Protecting patients by training physicians in fluoroscopic radiation management

Orthopaedic surgeons' knowledge and practice of radiation safety when using fluoroscopy during procedures: A narrative review

OBJECTIVES

The fluoroscopy environment poses a potential occupational radiation exposure risk to theatre personnel. Risks can be mitigated with effective application of radiation protection knowledge and methods. This review aimed to determine the link between orthopaedic surgeon's knowledge and the use of appropriate safety methods when using fluoroscopy.

KEY FINDINGS

A keyword search of three databases discovered six articles, totalling 2209 orthopaedic surgeons, who completed surveys to assess knowledge on various aspects of radiation safety and training. Participants had varying levels of experience. Moreover 1981 participants always wore a lead gown (89 %), while only 1052 participants wore thyroid protection (47 %). 449 participants (20 %) received some form of training.

CONCLUSION

Although surveys asked a range of questions it appeared that there was low knowledge of the ALARP principles. Usage of protective equipment is a legal requirement and thus was observed throughout, however, there were a number of incidences of disregarding some protective measures. Although there appeared to be limited knowledge surrounding radiation protection measures and lack of training provided, no clear link was demonstrated between compliance with protective methods and knowledge of the risks.

IMPLICATIONS FOR PRACTICE

Formal and continuous training should be provided for the enhancement of knowledge to ensure the safety of all staff and help prevent the long-term effects of ionising radiation when using fluoroscopy.

Secretagogin as a marker to distinguish between different neuron types in human frontal and temporal cortex

The principal aim of the present work was to chemically characterize the population of neurons labeled for the calcium binding protein secretagogin (SCGN) in the human frontal and temporal cortices (Brodmann's area 10 and 21, respectively). Both cortical regions are involved in many high cognitive functions that are especially well developed (or unique) in humans, but with different functional roles. The pattern of SCGN immunostaining was rather similar in BA10 and BA21, with all the labeled neurons displaying a non-pyramidal morphology (interneurons). Although SCGN cells were present throughout all layers, they were more frequently observed in layers II, III and IV, whereas in layer I they were found only occasionally. We examined the degree of colocalization of SCGN with parvalbumin (PV) and calretinin (CR), as well as with nitric oxide synthase (nNOS; the enzyme responsible for the synthesis of nitric oxide by neurons) by triple immunostaining. We looked for possible similarities or differences in the coexpression patterns of SCGN with PV, CR and nNOS between BA10 and BA21 throughout the different cortical layers (I-VI). The percentage of colocalization was estimated by counting the number of all labeled cells through columns (1,100-1,400 μm wide) across the entire thickness of the cortex (from the pial surface to the white matter) in 50 μm-thick sections. Several hundred neurons were examined in both cortical regions. We found that SCGN cells include multiple neurochemical subtypes, whose abundance varies according to the cortical area and layer. The present results further highlight the regional specialization of cortical neurons and underline the importance of performing additional experiments to characterize the subpopulation of SCGN cells in the human cerebral cortex in greater detail.

Medical doctors' awareness of radiation exposure in diagnostic radiology investigations in a South African academic institution

Background

Diagnostic investigations using radiation have become a critical feature of medical practice in recent times. However, the possibility of doctors’ underestimation of risks of over-exposure of patients to diagnostic radiation still warrants further evaluation.

Objectives

To investigate doctors’ awareness of diagnostic radiation exposure at Dr George Mukhari Academic Hospital, South Africa.

Methods

This was a cross-sectional, analytical investigation of the awareness of doctors about radiation exposure in diagnostic radiology investigations. A cluster sampling technique was employed to recruit 217 participants. Consent and approval of the participants were sought and obtained before questionnaire administration during departmental meetings between October 2017 and March 2018.

