1
|
Naidu J, Botchu R, Iyengar KP. Safe usage of Mini 'C'-arm in operating room environment: Implications for clinical practice. J Perioper Pract 2024:17504589241228138. [PMID: 38462719 DOI: 10.1177/17504589241228138] [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: 03/12/2024]
Abstract
BACKGROUND Mini 'C'-arm machine is an advanced medical imaging device used primarily for intraoperative imaging during surgical, orthopaedic and emergency care procedures. Since the technology is based on ionising radiation, safe usage of Mini 'C'-arm machine is mandatory to protect patients and operating personnel. OBJECTIVE The main objective is to describe the various components related to patients, operator and equipment to ensure safe usage of Mini 'C'-arm machine. A comprehensive search strategy using the PEO (Population, Exposure, Outcome) framework was conducted using Embase, PubMed, Google Scholar and ResearchGate databases to identify suitable literature. The keywords used for the search included 'Fluoroscopy', 'Ionising Radiation' and 'surgical safety'. KEY FINDINGS Safe usage of Mini 'C'-arm equipment involves components of operator training, operator safety, patient safety, radiation dose, operating room logistics, handling of images and auditing of Mini 'C'-arm use. CONCLUSION Mini 'C'-arm provides an invaluable, portable imaging tool in a spectrum of general surgical and orthopaedic interventional procedures. However, safe usage of Mini 'C'-arm machine requires a multifaceted approach including operator responsibility and safety, patient protection, equipment maintenance, radiation dose awareness, documentation and sound reporting mechanisms.
Collapse
Affiliation(s)
- Jatin Naidu
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | | | | |
Collapse
|
2
|
Rehm A, Linardatou Novak P, Newton A, Ngu AWT, Clegg R, Ashby E. Does radiation exposure during pediatric supracondylar humeral fracture surgery change according to the C-arm position? A comparison of two different techniques. Injury 2024; 55:111354. [PMID: 38246014 DOI: 10.1016/j.injury.2024.111354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/14/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Andreas Rehm
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
| | - Pinelopi Linardatou Novak
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ayla Newton
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Albert W T Ngu
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Rachael Clegg
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Elizabeth Ashby
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| |
Collapse
|
3
|
Moradi F, Jalili M, Saraee KRE, Abdi MR, Rashid HAA. Radiation shielding assessment for interventional radiology personnel: Geant4 dosimetry of lead-free compositions. Biomed Phys Eng Express 2024; 10:025029. [PMID: 38320327 DOI: 10.1088/2057-1976/ad26d5] [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: 10/17/2023] [Accepted: 02/06/2024] [Indexed: 02/08/2024]
Abstract
The inherent biological hazards associated with ionizing radiation necessitate the implementation of effective shielding measures, particularly in medical applications. Interventional radiology, in particular, poses a unique challenge as it often exposes medical personnel to prolonged periods of high x-ray doses. Historically, lead and lead-based compounds have been the primary materials employed for shielding against photons. However, the drawbacks of lead, including its substantial weight causing personnel's inflexibility and its toxicity, have raised concerns regarding its long-term impact on both human health and the environment. Barium tantalate has emerged as a promising alternative, due to its unique attenuation properties against low-energy x-rays, specifically targeting the weak absorption area of lead. In the present study, we employ the Geant4 Monte Carlo simulation tool to investigate various formulations of barium tantalate doped with rare earth elements. The aim is to identify the optimal composition for shielding x-rays in the context of interventional radiology. To achieve this, we employ a reference x-ray spectrum typical of interventional radiology procedures, with energies extending up to 90 keV, within a carefully designed simulation setup. Our primary performance indicator is the reduction in air kerma transmission. Furthermore, we assess the absorbed doses to critical organs at risk within a standard human body phantom protected by the shield. Our results demonstrate that specific concentrations of the examined rare earth impurities can enhance the shielding performance of barium tantalate. To mitigate x-ray exposure in interventional radiology, our analysis reveals that the most effective shielding performance is achieved when using barium tantalate compositions containing 15% Erbium or 10% Samarium by weight. These findings suggest the possibility of developing lead-free shielding solutions or apron for interventional radiology personnel, offering a remarkable reduction in weight (exceeding 30%) while maintaining shielding performance at levels comparable to traditional lead-based materials.
Collapse
Affiliation(s)
- F Moradi
- Faculty of Engineering, Multimedia University, Cyberjaya, Malaysia
| | - M Jalili
- Faculty of Physics, University of Isfahan, Isfahan, Iran
| | | | - M R Abdi
- Faculty of Physics, University of Isfahan, Isfahan, Iran
| | - H A Abdul Rashid
- Faculty of Engineering, Multimedia University, Cyberjaya, Malaysia
| |
Collapse
|
4
|
Thibault T, Gurung M, Leuvrey C, Boos A, Ronot P, El Masoudi I, Hoerner P, Bellemin-Laponnaz S. Lead-containing radiation-attenuating sterile gloves in simulated use: Lead transfer to sweat as an unknown risk to users. Radiography (Lond) 2024; 30:159-162. [PMID: 38035427 DOI: 10.1016/j.radi.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Lead protective gloves are widely used to attenuate scattered radiations during fluoroscopic-guided medical procedures, thereby reducing hand exposure to radiation. AIMS To determine whether lead-containing gloves present a risk of metal leaching onto the operator's skin, particularly due to the presence of sweat. METHODS Artificial sweat of varying acidity was introduced into two types of commercial gloves containing lead. The level of lead in the sweat was then assessed after different exposure times. Electron microscopy was used to observe the morphology of the glove layers. RESULTS Lead was detected in artificial sweat during each contact test on two different types of gloves. The concentration of lead increased with the acidity of the sweat, and the contact time. Gloves with a protective lining transferred less lead into sweat, but it was still present at significant levels. (i.e. few milligrams of lead per glove after one hour contact). CONCLUSIONS Fluoroscopy operators should be aware of the risk of leaching of lead ions when using lead gloves under intensive conditions, although the potential harmfulness of lead ions leached into the glove remains essentially unknown.
