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Clements W, Lukies M, Zia A, Fitzgerald M, Kavnoudias H. Let us settle the controversy-gelfoam is a safe intravascular embolic agent. Br J Radiol 2024; 97:933-937. [PMID: 38402518 DOI: 10.1093/bjr/tqae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES A 2021 safety alert restricted endovascular gelfoam use in Australia and resulted in an embargo on gelfoam sales to Interventional Radiology departments. This study aimed to show that gelfoam is safe in a population of trauma patients with pelvic injury, and discuss the basis of the recent controversies. METHODS Retrospective cohort study was conducted between 1 January 2010 and 21 May 2021 for the patients who underwent gelfoam embolization for pelvic arterial haemorrhage. Primary outcome was the rate of adverse events related to intravascular gelfoam administration. RESULTS Inclusion criteria met in 50 patients, comprising 58% males median age 59.9 years, and median injury severity score 31. There were 0 complications related to gelfoam use and 100% technical success. Thirty-five patients (70%) received a non-targeted embolization approach. All-cause mortality was observed in 5 patients (10%), unrelated to gelfoam. CONCLUSIONS Gelfoam is a safe and effective embolic agent in pelvic trauma. Patients are in urgent need of universal on-label registration of endovascular gelfoam products, as it is life-saving in major haemorrhage after trauma. ADVANCES IN KNOWLEDGE Endovascular gelfoam is mandatory for a high-quality trauma service, and this study shows that it is safe to use intentionally in the endovascular space. Companies should work with interventional radiologists, sharing and collaborating to ensure positive outcomes for patients.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne 3004, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne 3004, Australia
- National Trauma Research Institute, Central Clinical School, Monash University, Melbourne 3004, Australia
| | - Matthew Lukies
- Department of Radiology, Alfred Health, Melbourne 3004, Australia
| | - Adil Zia
- Department of Radiology, Alfred Health, Melbourne 3004, Australia
| | - Mark Fitzgerald
- Department of Surgery, Central Clinical School, Monash University, Melbourne 3004, Australia
- National Trauma Research Institute, Central Clinical School, Monash University, Melbourne 3004, Australia
- Department of Trauma, Alfred Health, Melbourne 3004, Australia
| | - Helen Kavnoudias
- Department of Radiology, Alfred Health, Melbourne 3004, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne 3004, Australia
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Clements W, Chenoweth A, Morphett L, Billington E, Nandurkar R, Phan T, Venn GA, Lukies MW. A cost outcome study of varicocoele embolisation and future pregnancy in an Australian public hospital setting. J Med Imaging Radiat Oncol 2024; 68:282-288. [PMID: 38437182 DOI: 10.1111/1754-9485.13629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Varicocoele is commonly encountered in males with infertility. Studies have shown that varicocoele repair (surgery or embolisation) can improve the rate of subsequent pregnancy. In Australia, there have been no studies assessing the cost of varicocoele embolisation and current practice is based on international data. This study aimed to assess the cost of varicocoele embolisation and estimate the treatment cost per pregnancy. METHODS Retrospective cost-outcome study of patients treated by embolisation between January 2018 and 2023. A bottom-up approach was used to calculate procedure costs whereas a top-down approach was used to calculate costs for all other patient services, including direct and indirect costs. To calculate cost per pregnancy, costs were adjusted according to existing published data on the rate of pregnancy after embolisation. RESULTS Costing data from 18 patients were included, of median age 33.5 years (range 26-60) and median varicocoele grade 2.5 (range 1-3). All patients had unilateral treatment, most commonly via right internal jugular (16 patients, 89%) and using a 0.035″ system (17 patients, 94%). The median cost for the entire treatment including procedural, non-procedural, ward and peri-procedural costs was AUD$2208.10 (USD$1405 or EUR€1314), range AUD$1691-7051. The projected cost to the healthcare system per pregnancy was AUD$5387 (USD$3429 or EUR€3207). CONCLUSION Total varicocoele embolisation cost and the cost per-pregnancy were lower than for both embolisation and surgical repair in existing international studies. Patients undergoing varicocoele treatment should have the option to access an interventional radiologist to realise the benefits of this low-cost pinhole procedure.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Abigail Chenoweth
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Laura Morphett
- Department of Finance, Alfred Health, Melbourne, Victoria, Australia
| | - Eliza Billington
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Rohan Nandurkar
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Tuan Phan
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Georgina A Venn
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Matthew W Lukies