Results

Of the participants, 80% had no formal training on radiation exposure and 33.8% of them correctly estimated natural background radiation. Correct estimates of the effective dose from a single-view abdominal X-ray (AXR) were expressed by 7.5%, quantity of radiation of a single-phase computed tomography (CT) abdomen by 30.3% and dosage from a two-view unilateral mammogram by 29.1% of the participants. More than 75% of participants agreed that children are more sensitive to radiation, but only 10.5% suggested medical termination of pregnancy for a woman who had CT abdomen and pelvis with contrast. Dosage and risk of inducing fatal cancer from common but more complex imaging procedures were poorly understood. Only the doctors of the radiology department showed a statistically significant (p < 0.0001) association with regards to their radiation awareness.

Conclusion

Because of the high rate of poor awareness of radiation risks observed in this study, it is important to initiate, early in the medical curriculum for medical students, the need for a rotation in the Department of Radiology, similar to such rotations in other medical specialties.

Differential expression of secretagogin immunostaining in the hippocampal formation and the entorhinal and perirhinal cortices of humans, rats, and mice

Secretagogin (SCGN) is a recently discovered calcium-binding protein belonging to the group of EF-hand calcium-binding proteins. SCGN immunostaining has been described in various regions of the human, rat and mouse brain. In these studies, it has been reported that, in general, the patterns of SCGN staining differ between rodents and human brains. These differences have been interpreted as uncovering phylogenetic differences in SCGN expression. Nevertheless, an important aspect that is not usually taken into account is that different methods are used for obtaining and processing brain tissue coming from humans and experimental animals. This is a critical issue since it has been shown that post-mortem time delay and the method of fixation (i.e., perfused vs. nonperfused brains) may influence the results of the immunostaining. Thus, it is not clear whether differences found in comparative studies with the human brain are simply due to technical factors or species-specific differences. In the present study, we analyzed the pattern of SCGN immunostaining in the adult human hippocampal formation (DG, CA1, CA2, CA3, subiculum, presubiculum, and parasubiculum) as well as in the entorhinal and perirhinal cortices. This pattern of immunostaining was compared with rat and mouse that were fixed either by perfusion or immersion and with different post-mortem time delays (up to 5 hr) to mimic the way the human brain tissue is usually processed. We found a number of clear similarities and differences in the pattern of labeling among the human, rat, and mouse in these brain regions as well as between the different brain regions examined within each species. These differences were not due to the fixation.

Radiology Trainee vs Faculty Radiologist Fluoroscopy Time for Imaging-Guided Procedures: A Retrospective Study of 17,966 Reports Over a 5.5-Year Period

To evaluate differences in fluoroscopy time (FT) for common vascular access and gastrointestinal procedures performed by radiology trainees vs faculty radiologists. Report information was extracted for all 17,966 index fluoroscopy services performed by trainees or faculty, or both from 2 university hospitals over 66 months. Various vascular access procedures (eg, peripherally inserted central catheters [PICCs] and ports) and gastrointestinal fluoroscopy procedures (eg, upper gastrointestinal and contrast enema studies) were specifically targeted. Statistical analysis was performed. FT was recorded in 17,549 of 17,966 reports (98%) The 1393 procedures performed by nonphysician providers or transitional year interns were excluded. Residents, fellows, and faculty were primary operators in 5066, 6489, and 4601 procedures, respectively. Average FT (in seconds) for resident and fellow services, respectively, was less than that of faculty only for PICCs (75 and 101 vs 148, P < 0.01). For all other procedures, average FT of trainee services was greater than that for faculty. This was statistically significant (P < 0.05) for fellows vs faculty port placement (121 vs 87), resident vs faculty small bowel series (130 vs 96), and both resident and fellow vs faculty esophagram procedures (143 and 183 vs 126 ). FT for residents was significantly less than that for fellows only for PICCs (75 vs 101, P < 0.01). For most, but not all, fluoroscopy procedures commonly performed by radiology trainees, FT is greater than that for procedures performed by faculty radiologists. Better awareness and understanding of such differences may aid training programs in developing benchmarks, protocols, and focused teaching in the safe use of fluoroscopy for patients and operators.