Collapse
Affiliation(s)
- T Thibault
- Institut de Physique et Chimie des Matériaux de Strasbourg (IPCMS) UMR7504, Université de Strasbourg & CNRS, 23 rue du Loess, F-67083 Strasbourg, France
| | - M Gurung
- Institut de Physique et Chimie des Matériaux de Strasbourg (IPCMS) UMR7504, Université de Strasbourg & CNRS, 23 rue du Loess, F-67083 Strasbourg, France
| | - C Leuvrey
- Institut de Physique et Chimie des Matériaux de Strasbourg (IPCMS) UMR7504, Université de Strasbourg & CNRS, 23 rue du Loess, F-67083 Strasbourg, France
| | - A Boos
- Université de Strasbourg, CNRS, IPHC UMR 7178, F-67000 Strasbourg, France
| | - P Ronot
- Université de Strasbourg, CNRS, IPHC UMR 7178, F-67000 Strasbourg, France
| | - I El Masoudi
- Université de Strasbourg, CNRS, IPHC UMR 7178, F-67000 Strasbourg, France
| | - P Hoerner
- IneoTech Sdn Bhd, PT5825, Jalan Cassia Selatan 3/11, Taman Perindustrian Batu Kawan, 14110 Simpang Ampat, Penang, Malaysia
| | - S Bellemin-Laponnaz
- Institut de Physique et Chimie des Matériaux de Strasbourg (IPCMS) UMR7504, Université de Strasbourg & CNRS, 23 rue du Loess, F-67083 Strasbourg, France.
| |
Collapse
|
5
|
Viniston J SB, Bhushan S, Saha S. Assessment and evaluation of work-related musculoskeletal disorders among nuclear medicine professionals in India: A cross-sectional study. Work 2024; 78:207-215. [PMID: 38701126 DOI: 10.3233/wor-230693] [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: 05/05/2024] Open
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) are a severe occupational health issue among medical radiation practitioners. It is mostly linked to personal protective wear, working posture, tools employed and ergonomics. OBJECTIVE To assess and evaluate the musculoskeletal disorders among nuclear medicine professionals (NMP) in India. METHODS An online survey was distributed to 455 NMP throughout India between November 2021 and March 2022 covering the demographic characteristics and questions for evaluation of musculoskeletal symptoms using the Standardized Nordic Musculoskeletal Questionnaire (NMQ). Participants with any pre-existing musculoskeletal disorder or trauma were excluded. Descriptive statistics summarized the data from the demographics, discomfort, aches and work-related musculoskeletal injuries. Chi-square test was used to examine the association between the obtained values. RESULTS 91 out of 124 respondents were included based on the inclusion and exclusion criteria. Results shows that there is a significant association between the height of the individual and neck pain, body mass index and elbows pain, age and low back pain, experience in the current work and upper back pain, the weight of the individual and knee pain, use of mobile lead screens and shoulder pain, use of gonad shield, trouble in the ankles and use of lead screens, and QC phantoms for gamma camera / PET and wrists/hands pain. CONCLUSION Work-related musculoskeletal disorders among NMP are resulting from factors of individual demographic variables (such as age, height, weight, body mass index), years of experience at the current workplace and of using instruments in their work area.
Collapse
Affiliation(s)
- Sam Blessing Viniston J
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Shivanand Bhushan
- Department of Nuclear Medicine, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Shovan Saha
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
6
|
Kim CL, Jeong HC, Kim JH. Radiation shielding effects of lead equivalent thickness of a radiation protective apron and distance during C-arm fluoroscopy-guided pain interventions: A randomized trial. Medicine (Baltimore) 2023; 102:e36447. [PMID: 38050291 PMCID: PMC10695529 DOI: 10.1097/md.0000000000036447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The present study aimed to evaluate the degree of radiation shielding effects according to lead equivalent thickness and distance during C-arm fluoroscopy-guided lumbar interventions. METHODS The exposure time and air kerma were recorded using a fluoroscope. The effective dose (ED) was measured with and without the shielding material of the lead apron using 2 dosimeters at 2 positions. According to the lead equivalent thickness of the shielding material and distance from the side of the table, the groups were divided into 4 groups: group 1 (lead equivalent thickness 0.6 mm, distance 0 cm), group 2 (lead equivalent thickness 0.6 mm, distance 5 cm), group 3 (lead equivalent thickness 0.3 mm, distance 0 cm), and group 4 (lead equivalent thickness 0.3 mm, distance 5 cm). Mean differences such as air kerma, exposure time, ED, and ratio of EDs (ED with protector/ED without protector) were analyzed. RESULTS A total of 400 cases (100 cases in each group) were collected. The ratio of ED was significantly lower in groups 1 and 2 (9.18 ± 2.78% and 9.56 ± 3.29%, respectively) when compared to that of groups 3 and 4 (21.93 ± 4.19% and 21.53 ± 4.30%, respectively). The reductive effect of a 5-cm distance was 33.3% to 36.1% when comparing the ED between groups 1 and 2 and groups 3 and 4. CONCLUSIONS The 0.3- and 0.6-mm lead equivalent thickness protectors have a radiation attenuation effect of 78.1% to 78.5% and 90.4% to 90.8%, respectively. The 5-cm distance from the side of the table reduces radiation exposure by 33.3% to 36.1%.
Collapse
Affiliation(s)
- Cho Long Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
- Department of Clinical Science, Konkuk University Graduate School of Medicine, Konkuk University School Seoul, Seoul, Republic of Korea
| | - Hae Chang Jeong
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
7
|
Duggan C, Chopra R, Taylor C. Decreasing exposure to thyroid radiation in an orthopaedic theatre setting: an educational intervention. Acta Orthop Belg 2023; 89:679-683. [PMID: 38205760 DOI: 10.52628/89.4.10174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
The use of personal protective equipment (PPE) can significantly reduce staff exposure to harmful radiation and infection. Fluoroscopic procedures in orthopaedic theatre can generate high levels of radiation and good adherence to PPE use is essential to reduce long term cancer risk, including thyroid cancer. To assess baseline compliance with PPE, availability of PPE in theatre and carry out an intervention to promote greater use of PPE. This was a closed-loop interventional study set in a level 1 trauma centre and an elective/rehabilitation unit. Data were collected in 40 cases pre and post-intervention from 26th May-7th July 2017. All health care practitioners present at fluoroscopic screening were observed. PPE availability was audited daily. A questionnaire was used to assess surgical and nursing knowledge/practices regarding radiation/infection safety. An educational presentation was delivered to the groups at highest risk of exposure. 39/41 questionnaires were completed (29 surgeons, 10 nurses). 41% of respondents had taken a radiation training course or felt they had adequate training. There was a significant increase in the use of thyroid guards by surgeons 13/115 (11.3%) pre-intervention to 54/117 (46.2%) post-intervention (p<0.001) and radiographers (p=0.019) post-intervention. Logistic regression showed an 89.7% increased likelihood of thyroid guard use post-intervention and a 12.7% increased chance of thyroid guard use for each extra guard available. A short educational, easily replicated session, significantly improved compliance with thyroid guards by orthopaedic surgeons.