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medical Imaging, Monash Health, Melbourne, Victoria, Australia
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Clements W, So J, Koukounaras J, Lau G, Lukies MW. Research output of radiologists in Australia and New Zealand: Strengths, weaknesses and future directions. J Med Imaging Radiat Oncol 2023; 67:697-702. [PMID: 37302986 DOI: 10.1111/1754-9485.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Clinical radiology is a popular career. However, academic radiology in Australia and New Zealand (ANZ) has not traditionally been a strength of the specialty which has a focus on clinical medicine and has been influenced by corporatisation of the specialty. The aim of this study was to review the source(s) of radiologist-led research in Australia and New Zealand, to identify areas of relative deficiency and propose plans to improve research output. METHODS A manual search was performed of all manuscripts in seven popular ANZ journals, where the corresponding or senior author was a radiologist. Publications between January 2017 and April 2022 were included. RESULTS There were 285 manuscripts from ANZ radiologists during the study period. This equates to 10.7 manuscripts per 100 radiologists based on RANZCR census data. Radiologists in Northern Territory, Victoria, Western Australia, South Australia and the Australian Capital Territory all produced manuscripts above the corrected mean incidence rate of 10.7 manuscripts per 100 radiologists. However, locations including Tasmania, New South Wales, New Zealand and Queensland were below the mean. The majority of manuscripts arose from public teaching hospitals with accredited trainees (86%), and there were a higher proportion of manuscripts published by female radiologists (11.5 compared to 10.4 per 100 radiologists). CONCLUSION Radiologists in ANZ are academically active; however, interventions aimed at increasing output could be targeted at certain locations and/or areas within a busy private sector. Time, culture, infrastructure and research support are vital, but personal motivation is also extremely important.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Joanne So
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Gabes Lau
- Radiology Department, Dunedin Public Hospital, Dunedin, New Zealand
| | - Matthew W Lukies
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore City, Singapore
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Clements W, Koukounaras J. Complications in Interventional Radiology: the role of clinical governance and iterative hospital systems in quality improvement. CVIR Endovasc 2023; 6:38. [PMID: 37542625 PMCID: PMC10404211 DOI: 10.1186/s42155-023-00388-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023] Open
Abstract
As modern Interventional Radiology (IR) evolves, and expands in scope and complexity, it will push the boundaries of existing literature. However, with all intervention comes risk and it is the shared judgement of the risk-benefit analysis which underpins the ethical and legal principles of care in IR.Complications in medicine are common, said to occur in 9.2% of in-hospital healthcare interactions. Healthcare complications also come at considerable cost. It is estimated that in the UK, prolonging hospital stays to manage complications can cost ₤2 billion per year.However, complications can't be viewed in isolation. Clinical governance is the umbrella within which complications are viewed. It can be defined as a broadly integrated and systematic approach to clinical care and accountability, that seeks to focus on quality of healthcare. This concept incorporates complications but acknowledges their interplay within a complex healthcare system in which negative adverse events are influenced by a range of intrinsic and extrinsic factors. It also includes the processes that result from monitoring and learning from complications, with feedback leading to systems-based improvements in care moving forward. The reality is that complications are uncommonly the result of medical negligence, but rather they are an unfortunate by-product of a healthcare industry with inherent risk.It is also important to remember that complications are not just a number on an audit sheet, but a potentially life-changing event for every patient that is affected. The events that follow immediately from an adverse outcome such as open disclosure are vital, and have implications for how that patient experiences healthcare and trusts healthcare professionals for the rest of their life. We must ensure that the patient and their family maintain trust in healthcare professionals into the future.Credentialling and accreditation are imperative for Interventional Radiologists to meet existing standards as well deal with challenging situations. These should integrate and align within the structure of an organization that has a safety and learning culture. It is the many layers of organisational clinical governance that arguably play the most important role in IR-related complications, rather than apportioning blame to an individual IR.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Rd, Melbourne, 3004, Australia.
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia.
- National Trauma Research Institute, Melbourne, Australia.