Interventional Radiologists: a Necessary Evaluation of Technical, Protective and Technological Operation

BACKGROUND AND PURPOSE

To present the results of occupational radiation doses investigated through a Hospitals of Mazandaran Medical Science Universities in north of Iran. Radiology unit has an important role in diagnosis of many disorders with providing suitable and high quality pictures. A good picture was provided using correct technical criteria and suitable circumstance of patient. Finally, operation and knowledge of radiology personnel directly has a primary role in determining quality of radiography.

MATERIALS AND METHODS

This study was done in order to determine personnel operation in the units of hospitals radiologist related to University of Mazandaran Medical Science. Data collection tools are made of a researcher check list that was used after obtaining suitable letter and validity indexes. All of the 73 personnel of radiology unit related to Mazandaran Medical Science were studied. 35 operations (in technical, protective and technological fields) of any personnel, in three distinct shifts were observed and recorded. All of them were tested regarding these three fields with a total of 40 questions.

RESULTS

The total scores received from personnel in technical part in the morning, evening and night shift were 66.4, 53.9 and 60.2 percent respectively. Received scores from personnel in the protective fields were 68.1, 59.5 and 60.2 percent. Moreover, received scores from personnel in the technological operation fields were 47.8, 39.95 and 43.65 percent respectively. Comparison of these three scores in technical, protective and technological operation fields showed a meaningful difference (p<0.05).

CONCLUSION

The overall quality of personnel operations were nearly desirable and in need of continuous education, supervision and evaluation. Emphasizing protection to beams, accessibility of necessary tools, continuous supervision regarding the usage of these equipments and respecting the other security points have an important role in decreasing patients absorbed doses.

Reported radiation overexposure accidents worldwide, 1980-2013: a systematic review

BACKGROUND

Radiation overexposure accidents are rare but can have severe long-term health consequences. Although underreporting can be an issue, some extensive literature reviews of reported radiation overexposures have been performed and constitute a sound basis for conclusions on general trends. Building further on this work, we performed a systematic review that completes previous reviews and provides new information on characteristics and trends of reported radiation accidents.

METHODS

We searched publications and reports from MEDLINE, EMBASE, the International Atomic Energy Agency, the International Radiation Protection Association, the United Nations Scientific Committee on the Effects of Atomic Radiation, the United States Nuclear Regulatory Commission, and the Radiation Emergency Assistance Center/Training Site radiation accident registry over 1980-2013. We retrieved the reported overexposure cases, systematically extracted selected information, and performed a descriptive analysis.

RESULTS

297 out of 5189 publications and reports and 194 records from the REAC/TS registry met our eligibility criteria. From these, 634 reported radiation accidents were retrieved, involving 2390 overexposed people, of whom 190 died from their overexposure. The number of reported cases has decreased for all types of radiation use, but the medical one. 64% of retrieved overexposure cases occurred with the use of radiation therapy and fluoroscopy. Additionally, the types of reported accidents differed significantly across regions.

CONCLUSIONS

This review provides an updated and broader view of reported radiation overexposures. It suggests an overall decline in reported radiation overexposures over 1980-2013. The greatest share of reported overexposures occurred in the medical fields using radiation therapy and fluoroscopy; this larger number of reported overexposures accidents indicates the potential need for enhanced quality assurance programs. Our data also highlights variations in characteristics of reported accidents by region. The main limitation of this study is the likely underreporting of radiation overexposures. Ensuring a comprehensive monitoring and reporting of radiation overexposures is paramount to inform and tailor prevention interventions to local needs.

Implementation of a competency check-off in diagnostic fluoroscopy for radiology trainees: impact on reducing radiation for three common fluoroscopic exams in children

BACKGROUND

Fluoroscopy is an important tool for diagnosis in the pediatric population, but it carries the risk of radiation exposure. Because radiology resident education and experience in the use of fluoroscopy equipment in children vary, we implemented an intervention to standardize fluoroscopy training.

OBJECTIVE

The purpose of this study is to determine the impact of implementing a fluoroscopy competency check-off for radiology resident trainees aimed at decreasing radiation exposure in three common pediatric fluoroscopic studies.