Collapse
|
8
|
Bafna KR, Kalra-Lall A, Gurajala RK, Karuppasamy K. Computed Tomography-Guided Pericardiocentesis: A Practical Guide. Curr Cardiol Rep 2023; 25:1433-1441. [PMID: 37856032 DOI: 10.1007/s11886-023-01965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article is to serve as a practical guide to computed tomography (CT)-guided pericardiocentesis and to discuss the role of this approach in current clinical practice. An overview of indications, technique, advantages, and limitations specific to CT-guided pericardiocentesis will be provided. The reader will have an enhanced understanding of the use of this imaging modality to guide pericardial drainage. RECENT FINDINGS Use of CT guidance to drain the pericardial space is safe, especially when adequate echocardiographic evaluation is precluded and when echocardiography-guided pericardiocentesis is deemed unsafe and or not feasible. Our review and experience indicate that CT-guided pericardiocentesis is technically successful in more than 94% of patients, with a low risk (<1%) of significant complications. CT-guided pericardiocentesis is therefore a viable alternative when echocardiographic guidance is insufficient and can obviate the need for surgery in most patients.
Collapse
Affiliation(s)
- Kunaal R Bafna
- Section of Interventional Radiology, Cleveland Clinic 9500 Euclid Avenue, L10, Cleveland, OH, 44195, USA
| | - Anouva Kalra-Lall
- Section of Interventional Radiology, Cleveland Clinic 9500 Euclid Avenue, L10, Cleveland, OH, 44195, USA
| | - Ram Kishore Gurajala
- Section of Interventional Radiology, Cleveland Clinic 9500 Euclid Avenue, L10, Cleveland, OH, 44195, USA
| | - Karunakaravel Karuppasamy
- Section of Interventional Radiology, Cleveland Clinic 9500 Euclid Avenue, L10, Cleveland, OH, 44195, USA.
| |
Collapse
|
9
|
Khafaji M, Ashour TM, Mozahim NF, Tashkandi A, Alqarni B, Malaikah AA, Bagabas AK, Alwasabi AA, Albahiti SK. Measurement of Occupational Eye and Thyroid Radiation Doses in Pediatric Interventional Cardiologists at a Tertiary Hospital. Cureus 2023; 15:e44894. [PMID: 37814769 PMCID: PMC10560443 DOI: 10.7759/cureus.44894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
Background Advances in imaging techniques have led to increased utilization of imaging devices in catheterization laboratories. Invasive surgical procedures for cardiac disorders have been largely replaced by fluoroscopic cardiac catheterization. With this increase, concerns and risks associated with exposure to ionizing radiation among interventional cardiologists are growing. This study aims to measure and compare the occupational doses to the eye lens and thyroid of pediatric interventional cardiologists during different procedures in the catheterization laboratory and its significance. Methodology In this study, cardiologists wore bandanas with attached dosimeters to measure the absorbed doses to the eyes and thyroid gland. The dosimeters were collected for reading. The procedure types were also collected. In addition, the total fluoroscopy time and tube voltage of the biplane machine were measured. SPSS version 23 (IBM Corp., Armonk, NY, USA) was used to analyze the data. The characteristics of the study sample were described using simple counts and percentages, whereas means and standard deviations were used for continuous variables. Statistical significance was set at p-values <0.05. Results A total of 93 procedures were evaluated. The mean absorbed doses for all 93 procedures in both eyes and thyroid were 0.09 mGy and 0.08 mGy, respectively. A significant difference was found between the left and right eye measurements (p = 0.034), with higher doses administered to the left eye. However, no significant difference was observed between the right and left thyroid doses (p = 0.281). Significant correlations were found between the eye and thyroid doses and the procedure type (p = 0.02 and p = 0.009, respectively). Conclusions A significant amount of radiation was measured in the measurements of both organs. In addition, radiation dose measurements varied between different types of procedures. Our current results indicate the importance and necessity of applying the radiation protection concept of dose optimization.
Collapse
Affiliation(s)
- Mawya Khafaji
- Radiology Department, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Tariq M Ashour
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Naif F Mozahim
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | - Basil Alqarni
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | | | | | - Sarah K Albahiti
- Radiology Department, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| |
Collapse
|
10
|
Qazi E, Ursani A, Patel N, Kennedy SA, Bassett P, Jaberi A, Rajan D, Tan KT, Mafeld S. Operator Intracranial Dose Protection During Fluoroscopic-Guided Interventions. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03458-2. [PMID: 37280331 DOI: 10.1007/s00270-023-03458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/27/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE We utilized an anthropomorphic model made with a human skull to determine how different personal protective equipment influence operator intracranial radiation absorbed dose. MATERIALS AND METHODS A custom anthropomorphic phantom made with a human skull coated with polyurethane rubber, mimicking superficial tissues, and was mounted onto a plastic thorax. To simulate scatter, an acrylic plastic scatter phantom was placed onto the fluoroscopic table with a 1.5 mm lead apron on top. Two Radcal radiation detectors were utilized; one inside of the skull and a second outside. Fluoroscopic exposures were performed with and without radiation protective equipment in AP, 45-degree RAO, and 45-degree LAO projections. RESULTS The skull and soft tissues reduce intracranial radiation by 76% when compared to radiation outside the skull. LAO (308.95 μSv/min) and RAO projections (96.47μSv/min) result in significantly higher radiation exposure to the primary operator when compared to an AP projection (54 μSv/min). All tested radiation protection equipment demonstrated various reduction in intracranial radiation when compared to no protection. The hood (68% reduction in AP, 91% LAO, and 43% in RAO), full cover (53% reduction in AP, 76% in LAO, and 54% in RAO), and open top with ear coverage (43% reduction in AP, 77% reduction in LAO, and 22% in RAO) demonstrated the most reduction in intracranial radiation when compared to the control. CONCLUSION All tested equipment provided various degrees of additional intracranial protection. The skull and soft tissues attenuate a portion of intracranial radiation.
