P = .88) and average dose rate per case (P = .10). With the use of either modality, average monthly eye radiation exposure fell within the undetectable range (<30 mrem), significantly less than the current recommended limit of critical eye radiation (167 mrem/month). Conclusions: The impact of various fluoroscopic sources on eye radiation exposure remains relatively unexplored. In this study, the minimal detectable eye radiation dosages observed in both groups were reliably consistent. Our findings suggest that accumulated eye radiation dosage, from the use of either fluoroscopic modality, does not approach previously reported levels of critical radiation loads.
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Affiliation(s)
- Mark L. Wang
- Thomas Jefferson University, Philadelphia, PA, USA,Mark L. Wang, Department of Orthopedic Surgery, The Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107-1216, USA.
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Horsburgh BA, Higgins M. A Study of Occupational Radiation Dosimetry During Fluoroscopically Guided Simulated Urological Surgery in the Lithotomy Position. J Endourol 2016; 30:1312-1320. [DOI: 10.1089/end.2016.0596] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ben A. Horsburgh
- Department of Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Mike Higgins
- Diagnostic Radiation Protection, Integrated Radiological Services (IRS) Limited, Liverpool, United Kingdom
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Zanzonico P, Dauer L, Strauss HW. Radiobiology in Cardiovascular Imaging. JACC Cardiovasc Imaging 2016; 9:1446-1461. [PMID: 27931527 PMCID: PMC5877470 DOI: 10.1016/j.jcmg.2016.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 12/18/2022]
Abstract
The introduction of ionizing radiation in medicine revolutionized the diagnosis and treatment of disease and dramatically improved and continues to improve the quality of health care. Cardiovascular imaging and medical imaging in general, however, are associated with a range of radiobiologic effects, including, in rare instances, moderate to severe skin damage resulting from cardiac fluoroscopy. For the dose range associated with diagnostic imaging (corresponding to effective doses on the order of 10 mSv [1 rem]), the possible effects are stochastic in nature and largely theoretical. The most notable of these effects, of course, is the possible increase in cancer risk. The current review addresses radiobiology relevant to cardiovascular imaging, with particular emphasis on radiation induction of cancer, including consideration of the linear nonthreshold dose-response model and of alternative models such as radiation hormesis.
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Affiliation(s)
- Pat Zanzonico
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Lawrence Dauer
- Memorial Sloan Kettering Cancer Center, New York, New York
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Ciraj-Bjelac O, Antic V, Selakovic J, Bozovic P, Arandjic D, Pavlovic S. EYE LENS EXPOSURE TO MEDICAL STAFF PERFORMING ELECTROPHYSIOLOGY PROCEDURES: DOSE ASSESSMENT AND CORRELATION TO PATIENT DOSE. RADIATION PROTECTION DOSIMETRY 2016; 172:475-482. [PMID: 26822419 DOI: 10.1093/rpd/ncv552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 12/10/2015] [Accepted: 12/12/2015] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to assess the patient exposure and staff eye dose levels during implantation procedures for all types of pacemaker therapy devices performed under fluoroscopic guidance and to investigate potential correlation between patients and staff dose levels. The mean eye dose during pacemaker/defibrillator implementation was 12 µSv for the first operator, 8.7 µSv for the second operator/nurse and 0.50 µSv for radiographer. Corresponding values for cardiac resynchronisation therapy procedures were 30, 26 and 2.0 µSv, respectively. Significant (p < 0.01) correlation between the eye dose and the kerma-area product was found for the first operator and radiographers, but not for other staff categories. The study revealed eye dose per procedure and eye dose normalised to patient dose indices for different staff categories and provided an input for radiation protection in electrophysiology procedures.
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Affiliation(s)
- Olivera Ciraj-Bjelac
- Vinca Institute of Nuclear Science, Radiation and Environmental Protection Department, University of Belgrade, P.O. Box 522, Belgrade 11001, Serbia
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
| | - Vojislav Antic
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
- Clinical Centre of Serbia, Belgrade, Serbia
| | - Jovana Selakovic
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
| | - Predrag Bozovic
- Vinca Institute of Nuclear Science, Radiation and Environmental Protection Department, University of Belgrade, P.O. Box 522, Belgrade 11001, Serbia
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
| | - Danijela Arandjic
- Vinca Institute of Nuclear Science, Radiation and Environmental Protection Department, University of Belgrade, P.O. Box 522, Belgrade 11001, Serbia
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
| | - Sinisa Pavlovic
- Clinical Centre of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
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A Review of Radiation Protection Solutions for the Staff in the Cardiac Catheterisation Laboratory. Heart Lung Circ 2016; 25:961-7. [DOI: 10.1016/j.hlc.2016.02.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/03/2016] [Accepted: 02/23/2016] [Indexed: 12/22/2022]
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Kaljevic J, Ciraj-Bjelac O, Stankovic J, Arandjic D, Bozovic P, Antic V. OCCUPATIONAL DOSE ASSESSMENT IN INTERVENTIONAL CARDIOLOGY IN SERBIA. RADIATION PROTECTION DOSIMETRY 2016; 170:279-283. [PMID: 26464526 DOI: 10.1093/rpd/ncv439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of this work is to assess the occupational dose in interventional cardiology in a large hospital in Belgrade, Serbia. A double-dosimetry method was applied for the estimation of whole-body dose, using thermoluminescent dosemeters, calibrated in terms of the personal dose equivalent Hp(10). Besides the double-dosimetry method, eye dose was also estimated by means of measuring ambient dose equivalent, H*(10), and doses per procedure were reported. Doses were assessed for 13 physicians, 6 nurses and 10 radiographers, for 2 consequent years. The maximum annual effective dose assessed was 4.3, 2.1 and 1.3 mSv for physicians, nurses and radiographers, respectively. The maximum doses recorded by the dosemeter worn at the collar level (over the apron) were 16.8, 11.9 and 4.5 mSv, respectively. This value was used for the eye lens dose assessment. Estimated doses are in accordance with or higher than annual dose limits for the occupational exposure.
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Affiliation(s)
- J Kaljevic
- Vinca Institute of Nuclear Sciences, University of Belgrade, M. P. Alasa 12-14, Belgrade 11001, Serbia
| | - O Ciraj-Bjelac
- Vinca Institute of Nuclear Sciences, University of Belgrade, M. P. Alasa 12-14, Belgrade 11001, Serbia School of Electrical Engineering, University of Belgrade, Bulevar Kralja Aleksandra 73, Belgrade 11120, Serbia
| | - J Stankovic
- Vinca Institute of Nuclear Sciences, University of Belgrade, M. P. Alasa 12-14, Belgrade 11001, Serbia School of Electrical Engineering, University of Belgrade, Bulevar Kralja Aleksandra 73, Belgrade 11120, Serbia
| | - D Arandjic
- Vinca Institute of Nuclear Sciences, University of Belgrade, M. P. Alasa 12-14, Belgrade 11001, Serbia School of Electrical Engineering, University of Belgrade, Bulevar Kralja Aleksandra 73, Belgrade 11120, Serbia
| | - P Bozovic
- Vinca Institute of Nuclear Sciences, University of Belgrade, M. P. Alasa 12-14, Belgrade 11001, Serbia School of Electrical Engineering, University of Belgrade, Bulevar Kralja Aleksandra 73, Belgrade 11120, Serbia
| | - V Antic
- Center for Nuclear Medicine, University Clinical Centre of Serbia, Pasterova 2, Belgrade 11000, Serbia
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