MATERIALS AND METHODS

A fluoroscopy competency check-off form was developed for radiology resident trainees performing pediatric procedures. Techniques used to limit radiation exposure for common pediatric radiologic studies were reviewed as part of the check-off process. Pediatric radiologists supervised each trainee until they demonstrated competence to independently perform three specified procedures. Radiation dose was recorded for the three procedures, upper GI (UGI), voiding cystourethrogram (VCUG) and oropharyngeal (OPM) exams, over 6 months preceding and 6 months following implementation of the competency check-off. The mean cumulative dose for each procedure was compared before and after implementation of competency check-off using a Kruskal-Wallis test.

RESULTS

During the 12-month study period doses from 909 fluoroscopic procedures were recorded. In the 6 months preceding competency check-off implementation, procedures were performed by 24 radiology resident trainees including 171 UGI, 176 VCUG and 171 OPM exams. In the 6 months following competency check-off, 23 trainees performed 114 UGI, 145 VCUG and 132 OPM exams. After competency check-off implementation, a statistically significant reduction in average radiation dose was found for all three studies (P < 0.001). Median cumulative doses (mGy) were decreased by 33%, 36% and 13% for UGIs, VCUGs and OPMs, respectively.

CONCLUSION

Implementation of a competency check-off for radiology resident trainees can reduce average radiation doses in pediatric patients undergoing three common fluoroscopic studies.

Analysis of dose measurement other than the radiation protection during the radiographic examination

OBJECTIVES

The study measured the dose on body regions that were not shielded to protect from radiation exposure during the general procedure, with the goal of providing basic radiation dose data for radiological technologists who perform the radiographic examination.

MATERIALS AND METHODS

Shooting parts with the phantom were similar to human tissues using general shooting equipment in the general examination room. The scattered rays were measured with the ion chamber. The hand received the highest average radiation dose and the kidney the lowest. The same pattern was evident for the average equivalent dose. The available daily shooting was highest in the anterior/posterior skull, followed by the posterior/anterior chest, abdomen, anterior/posterior spine and extremities.

RESULTS

The daily available numbers for the eye were lower than other body regions (6-times, 4-times, 26-times, 3-times and 121-times) and the numbers on the foot were higher than for other regions (73-times, 48-times, 263-times, 39-times and 702-times).

CONCLUSIONS

Radiation should be thoroughly blocked by the apron to protect the radiological technologist from the radiation exposure, the proper distance from the irradiation source should be maintained exposure is inevitable and the exposure dose and working environment shall be regularly assessed to ensure minimal exposure dose of the radiological technologist in accordance with the International Commission on Radiological Protection recommendation.

New automated fluoroscopic systems for pediatric applications

Pediatric patients are at higher risk to the adverse effects from exposure to ionizing radiation than adults. The smaller sizes of the anatomy and the reduced X-ray attenuation of the tissues provide special challenges. The goal of this effort is to investigate strategies for pediatric fluoroscopy in order to minimize the radiation exposure to these individuals, while maintaining effective diagnostic image quality. Modern fluoroscopy systems are often entirely automated and computer controlled. In this paper, various selectable and automated modes are examined to determine the influence of the fluoroscopy parameters upon the patient radiation exposures and image quality. These parameters include variable X-ray beam filters, automatic brightness control programs, starting kilovolt peak levels, fluoroscopic pulse rates, and other factors. Typical values of radiation exposure rates have been measured for a range of phantom thicknesses from 5 cm to 20 cm of acrylic. Other factors that have been assessed include spatial resolution, low contrast discrimination, and temporal resolution. The selection menu for various procedures is based upon the examination type, anatomical region, and patient size. For pediatric patients, the automated system can employ additional filtration, special automatic brightness control curves, pulsed fluoroscopy, and other features to reduce the patient radiation exposures without significantly compromising the image quality. The benefits gained from an optimal selection of automated programs and settings for fluoroscopy include ease of operation, better image quality, and lower patient radiation exposures.