Collapse
Affiliation(s)
- Emmad Qazi
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada.
| | - Ali Ursani
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Neeral Patel
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Sean A Kennedy
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Paul Bassett
- Statsconsultancy Ltd. Freelance Statistical Consultancy, Amersham, Bucks, UK
| | - Arash Jaberi
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Dheeraj Rajan
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Kong Teng Tan
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Sebastian Mafeld
- Department of Vascular and Interventional Radiology, Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| |
Collapse
|
11
|
Sattar Y, Sengodan PM, Cheema MS, Javed N, Ashraf S, Fakhra S, Alharbi A, Syed M, Alam M, Elgendy IY, Haleem A, Kawsara A, Alraies MC, Daggubati R. Lead Cap Use in Interventional Cardiology: Time to Protect Our Head in the Cardiac Catheterisation Laboratory? Interv Cardiol 2023; 18:e18. [PMID: 37435603 PMCID: PMC10331561 DOI: 10.15420/icr.2023.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/27/2023] [Indexed: 07/13/2023] Open
Abstract
Background: Radiation exposure is an occupational hazard for interventional cardiologists and cardiac catheterisation laboratory staff that can manifest with serious long-term health consequences. Personal protective equipment, including lead jackets and glasses, is common, but the use of radiation protective lead caps is inconsistent. Methods: A systematic review qualitative assessment of five observational studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines protocol was performed. Results: It was concluded that lead caps significantly reduce radiation exposure to the head, even when a ceiling-mounted lead shield was present. Conclusion: Although newer protective systems are being studied and introduced, tools, such as lead caps, need to be strongly considered and employed in the catheterisation laboratory as mainstay personal protective equipment.
Collapse
Affiliation(s)
- Yasar Sattar
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | | | - Mustafa Sajjad Cheema
- Department of Medicine, CMH Lahore Medical College and Institute of DentistryLahore, Punjab, Pakistan
| | - Nismat Javed
- Department of Internal Medicine, BronxCare Health SystemNew York, NY, US
| | - Shoaib Ashraf
- Department of Cardiology, Hackensack University Medical CentreNJ, US
| | - Sadaf Fakhra
- Department of Internal Medicine, University of Nevada, Kirk Kerkorian School of MedicineLas Vegas, NV, US
| | - Anas Alharbi
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | - Moinuddin Syed
- Department of Cardiology, Boston UniversityBoston, MA, US
| | - Mahboob Alam
- Department of Cardiology, Baylor College of MedicineHouston, TX, US
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of KentuckyLexington, KT, US
| | - Affan Haleem
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | - Akram Kawsara
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| | - M Chadi Alraies
- Detroit Medical Centre, Wayne State UniversityDetroit, MI, US
| | - Ramesh Daggubati
- Department of Cardiology, West Virginia UniversityMorgantown, WV, US
| |
Collapse
|
12
|
Bahrami Asl F, Islami-seginsara M, Ebrahimi Kalan M, Hemmatjo R, Hesam M, Shafiei-Irannejad V. Exposure to ionizing radiations and changes in blood cells and interleukin-6 in radiation workers. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:35757-35768. [PMID: 36538225 PMCID: PMC9764314 DOI: 10.1007/s11356-022-24652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Long-term exposure to ionizing radiation (IR) can cause dire health consequences even less than the dose limits. Previous biomonitoring studies have focused more on complete blood counts (CBCs), with non-coherent results. In this study, we aimed to investigate the association between exposure to IR and cytokine interleukin-6 (IL-6) along with hematological parameters in Tabriz megacity's radiation workers. In this hospital-based study, blood samples were taken from 33 radiation workers (exposed group) and 34 non-radiation workers (control group) in 4 hospitals. Absorbed radiation dose was measured by a personal film badge dosimeter in radiation workers. The studied biomarkers and all of the selected covariates were measured and analyzed using adjusted multiple linear regression models. The exposed doses for all radiation workers were under the dose limits (overall mean = 1.18 mSv/year). However, there was a significant association between exposure to ionizing radiation and IL-6 (49.78 vs 36.17; t = 2.4; p = 0.02) and eosinophils (0.17 vs 0.14; t = 2.02; p = 0.049). The difference between the mean of the other biomarkers in radiation workers was not statistically significant compared to the control group. This study demonstrated that long-term exposure to ionizing radiation, even under the dose limits, is related to a significantly increased level of some blood biomarkers (Il-6 and eosinophil) that, in turn, can cause subsequent health effects such as cancer.
Collapse
Affiliation(s)
- Farshad Bahrami Asl
- Department of Environmental Health Engineering, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Mahdi Islami-seginsara
- Department of Environmental Health Engineering, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Ebrahimi Kalan
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Rasoul Hemmatjo
- Department of Occupational Health, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Mousa Hesam
- Radiation Health Unit, Department of Environmental Health Engineering, Health Vice-Chancellor, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Shafiei-Irannejad
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
13
|
Johary YH, Albarakati S, AlSohaim A, Aamry A, Aamri H, Tamam N, Salah H, Tahir D, Alkhorayef M, Sulieman A, Bradley D. Evaluation occupationally radiation exposure during diagnostic imaging examinations. Appl Radiat Isot 2023; 193:110648. [PMID: 36669265 DOI: 10.1016/j.apradiso.2023.110648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 12/17/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
Occupational radiation exposure can occur due to various human activities, including the use of radiation in medicine. Occupationally exposed personnel surpassing 7.4 millions, and respresent the biggest single group of employees who are exposed to artificial radiation sources at work. This study compares the occupational radiation dose levels for 145 workers in four different hospitals located in the Aseer region in Saudi Arabia. The occupational exposure was quantified using thermoluminescence dosimeters (TLD-100). The levels of annual occupational exposures in targeted hospitals were calculated and compared with the levels of the international atomic energy agency (IAEA) Safety Standards. An average yearly cumulative dose for the two consecutive years. The average, highest and lowest resulted occupational doses under examination in this work is 1.42, 3.9 mSv and 0.72 for workers in various diagnostic radiology procedures. The resulted annual effective dose were within the IAEA approved yearly dose limit for occupational exposure of workers over 18, which is 20 mSv. Staff should be monitored on a regular basis, according to current practice, because their annual exposure may surpass 15% of the annual effective doses.
