Effectiveness of Breast and Eye Shielding During Cervical Spine Radiography: An Experimental Study

Radiation Shielding Effect of Surgical Loupes Compared with Lead-Lined Glasses and Plastic Face Shields

BACKGROUND

Fluoroscopy plays a crucial role in various medical procedures, especially in orthopaedic and spinal surgery. However, concerns have arisen regarding ocular radiation exposure given its association with posterior lens opacities and cataracts. Protective measures are essential to mitigate ocular radiation exposure. During spine surgery, loupes are frequently used but often lack lead lining. The purpose of the present study was to assess the effect of surgical loupes, as compared with lead glasses and plastic face shields, on ocular radiation exposure.

METHODS

Dosimeters were positioned anterior (unshielded) and posterior (shielded) to the lens of each type of eyewear: lead glasses, surgical loupes, and plastic face shields. Eyewear/dosimeters were exposed directly to the horizontal beam of a C-arm for 2 minutes of continuous fluoroscopy. This was repeated 20 times for each type of eyewear (40 total/eyewear, 120 times overall). Radiation doses were modeled with use of generalized estimating equations with a Gaussian distribution and identity link function. Separate models were employed for each outcome, including eyewear category (lead glasses, loupes, plastic shield) and dosimeter position (anterior/unshielded versus posterior/shielded).

RESULTS

Radiation dose was significantly lower in posterior compared with anterior dosimeters for lead glasses (0.00 versus 1,689.80 mRem; p < 0.001) and for loupes (20.27 versus 1,705.95 mRem; p < 0.001). The difference for plastic face shields did not reach significance (1,539.75 versus 1,701.45 mRem; p = 0.06). Lead glasses offered the most protection, followed by surgical loupes and then plastic shields, when comparing the shielded dosimeter readings (0.00 versus 20.27 versus 1,539.75; p < 0.001 for all comparisons). There was no significant difference in radiation dose for dosimeters placed anterior to lead glasses, loupes, and plastic face shields (1,689.80 versus 1,705.95 versus 1,701.45 mRem; p = 0.99).

CONCLUSIONS

Lead glasses were most effective (∼100% reduction), followed by surgical loupes (97%), whereas plastic face shields showed no significant reduction in radiation dose. Surgical loupes can substantially reduce ocular radiation exposure.

CLINICAL RELEVANCE

Surgical loupes may offer ocular radiation protection.

Attitudes and awareness regarding the European consensus statement on the use of patient contact shielding

INTRODUCTION

Lead contact shielding has been an essential element of patient radiation protection since its introduction in the early 1900s. The European Consensus Statement (ECS) on Patient Contact Shielding argues that diagnostic radiation doses have decreased to negligible levels. Given the potential for lead shielding to be misaligned or displaced, the ECS recommends refraining from its use to prevent the occurrence of repeated radiation exposures. This study aims to describe the awareness of radiographers concerning the European Consensus Statement with emphasis dedicated to shielding outside the FOV or out-of-field shielding (OFS).

METHODS

An online survey was designed to assess radiographer's awareness and attitudes to the ECS. This survey incorporated quantitative and qualitative elements. The survey was distributed to a target population of registered radiographers.

RESULTS

There were 112 participants who registered as Irish radiographers. Seventy-nine (71 %) participants knew of the European Consensus publication on patient contact shielding. Eighty-one (72.3 %) participants agreed that the risk from ionising radiation in general radiography exams is negligible. Seventy-two (63.4 %) participants felt more training should be provided on OFS. Thirty-two (28.6 %) participants agreed that some patients are more sensitive to ionising radiation, and shielding may be the safest action.

CONCLUSION

The results of this study indicate that responding radiographers are aware of the European Consensus Statement and largely agree with its recommendations to discontinue the use of shielding during low-dose X-ray examinations. Additionally, the study reveals that most radiographers do not employ lead shielding in various common clinical practice scenarios.

IMPLICATIONS FOR PRACTICE

Further investigation is required to evaluate radiographer's attitudes toward contact shielding. Future research might explore the psychological impact on patients, infection concerns, departmental protocols, and discomfort related to contact shielding.

Assessment of the Occupational Radiation Exposure of Anesthesia Staff in Interventional Cardiology

Introduction

This research seeks to evaluate the occupational radiation dose, quantified as the whole-body Annual Mean Effective Dose (AMED), received by anesthesia personnel in interventional cardiology.

Methods

Thermoluminescent dosimetry data was collected over five years (2019-2023) for a total of 175 anesthesia staff. Technologists comprised approximately 72.4% of the participants (55% male and 45% female), while consultants accounted for 27.6% (70% male and 30% female). Statistical tests, including Independent Samples T-Test and One-Way ANOVA, compared AMED across genders, job titles, and years.