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, 55 Commercial Rd, Melbourne, 3004, Australia
- Department of Surgery, Monash University Central Clinical School, Melbourne, Australia
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Clements W, Cheung A, Brown N. A new subsection within JMIRO: Acknowledging the importance of Interventional Radiology and Interventional Neuroradiology research in Australia and New Zealand. J Med Imaging Radiat Oncol 2023. [PMID: 36738131 DOI: 10.1111/1754-9485.13514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Warren Clements
- Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Andrew Cheung
- Department of Interventional Radiology, Liverpool Hospital, Sydney, New South Wales, Australia.,Neurointervention, Institute of Neurological Sciences, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South West Sydney Clinical Campuses, UNSW Sydney, Sydney, New South Wales, Australia
| | - Nicholas Brown
- The University of Queensland, Brisbane, Queensland, Australia.,Wesley Hospital, Brisbane, Queensland, Australia.,The Prince Charles Hospital, Brisbane, Queensland, Australia
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Clements W, Zia A, Srinivas A, Davis J, Goh GS. A prospective cross-sectional study assessing teaching of interventional radiology across 20 Australian medical schools, endorsed by the Australian Medical Students Association. CVIR Endovasc 2022; 5:66. [PMID: 36536064 PMCID: PMC9763521 DOI: 10.1186/s42155-022-00344-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Existing literature from around the world has shown that teaching of Interventional Radiology (IR) to medical students remains suboptimal. Despite calls for improvement at a "grass-roots" level, most IRs find that junior doctors have limited or no knowledge of IR, and thus reduced awareness of potential IR treatments for their patients or contemplating IR as a future career. The aim of this study was to survey current medical students to assess perception of whether a wider variety of medical schools are integrating IR into their curriculum, from universities all across Australia. This was a prospective cross-sectional study of members of the Australian Medical Students Association (AMSA) from across Australia. Students were given a 14-question survey of current university teaching and students' knowledge of the discipline of IR. The primary outcome was perception of current teaching and knowledge of IR. Secondary outcomes include awareness of technical, clinical, and other duties of IRs. RESULTS Surveys were sent in a newsletter and posted on the AMSA Facebook page to their members. 82 responses were received via students from 20 out of 23 Australian medical schools. 61% of students described poor or no knowledge of IR. Teaching of IR was significantly worse than diagnostic radiology (p < 0.001), only 12% suggested that current IR teaching was adequate, and 99% suggested that IR teaching could be improved. Only 11% of students would consider a career in IR. CONCLUSIONS Medical student perception of exposure to IR is poor compared to diagnostic radiology. Better awareness may lead to improved referral patterns for patients and more career interest in IR.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Rd, Melbourne, VIC 3004 Australia ,grid.1002.30000 0004 1936 7857Department of Surgery, Monash University Central Clinical School, Melbourne, Australia ,grid.511499.1National Trauma Research Institute, Melbourne, Australia
| | - Adil Zia
- Department of Radiology, Alfred Health, 55 Commercial Rd, Melbourne, VIC 3004 Australia
| | - Abhishekh Srinivas
- Department of Radiology, Alfred Health, 55 Commercial Rd, Melbourne, VIC 3004 Australia ,Australian Medical Students Association, Australian Capital Territory, Barton, Australia
| | - Jasmine Davis
- Australian Medical Students Association, Australian Capital Territory, Barton, Australia
| | - Gerard S. Goh
- Department of Radiology, Alfred Health, 55 Commercial Rd, Melbourne, VIC 3004 Australia ,grid.1002.30000 0004 1936 7857Department of Surgery, Monash University Central Clinical School, Melbourne, Australia ,grid.511499.1National Trauma Research Institute, Melbourne, Australia
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Clements W, Koukounaras J, Joseph T. Reply to "Damage Control Interventional Radiology (DCIR): Evolving Value of Interventional Radiology in Trauma". Cardiovasc Intervent Radiol 2022. [PMID: 36151338 DOI: 10.1007/s00270-022-03275-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/02/2022]
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Lukies M, Clements W. Current Strategies for Prevention of Infection After Uterine Artery Embolisation. Cardiovasc Intervent Radiol 2022; 45:911-917. [PMID: 35578034 PMCID: PMC9225967 DOI: 10.1007/s00270-022-03158-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
Uterine artery embolisation (UAE) is a safe and effective procedure for symptomatic uterine fibroids with an estimated rate of post-operative intra-uterine infection of 0.9-2.5%. While rates of infection have remained low over the past two decades, there is variation in infection prevention practices. Intra-uterine infection after UAE may occur via access site haematogenous spread or ascension of vaginal flora through the cervical canal. Although the evidence base is immature, risk factors for infection including previous pelvic infection, hydrosalpinx, endocervical incompetence, diabetes, smoking, obesity, respiratory disease, and immunosuppression should be assessed during the pre-operative consultation with the interventional radiologist to tailor a plan for minimising infection, which may include optimisation of any modifiable risk facts and prophylactic antibiotics.