Collapse
Affiliation(s)
- Yehia H Johary
- Radiation Protection Department, General Directorate of Health Affairs in Aseer Region, Abha, Saudi Arabia
| | - Sultan Albarakati
- Radiation Protection Department, General Directorate of Health Affairs in Aseer Region, Abha, Saudi Arabia
| | - Abdullah AlSohaim
- Radiation Protection Department, General Directorate of Health Affairs in Aseer Region, Abha, Saudi Arabia
| | - Ali Aamry
- Medical Imaging Administration, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Hussin Aamri
- Medical Physics Department, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia
| | - N Tamam
- Department of Physics, College of Science, Princess Nourah Bint Abdulrahman University, P.O Box 84428, Riyadh, 11671, Saudi Arabia
| | - Hassan Salah
- INAYA Medical Collage, Nuclear Medicine Department, Riyadh, Saudi Arabia
| | - Dahlang Tahir
- Department of Physics, Hasanuddin University, Makassar, 90245, Indonesia
| | - Mohammed Alkhorayef
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, P.O Box 10219, Riyadh, 11433, Saudi Arabia
| | - Abdelmoneim Sulieman
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, P.O.Box 422, Alkharj, 11942, Saudi Arabia
| | - David Bradley
- Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK; Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, 47500, Bandar Sunway, Selangor, Malaysia
| |
Collapse
|
14
|
Anushya P, Jayaraman ML. Knowledge, attitude, and practice of lead aprons among dental practitioners and specialists. J Adv Pharm Technol Res 2022; 13:S12-S15. [PMID: 36643119 PMCID: PMC9836117 DOI: 10.4103/japtr.japtr_230_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 01/17/2023] Open
Abstract
In dentistry, radiographs are often used to diagnose and assess problems relating to oral conditions as well as for better treatment planning. Even though the radiation risk offered by X-rays is minimal, the absorption of this lower level radiation in the individual for a long time challenges a health concern. The aim of the study was to assess the knowledge, attitude and practice of lead aprons among dental practitioners and specialists in Tamil Nadu. A cross-sectional survey was performed around 100 dentists in Tamil Nadu, India, by framing standard questionnaires and collecting responses by online survey forms such as "Google Forms." The statistical study was undertaken with SPSS version 22 and the Chi-square test was selected to determine the correlation. This study showed that lead aprons were regularly used by 63% of participants during radiation exposure. Thirty percent of participants were aware of radiation protection protocol but neglected to use lead aprons routinely (P = 0.113). About 91% of participants gave more preference for thyroid gland to protect it from dental radiation rather than other head-and-neck organs and 82% of them were using thyroid collars for patients during exposure (P = 0.671). Our survey shows that the usage of lead aprons is practiced strictly by dental practitioners under <5 years of clinical experience. However, dental practitioners and specialists were aware of radiation protective aprons but often neglected to use them in practice.
Collapse
Affiliation(s)
- P. Anushya
- Department of Conservative Dentistry and Endodontics Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai, Tamil Nadu, India
| | - Maha Lakshmi Jayaraman
- Department of Conservative Dentistry and Endodontics Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai, Tamil Nadu, India,Address for correspondence: Dr. Maha Lakshmi Jayaraman, Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai - 600 077, Tamil Nadu, India. E-mail:
| |
Collapse
|
15
|
Kim SC. Comparison of Shielding Material Dispersion Characteristics and Shielding Efficiency for Manufacturing Medical X-ray Shielding Barriers. MATERIALS (BASEL, SWITZERLAND) 2022; 15:6075. [PMID: 36079456 PMCID: PMC9457979 DOI: 10.3390/ma15176075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
During medical diagnoses, X-ray shielding barriers are used to protect against direct and indirect X-rays. Currently, lead is used as the primary material for shielding barriers; however, the demand for eco-friendly shielding barriers has been increasing. Conventionally, shielding barriers are manufactured using a mechanically bonded combination of lead and aluminum; however, in this study, a plastic-based injection-molded product was developed using tungsten as an eco-friendly alternative to lead. A new process technology was required for mixing tungsten-which can be difficult to process-with a polymer. Consequently, the mixing conditions within the injection molding machine and the related compounding technology factors were analyzed. The process technology considered the pre-mixing method using powdery polymer, particle dispersion method, number of screw rotations, and amount of filler input. The product's shielding performance was then analyzed. The tungsten content of the 2-mm thick barrier manufactured using the proposed method was 90 wt%, and the lead equivalent was 0.321 mmPb. To increase the effectiveness of injection molding in the manufacturing process, specific hourly compounding conditions were proposed. Consequently, the process technology method developed in this study can be considered suitable for manufacturing various shielding barriers.
Collapse
Affiliation(s)
- Seon-Chil Kim
- Department of Biomedical Engineering, School of Medicine, Keimyung University, 1095 Dalgubeol-daero, Daegu 42601, Korea
| |
Collapse
|
16
|
Liu Z, Wang S, Feng F, Xie L. A Magnetorheological Fluid Based Force Feedback Master Robot for Vascular Interventional Surgery. J INTELL ROBOT SYST 2022. [DOI: 10.1007/s10846-022-01716-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
17
|
Budošová D, Horváthová M, Bárdyová Z, Balázs T. CURRENT TRENDS OF RADIATION PROTECTION EQUIPMENT IN INTERVENTIONAL RADIOLOGY. RADIATION PROTECTION DOSIMETRY 2022; 198:554-559. [PMID: 36005965 DOI: 10.1093/rpd/ncac098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/11/2022] [Accepted: 05/22/2020] [Indexed: 06/15/2023]
Abstract
Interventional radiology represents subspecialty of radiology, which does not use imaging modalities only for diagnostics, but mostly for therapeutic purposes. Realisation of interventional procedures is done through X-rays, which replaces direct visual control done by interventional radiologist or cardiologist. For the targeted reduction of the radiation exposure, the interventional radiology staff use personal protective equipment. Usually, aprons with lead-equivalent are used, which provide protection for 75% of the radiosensitive organs. As the eye lens and thyroid gland belong to the radiosensitive organs, lead eyeglasses and thyroid collar are commonly used for their protection. Cap and gloves with lead-equivalent can be utilised as an additional personal protective equipment, that is commercially available. Innovative protection systems, such as mobile radiation protection cabin and suspended radiation protection, have been designed to ensure better radiation protection and safety. These systems provide the comfort for the interventional radiologists at work, while offering better protection against ionising radiation.