Results

The study's findings on AMED across all staff from 2019 to 2023 showed marked variability in AMED. There was a significant rise in AMED from 0.72 mSv in 2019 to 0.92 mSv in 2020, then a decline to 0.82 mSv in 2021, with further decreases to 0.67 mSv in 2022 and finally to 0.65 mSv in 2023 (p < 0.001). The average AMED over the five-year span (2019-2023) was 0.76 ± 0.4 mSv. In terms of gender, the overall AMED for males was 0.73 ± 0.36 mSv and for females 0.79 ± 0.45 mSv, showing no significant statistical difference (p = 0.272). Significant differences in exposure were observed between the technologists who experienced a higher overall AMED (0.8 ± 0.43 mSv) compared to consultants (0.63 ± 0.29 mSv, p = 0.008).

Discussion

Despite these variations, AMED values remained lower than the annual occupational dose limit of 20 mSv, indicating generally low radiation exposure for anesthesia staff. This study emphasizes the importance of ongoing monitoring and enhanced protective measures to safeguard the health of medical professionals working with radiation.

The effect of breast shielding outside the field of view on breast entrance surface dose in axial X-ray examinations: a phantom study

PURPOSE

The purpose of this study was to evaluate the effect of outside-field-of-view (FOV) lead shielding on the entrance surface dose (ESD) of the breast on an anthropomorphic X-ray phantom for a variety of axial skeleton X-ray examinations.

METHODS

Using an anthropomorphic phantom and radiation dosimeter, the ESD of the breast was measured with and without outside-FOV shielding in anterior-posterior (AP) abdomen, AP cervical spine, occipitomental 30° (OM30) facial bones, AP lumbar spine, and lateral lumbar spine radiography. The effect of several exposure parameters, including a low milliampere-seconds technique, grid use, automatic exposure control use, wraparound lead (WAL) use, trolley use, and X-ray table use, on the ESD of the breast with and without outside-FOV shielding was investigated. The mean ESD (μSv) and standard deviation for each radiographic protocol were calculated. A one-tailed Student's t-test was carried out to evaluate whether ESD to the breast was reduced with the use of outside-FOV shielding.

RESULTS

A total of 920 breast ESD measurements were recorded across the different protocol parameters. The largest decrease in mean ESD of the breast with outside-FOV shielding was 0.002 μSv (P = 0.084), recorded in the AP abdomen on the table with a grid, OM30 on the table with a grid, OM30 standard protocol on the trolley, and OM30 on the trolley with WAL protocols. This decrease was found to be statistically non-significant.

CONCLUSION

This study found no significant decrease in the ESD of the breast with the use of outside-FOV shielding for the AP abdomen, AP cervical spine, OM30 facial bones, AP lumbar spine, or lateral lumbar spine radiography across a range of protocols.

Toward the strengthening of radioprotection during mammography examinations through transparent glass screens: A benchmarking between experimental and Monte Carlo simulation studies

Introduction

A lead-acrylic protective screen is suggested to reduce radiation exposure to the unexposed breast during mammography. The presence of toxic lead in its structure may harm the tissues with which it comes in contact. This study aimed to design a CdO-rich quaternary tellurite glass screen (C40) and evaluate its efficiency compared to the Lead-Acrylic protective screen.

Methods

A three-layer advanced heterogeneous breast phantom designed in MCNPX (version 2.7.0) general-purpose Monte Carlo code. Lead acrylic and C40 shielding screens were modeled in the MCNPX and installed between the right and left breast. The reliability of the absorption differences between the lead acrylic and C40 glass were assessed.

Results and discussion

The results showed that C40 protective glass screen has much superior protection properties compared to the lead acrylic protective screen. The amount of total dose absorbed in the unexposed breast for C40 was found to be much less than that for lead-based acrylic. The protection provided by the C40 glass screen is 35–38% superior to that of the Lead-Acrylic screen. The C40 offer the opportunity to avoid the toxic Pb in the structure of Lead-Acrylic material and may be utilized for mammography to offer superior radioprotection to Lead-Acrylic and significantly lower the dose amount in the unexposed breast. It can be concluded that transparent glass screens may be utilized for radiation protection purposes in critical diagnostic radiology applications through mammography.

IMPACT OF RADIATION FIELD SIZE ON ABSORBED ORGAN DOSES IN NEONATES UNDERGOING CHEST RADIOGRAPHY IN AN ANTERIOR-POSTERIOR PROJECTION: A MONTE CARLO SIMULATION STUDY

Electronic image cropping and poor collimation practices are used by some radiographers during paediatric radiography. Advantages of collimation should be investigated to disseminate convenient use among radiographers and create awareness. The aim of this study was to use Monte Carlo simulation to investigate the extent of the effect of collimation on the absorbed organ dose in neonates undergoing anterior-posterior chest examination. The minimum field size recommended by the European guidelines was calculated experimentally using a neonate phantom. A PCXMC version 2.0 simulation calculated the organ and effective doses at the minimum field size and at different field sizes. Increasing the field size by 1 cm in the head-to-feet direction increases the dose to the urinary bladder and prostate, whereas increasing the field size by 1 cm on all sides increases the dose to the upper limbs, ovaries, testicles and prostate. The use of an optimal field size reduces organ doses for neonates undergoing chest X-ray. Cropping X-ray images to reduce unnecessarily large field sizes results in unnecessary patient dosages and should be avoided. The primary beam should be restricted to expose only the area of interest, and image cropping should be discouraged.