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Affiliation(s)
- Matthew Lukies
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Surgery, Monash University, Melbourne, VIC, Australia. .,National Trauma Research Institute, Melbourne, VIC, Australia.
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Affiliation(s)
- Warren Clements
- Department of Radiology, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Surgery, Monash University, Melbourne, Australia. .,National Trauma Research Institute, Central Clinical School, Monash University, Melbourne, Australia.
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Chong CCW, Chennapragada SM, Schick C, McAuliffe W, Schlaphoff G, Lodh S, Whitley J, Cheung A. The 'Sic Vos non Vobis' of Interventional Radiology - Rebranding and modernising the Interventional Specialities of Radiology in Australia and New Zealand. J Med Imaging Radiat Oncol 2022; 66:423-427. [PMID: 35107218 PMCID: PMC9303623 DOI: 10.1111/1754-9485.13380] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Colin Chun Wai Chong
- Department of Radiology, Macquarie University Hospital, Sydney, New South Wales, Australia.,Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Satyanarayana Murthy Chennapragada
- Department of Medical Imaging, SCHN-Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Christoph Schick
- Department of Radiology, Northland District Health Board, Whangarei, New Zealand
| | - William McAuliffe
- Neurological Intervention & Imaging Service of Western Australia, Nedlands, Western Australia, Australia
| | - Glen Schlaphoff
- Department of Interventional Radiology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Suhrid Lodh
- Department of Radiology, St George Hospital, Sydney, New South Wales, Australia.,St George & Sutherland Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Justin Whitley
- Department of Interventional Radiology, Liverpool Hospital, Sydney, New South Wales, Australia.,Department of Radiology, St George Hospital, Sydney, New South Wales, Australia.,Neurointervention, Institute of Neurological Sciences, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Andrew Cheung
- Department of Interventional Radiology, Liverpool Hospital, Sydney, New South Wales, Australia.,Neurointervention, Institute of Neurological Sciences, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South West Sydney Clinical Campuses, UNSW Sydney, Sydney, New South Wales, Australia
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Moriarty HK, Clements W, Phan T, Wang S, Goh GS. Occupational radiation exposure to the lens of the eye in interventional radiology. J Med Imaging Radiat Oncol 2021; 66:34-40. [PMID: 34342393 DOI: 10.1111/1754-9485.13307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cataract formation is a tissue reaction effected by radiation exposure. The purpose of this study was to evaluate the occupational exposure to the lens of the eye of interventional radiologists (IR's) and interventional radiology staff, with and without lead glasses. METHODS Ethical approval was provided by the hospital research and ethics committee. A prospective cohort study was performed over 1 year, doses recorded, lifetime dose (estimated at working 5 days in angiography, for 30 years) was estimated and dose compared to current guidelines. Thermoluminescent dosimeters (TLDs; Landauer, Glenwood, USA) Hp(3) were placed on both the exterior and interior side of the personal lead glasses worn by three interventional radiologists and two radiographers. They were monitored during all procedures performed within 1 year. Lead glasses (AttenuTech® Microlite® , Florida, USA) with specifications were 0.75 mm lead equivalent front shield, and Side shield 0.3 mm Pb equivalent. A control TLD was placed in the storage location of the lead glasses when not in use. Yearly dose was measured and lifetime dose was calculated from the data obtained. Calculation of dose received per day(s) spent performing procedures for both annual and lifetime exposure was performed. In addition a record of occurrence of splashes on glasses was made after each case. RESULTS Eye doses without protection were double the recommended limits for both annual and lifetime dose. For interventional radiologists working between 3 and 4 or more days in the lab per week, annual dose thresholds would be exceeded (20 mSv/year averaged over 5 years, no more than 50 mSv in 1 year). If interventional radiologists worked between 3 and 4 or more days in the lab, lifetime dose thresholds would be exceeded (500 mSv lifetime dose). Lead glasses reduced radiation exposure by an average of 79%. If lead glasses were worn no interventional radiologists would exceed annual or lifetime dose thresholds to the eyes even if working 5 days per week as the primary operator. Radiographers would not exceed annual or lifetime dose thresholds even without lead glasses. Splash incidents occurred for all interventional radiologists and one radiographer. CONCLUSION The use of lead glasses even in this small study resulted in a decreased dose of radiation to the lens of the eye. Regular use of radiation protection eyewear will reduce eye dose for primary proceduralists to well below yearly and lifetime thresholds.
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Affiliation(s)
- Heather K Moriarty
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Tuan Phan
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Sherry Wang
- University of Utah, Salt Lake City, Utah, USA
| | - Gerard S Goh
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
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