Collapse
Affiliation(s)
- Darina Budošová
- Trnava University in Trnava, Faculty of Health Care and Social Work, Department of Laboratory Medicine, Univerzitné námestie 1, Trnava 918 43, Slovakia
| | - Martina Horváthová
- Trnava University in Trnava, Faculty of Health Care and Social Work, Department of Laboratory Medicine, Univerzitné námestie 1, Trnava 918 43, Slovakia
| | - Zuzana Bárdyová
- Trnava University in Trnava, Faculty of Health Care and Social Work, Department of Laboratory Medicine, Univerzitné námestie 1, Trnava 918 43, Slovakia
| | - Tibor Balázs
- CINRE s.r.o., Center for Interventional Neuroradiology and Endovascular Treatment, Tematínska 5/a, Bratislava 851 05, Slovakia
| |
Collapse
|
18
|
Kaewpirom S, Chousangsuntorn K, Boonsang S. Evaluation of Micro- and Nano-Bismuth(III) Oxide Coated Fabric for Environmentally Friendly X-Ray Shielding Materials. ACS OMEGA 2022; 7:28248-28257. [PMID: 35990472 PMCID: PMC9386847 DOI: 10.1021/acsomega.2c02578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
This research focuses on the development of environmentally friendly textile-based shielding composites, from micro-sized and nanosized Bi2O3 particles, against ionizing radiation. Polyester fabric dyne-coated with either micro- or nano-Bi2O3 particles shields some X-rays but the effectiveness is poor. With only ∼58% uptake of micro-sized Bi2O3 particles dyeing on polyester fabric, the insufficient amount of Bi2O3 leaded to the low density of particles, resulting in only 30% of X-ray shielding at 80 kVp. Cotton fabric coated with either micro- or nano-Bi2O3/poly(vinyl alcohol) (PVA) composites, on the other hand, demonstrated the capacity to attenuate X-ray generated by high diagnostic X-ray tube voltages of 70-100 kVp, in compliance with medical protection requirements. The X-ray attenuation performance of cotton fabric coated with either micro-Bi2O3/PVA or nano-Bi2O3/PVA nanocomposite decreased progressively with increasing tube acceleration voltages, however their ionizing radiation-shielding performance enhanced with the number of fabric layers. Interestingly, for all X-ray tube voltages evaluated, the micro-Bi2O3/PVA composite outperformed the nano- Bi2O3/PVA composite in terms of X-ray shielding. At a weight ratio of 66.7% Bi2O3, 10 layers of cotton fabric coated with micro- Bi2O3/PVA composite can attenuate 90, 85, and 80% of X-ray photons at 70, 80, and 100 kVp, respectively. As a result, these less harmful X-ray shielding materials have the potential to replace lead-based composites, which are highly toxic to human health and have negative environmental consequences.
Collapse
Affiliation(s)
- Supranee Kaewpirom
- Department
of Chemistry, Faculty of Science, Burapha
University, Chonburi 20131, Thailand
| | - Khaisang Chousangsuntorn
- Department
of Radiological Technology, Faculty of Medical Technology, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Siridech Boonsang
- Department
of Electrical Engineering, School of Engineering, King Mongkut’s Institute of Technology Ladkrabang, Bangkok 10520, Thailand
| |
Collapse
|
19
|
Najjar RH, Alsulaiman AM, Alraddadi JS, Alrohaimi NH, Algarni BA, Al-Arafa AM, Alsubait RA. Assessment of Physicians’ Knowledge and Awareness About the Hazards of Radiological Examinations on the Health of Their Patients at a Tertiary Care Hospital, Riyadh, Saudi Arabia. Cureus 2022; 14:e27479. [PMID: 36060404 PMCID: PMC9421100 DOI: 10.7759/cureus.27479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background One of the vital tools in diagnosing a variety of medical conditions is through radiological examinations which can lead to severe biological effects if precautions are not taken. To limit the harmful effects, as low as reasonably achievable (ALARA) was implemented. ALARA aims to minimize the time, increase the distance, and promote the use of protective shielding. Method The cross-sectional study included 454 physicians in King Abdulaziz Medical City (KAMC) and King Abdullah Specialist Children’s Hospital (KASCH), Riyadh, Saudi Arabia. The study assessed physicians’ knowledge and awareness about the hazards of radiological examinations on their patients’ health using a self-administered questionnaire to measure knowledge, attitude, and practice (KAP). KAP was compared with the sociodemographic characteristics using the Mann-Whitney Z-test as well as Kruskal Wallis H-test. Results Out of 454 physicians, males exceeded the females (61.7% vs 38.3%) with nearly three-quarters (72.5%) working in King Abdulaziz Medical City. The most commonly mentioned specialty was internal medicine, while the least common specialty was orthopedics. Based on a cutoff point of 60%, it was revealed that poor knowledge was observed in 70.5% of physicians. With regards to attitude, 65.2% of physicians had a positive attitude. For practices, 49.8% had poor practices while 50.2% had good practices. The mean scores for knowledge, attitude and practice were 9.19 (SD 7.03) out of 23 points, 1.89 (SD 1.06) out of 3 points, and 5.43 (SD 1.67) out of 8 points, respectively. Conclusion In conclusion, poor knowledge, practice, and positive attitude were detected among physicians. However, our study was limited by the use of a self-administered online questionnaire.
Collapse
|
20
|
Prabhu S, S. G Bubbly, Gudennavar SB. X-Ray and γ-Ray Shielding Efficiency of Polymer Composites: Choice of Fillers, Effect of Loading and Filler Size, Photon Energy and Multifunctionality. POLYM REV 2022. [DOI: 10.1080/15583724.2022.2067867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Srilakshmi Prabhu
- Department of Physics and Electronics, Bangalore Central Campus, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - S. G Bubbly
- Department of Physics and Electronics, Bangalore Central Campus, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - Shivappa B. Gudennavar
- Department of Physics and Electronics, Bangalore Central Campus, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| |
Collapse
|
21
|
Robatjazi M, Dareyni A, Baghani HR, Hosseinzade M, Akbarzadeh R, Mehrpoyan M. Investigation of radiation dose around C-arm fluoroscopy and relevant cancer risk to operating room staff. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2022; 61:301-307. [PMID: 35171318 DOI: 10.1007/s00411-022-00965-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/29/2022] [Indexed: 06/14/2023]
Abstract
This study aimed to evaluate the ambient dose equivalent around a C-arm device during spinal surgeries and determine the optimum locations for the surgeon and staff to keep radiation exposure as low as reasonably achievable. Furthermore, cancer risk incidence was estimated using the excess relative risk (ERR) concept of the biologic effects of ionizing radiation VII report for operating room (OR) staff. A lateral projection of the C-arm setup was considered in the current study. The ambient dose equivalent rate was measured using an electronic dosimeter in 30° steps all around for 1, and 1.6-m heights as well as 1, and 2-m distances away from a water tank (scattering medium). By assuming a typical workload, the annual ambient dose and a maximum number of permissible operations were determined. For a worst-case scenario, the dose was used to estimate the ERR for various organs including prostate, ovary, breast, lung, thyroid, and colon for attained ages of 35, 40, and 50 years. The maximum ambient dose equivalent rate was seen at 330° and 30° (about 600 µSv/h at 1 m height and a distance of 1 m from the scattering medium). The corresponding permissible workload for an OR staff was about 30,660 operations. Based on the obtained results, 60° next to the image intensifier was the optimum position for the surgeon, while 30° next to the tube was the worst position because of backscattered radiation. The ERR results showed that the lung and colon have the highest cancer risk incidence among the considered organs for both males and females, respectively.