A dual-modality quantification of scattered radiation from head to female breasts during radiological investigations in a tertiary hospital in Nigeria

Background

To quantify the amount of scattered radiation reaching the breasts during x-ray and CT investigations of the head in order to find appropriate justification for an intended change in practice involving torso shielding.

Results

Scattered radiation from the head reached the breasts in both procedures. The range and mean dose were (CR 1.02–3.61/1.94 ± 0.63 mGy) and (CT 2.20–8.50/3.74 ± 2.28 mGy). Both breasts had enormous dose difference in CR (72.3%) and CT (51.4%) which were statistically significant (p < 0.05). Correlation of dose with anthropometric parameters gave weak results.

Conclusion

Despite dose mitigation strategies such as software and hardware modifications in radiological modalities, use of anti-scatter grid, appropriate collimation and dose optimization by radiographers, scattered radiation still traveled from the head to the breasts. These were, however, significantly reduced when shielding was applied. For a dose-safe practice, radiographers are urged, in addition to current strategies at mitigating scatters, to adopt torso shielding during examinations involving contiguous anatomies to the breast.

Impact of Eye and Breast Shielding on Organ Doses During Cervical Spine Radiography: Design and Validation of MIRD Computational Phantom

Purpose: The study aimed to design and validate computational phantoms (MIRD) using the MCNPX code to assess the impact of shielding on organ doses. Method: To validate the optimized phantom, the obtained results were compared with experimental results. The validation of the optimized MIRD phantom was provided by using the results of a previous anthropomorphic phantom study. MIRD phantom was designed by considering the parameters used in the anthropomorphic phantom study. A test simulation was performed to compare the dose reduction percentages (%) between the experimental anthropomorphic phantom study and the MCNPX-MIRD phantom. The simulation was performed twice, with and without shielding materials, using the same number and locations of the detector. Results: The absorbed dose amounts were directly extracted from the required organ and tissue cell parts of output files. Dose reduction percentages between the simulation with shielding and simulation without shielding were compared. The highest dose reduction was noted in the thymus (95%) and breasts (88%). The obtained dose reduction percentages between the anthropomorphic phantom study and the MCNPX-MIRD phantom were highly consistent and correlated values with experimental anthropomorphic data. Both methods showed Relative Difference (%) ranges between 0.88 and 2.22. Moreover, the MCNPX-MIRD optimized phantom provides detailed dose analysis for target and non-target organs and can be used to assess the efficiency of shielding in radiological examination. Conclusion: Shielding breasts and eyes during cervical radiography reduced the radiation dose to many organs. The decision to not shield patients should be based on research evidence as this approach does not apply to all cases.

The radiology workforce's response to the COVID-19 pandemic in the Middle East, North Africa and India

INTRODUCTION

This study aimed to investigate the response of the radiology workforce to the impact of the coronavirus disease 2019 (COVID-19) pandemic on professional practice in India and eight other Middle Eastern and North African countries. It further investigated the levels of fear and anxiety among this workforce during the pandemic.

METHODS

A quantitative cross-sectional study was conducted using an online survey from 22 May-2 June 2020 among radiology workers employed during the COVID-19 pandemic. The survey collected information related to the following themes: (1) demographic characteristics, (2) the impact of COVID-19 on radiology practice, and (3) fear and (4) anxiety emanating from the global pandemic.

RESULTS

We received 903 responses. Fifty-eight percent had completed training on infection control required for handling COVID-19 patients. A large proportion (79.5%) of the respondents strongly agreed or agreed that personal protective equipment (PPE) was adequately available at work during the pandemic. The respondents reported experiences of work-related stress (42.9%), high COVID-19 fear score (83.3%) and anxiety (10%) during the study period.

CONCLUSION

There was a perceived workload increase in general x-ray and Computed Tomography imaging procedures because they were the key modalities for the initial and follow-up investigations of COVID-19. However, there was adequate availability of PPE during the study period. Most radiology workers were afraid of being infected with the virus. Fear was predominant among workers younger than 30 years of age and also in temporary staff. Anxiety occurred completely independent of gender, age, experience, country, place of work, and work status.

IMPLICATIONS FOR PRACTICE

It is important to provide training and regular mental health support and evaluations for healthcare professionals, including radiology workers, during similar future pandemics.