Collapse
Affiliation(s)
- Mostafa Robatjazi
- Department of Medical Physics and Radiological Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Non-communicable Disease Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Amir Dareyni
- Department of Medical Physics and Radiological Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Mohammad Hosseinzade
- Department of Operating Room, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Roya Akbarzadeh
- Department of Anesthesia, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohammad Mehrpoyan
- Department of Medical Physics and Radiological Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran
| |
Collapse
|
22
|
Park S, Kim M, Kim JH. Radiation safety for pain physicians: principles and recommendations. Korean J Pain 2022; 35:129-139. [PMID: 35354676 PMCID: PMC8977205 DOI: 10.3344/kjp.2022.35.2.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 11/05/2022] Open
Abstract
C-arm fluoroscopy is a useful tool for interventional pain management. However, with the increasing use of C-arm fluoroscopy, the risk of accumulated radiation exposure is a significant concern for pain physicians. Therefore, efforts are needed to reduce radiation exposure. There are three types of radiation exposure sources: (1) the primary X-ray beam, (2) scattered radiation, and (3) leakage from the X-ray tube. The major radiation exposure risk for most medical staff members is scattered radiation, the amount of which is affected by many factors. Pain physicians can reduce their radiation exposure by use of several effective methods, which utilize the following main principles: reducing the exposure time, increasing the distance from the radiation source, and radiation shielding. Some methods reduce not only the pain physician's but also the patient's radiation exposure. Taking images with collimation and minimal use of magnification are ways to reduce the intensity of the primary X-ray beam and the amount of scattered radiation. It is also important to carefully select the C-arm fluoroscopy mode, such as pulsed mode or low-dose mode, for ensuring the physician's and patient's radiation safety. Pain physicians should practice these principles and also be aware of the annual permissible radiation dose as well as checking their radiation exposure. This article aimed to review the literature on radiation safety in relation to C-arm fluoroscopy and provide recommendations to pain physicians during C-arm fluoroscopy-guided interventional pain management.
Collapse
Affiliation(s)
- Sewon Park
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Minjung Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| |
Collapse
|
23
|
Andrew S, Abdelmonem MR, Kohli S, Dabke H. Evaluation of Back Pain and Lead Apron Use Among Staff at a District General Hospital. Cureus 2021; 13:e18859. [PMID: 34804712 PMCID: PMC8597674 DOI: 10.7759/cureus.18859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives To evaluate the prevalence of back pain among staff who regularly use lead aprons, correlating this to their use, and improve the knowledge and understanding of lead apron use among staff. Methods A questionnaire study was undertaken from November 2018 to February 2019 on staff in departments using lead aprons on a routine basis (n = 59) defined as the study group (SG), and staff who did not wear lead aprons (n = 62) defined as the control group (CG). Additionally, a separate questionnaire (n = 43) was distributed to lead apron users regarding education and knowledge, following which an education session was set up and the staff was re-evaluated. Results The prevalence of back pain was higher in the SG; 63% (SG) versus 32% (CG). The proportion of staff that felt lead aprons (SG) or work (CG) was the cause of this back pain was also higher in the SG than the CG: 83% versus 37%. A significant proportion of staff was unaware of the lead equivalence, material, and types of lead aprons available, after education this improved; 92% of staff now think more carefully when choosing a lead apron. Discussion Back pain is prevalent among staff using lead aprons and a lack of education regarding their use is evident. This could result in time off work and lead to unsafe practices around ionizing radiation. Education improved the knowledge and understanding of lead apron use. This could lead to increased comfort and less strain on the back, potentially lowering the prevalence of back pain.
Collapse
Affiliation(s)
- Stefanie Andrew
- Trauma and Orthopaedics, Salisbury NHS Foundation Trust, Salisbury, GBR
| | - Mohamed R Abdelmonem
- Trauma and Orthopaedics, University Hospitals, Plymouth NHS Trust, Plymouth, GBR
| | - Suraj Kohli
- Trauma and Orthopaedics, Salisbury NHS Foundation Trust, Salisbury, GBR
| | - Harshad Dabke
- Trauma and Orthopaedics, Salisbury NHS Foundation Trust, Salisbury, GBR
| |
Collapse
|
24
|
Ji YS, Park EK, Kwon HC, Han WK, Nahm FS. Radiation-Shielding Devices: The Best Combination for Spine Interventional Procedures. J Vasc Interv Radiol 2021; 33:225-232. [PMID: 34700011 DOI: 10.1016/j.jvir.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/20/2021] [Accepted: 10/02/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Although many studies have examined the efficiency of various protective devices for reducing the dose of radiation exposure to physicians during interventional pain procedures, no study has compared the protective effect of these devices when they are used in combination. The purpose of this prospective experimental study was to determine the best combination of radiation-shielding devices. MATERIALS AND METHODS Using anthropomorphic phantoms of a physician and patient, we measured the radiation protection efficiency (RPE) of each of the following protection methods and in combination during C-arm-guided simulated lumbar epidural injection: (a) personal protective equipment (PPE), (b) bedside curtain shield (Curtain), (c) x-ray tube filter (Filter), and (d) fluoroscopic collimation method (Collimation). We measured exposure doses using personal electronic dosimeters at the eye, thyroid, and gonad levels for 1 minute. Each experiment was repeated 15 times. RESULTS The radiation exposure dose and RPE with the best single-, double-, and triple-protection methods were as follows: PPE for the single-protection method (11.82 μSv/min, 80.04%), PPE + Collimation for the double-combination method (4.68 μSv/min, 92.09%), and PPE + Collimation + Curtain for the triple-combination method (3.08 μSv/min, 93.39%). Additionally, PPE + Collimation + Curtain + Filter for the quadruple-combination method resulted in a radiation exposure and RPE of 2.91 μSv/min and 93.61%, respectively, compared with nonprotection. CONCLUSIONS The best single-, double-, and triple-protection method was PPE, PPE + Collimation, and PPE + Collimation + Curtain, respectively. While preparing protective equipment, we recommend prioritizing equipment in this order.
Collapse
Affiliation(s)
- Young Seok Ji
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun Kyul Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyuk Chan Kwon
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Woong Ki Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| |
Collapse
|
25
|
Alwasiah R, Jawhari A, Orri RA, Khafaji M, Al Bahiti S. MEASUREMENT OF RADIATION DOSE TO THE EYE LENS IN NON-ENHANCED CT SCANS OF THE BRAIN. RADIATION PROTECTION DOSIMETRY 2021; 195:56-60. [PMID: 34337658 DOI: 10.1093/rpd/ncab118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/16/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
Radiation can have undesirable effects on the eye, including a gradual loss of vision. Unnecessary radiation can reach the eye lens during non-enhanced computed tomography (CT) scans of the brain. The International Commission on Radiological Protection states the threshold for acute and chronic eye lens exposure is 500 mGy and the equivalent dose limit for the eye lens for public exposure is 15 mSv per year. Therefore, we measured the direct radiation dose to the eye lens during head CT scans using NanoDots in 216 adults. The mean absorbed dose to both eyes was 33.62 mGy (standard deviation ±12.442). The averages for the other variables were: tube current-time product: 260 mAs; dose-length product: 708 mGy cm and CT dose index: 35.5 mGy. Our findings encourage further study of radiation exposure and modifications in CT imaging protocols.
Collapse
Affiliation(s)
- Reem Alwasiah
- Department of Radiology, King Fahad General Hospital, Jeddah, Saudi Arabia
| | | | - Rafal Al Orri
- Faculty of Medicine, King Abdulaziz University Jeddah, Saudi Arabia
| | - Mawya Khafaji
- Department of Radiology, King Abdulaziz University Hospital Jeddah, Saudi Arabia
| | - Sarah Al Bahiti
- Department of Radiology, King Abdulaziz University Hospital Jeddah, Saudi Arabia
| |
Collapse
|
26
|
Hong SW, Kim TW, Kim JH. RADIATION EXPOSURE TO THE BACK WITH DIFFERENT TYPES OF APRONS. RADIATION PROTECTION DOSIMETRY 2021; 193:185-189. [PMID: 33839791 DOI: 10.1093/rpd/ncab044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/17/2021] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
Physicians and nurses stand with their back towards the C-arm fluoroscope when using the computer, taking things out of closets and preparing drugs for injection or instruments for intervention. This study was conducted to investigate the relationship between the type of lead apron and radiation exposure to the backs of physicians and nurses while using C-arm fluoroscopy. We compared radiation exposure to the back in the three groups: no lead apron (group C), front coverage type (group F) and wrap-around type (group W). The other wrap-around type apron was put on the bed instead of on a patient. We ran C-arm fluoroscopy 40 times for each measurement. We collected the air kerma (AK), exposure time (ET) and effective dose (ED) of the bedside table, upper part and lower part of apron. We measured these variables 30 times for each location. In group F, ED of the upper part was the highest (p < 0.001). ED of the lower part in group C and F was higher than that in group W (p = 0.012). The radiation exposure with a front coverage type apron is higher than that of the wrap-around type and even no apron at the neck or thyroid. For reducing radiation exposure to the back of physician or nurse, the wrap-around type apron is recommended. This type of apron can reduce radiation to the back when the physician turns away from the patient or C-arm fluoroscopy.
Collapse
Affiliation(s)
- Seung Wan Hong
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Tae Won Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| |
Collapse
|
27
|
Burman S, Das A, Mahajan C, Rath GP. Radiation Concerns for the Neuroanesthesiologists. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2020. [DOI: 10.1055/s-0040-1715354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractWith the advent of minimally invasive neurosurgical techniques and rapid innovations in the field of neurointervention, there has been a sharp rise in diagnostic and therapeutic modalities requiring radiation exposure. Neuroanesthesiologists are currently involved in various procedures inside as well as outside the operating room (OR) like intensive care units, interventional suites, and gamma knife units. The ambit expands from short-lasting diagnostic scans to lengthy therapeutic procedures performed under fluoroscopic guidance. Hence, a modern-day neuroanesthesiologist has to bear the brunt of the radiation exposure in both inside and outside the OR. However, obliviousness and nonadherence to the relevant radiation safety measures are still prevalent. Radiation protection and safety are topics that need to be discussed with new vigor in the light of current practice.
Collapse
Affiliation(s)
- Sourav Burman
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Abanti Das
- Department of Radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Charu Mahajan
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Girija P. Rath
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
28
|
Shankar S, Padmanabhan D, Chandrashekharaiah A, Deshpande S. Strategies to Reduce Radiation Exposure in Electrophysiology and Interventional Cardiology. US CARDIOLOGY REVIEW 2020. [DOI: 10.15420/usc.2019.21.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clinical diagnosis sometimes involves the use of medical instruments that employ ionizing radiation. However, ionizing radiation exposure is a workplace hazard that goes undetected and is detrimental to patients and staff in the catheterization laboratory. Every possible effort should be made to reduce the amount of radiation, including scattered radiation. Implementing radiation dose feedback may have a role in reducing exposure. In medicine, it is important to estimate the potential biologic effects on, and the risk to, an individual. In general, implantation of cardiac resynchronization devices is associated with one of the highest operator exposure doses due to the proximity of the operator to the radiation source. All physicians should work on the principle of as low as reasonably achievable. Methods for reducing radiation exposure must be implemented in the catheterization laboratory. In this article, we review the available tools to lower the radiation exposure dose to the operator during diagnostic, interventional, and electrophysiological cardiac procedures.
Collapse
Affiliation(s)
- Sandeep Shankar
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Deepak Padmanabhan
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | | | - Saurabh Deshpande
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|