This paper investigates over five decades of work practices in interventional cardiology, with an emphasis on radiation protection. The analysis is based on data from more than 400 cardiologists from various European countries recruited for a EURALOC study and collected in the period from 2014 to 2016. Information on the types of procedures performed and their annual mean number, fluoroscopy time, access site choice, x-ray units and radiation protection means used was collected using an occupational questionnaire. Based on the specific European data, changes in each parameter have been analysed over decades, while country-specific data analysis has allowed us to determine the differences in local practices. In particular, based on the collected data, the typical workload of a European cardiologist working in a haemodynamic room and an electrophysiology room was specified for various types of procedures. The results showed that when working in a haemodynamic room, a transparent ceiling-suspended lead shield or lead glasses are necessary in order to remain below the recommended eye lens dose limit of 20 mSv. Moreover, the analysis revealed that new, more complex cardiac procedures such as chronic total occlusion, valvuloplasty and pulmonary vein isolation for atrial fibrillation ablation might contribute substantially to annual doses, although they are relatively rarely performed. The results revealed that considerable progress has been made in the use of radiation protection tools. While their use in electrophysiology procedures is not generic, the situation in haemodynamic procedures is rather encouraging, as ceiling-suspended shields are used in 90% of cases, while the combination of ceiling shield and lead glasses is noted in more than 40% of the procedures. However, we find that still 7% of haemodynamic procedures are performed without any radiation protection tools.
A personal dosimeter worn outside a protective apron is a good screening device for dose to the eyes and fingers as well as for effective dose, even though the effective dose is grossly overestimated. Relatively high dose to the fingers and eyes remains undetected by a dosimeter worn under the apron.
BackgroundRadiation, which is used extensively to diagnose and treat human diseases, poses an occupational health risk for the concerned health workers. Personal dosimetry is an important tool to monitor occupational radiation exposures.
ObjectiveThis study was conducted to reveal and to describe the situation of occupational radiation exposure monitoring among staffs in different health care facilities in Nepal.
MethodsA cross-sectional study was performed among the 35 Health Care Facilities. Information about types and number of X-ray procedures performed, types and number of personnel involved, workload and the availability of personal dosimetry service were collected.
ResultsSix Health Care Facilities had personal dosimetry service available for a total of 149 personnel. Of a total of nearly one million X-ray procedures performed in the 35 Health Care Facilities in 2007, 76 % was performed by non-monitored personnel. The majority of the facilities performing high dose procedures, like catheterisation, angiography and intestinal barium procedures did not offer personal dosimetry for the involved personnel.
ConclusionThere are a limited number of personnel being monitored with personal dosimetry. There are no regulatory dose limits for occupationally exposed staff. Thus, there is an urgent need to establish a national radiation protection authority to regulate the use of radiation in Nepal.
The Nordic radiation protection authorities have already published recommended guidance levels for patient doses for six conventional radiological examinations. Over the past two years a similar protocol has been in progress for three interventional procedures. Measurements have been performed in 22 different hospitals in the Nordic countries on patients in the weight range 40-100 kg. The selected procedures are percutaneous transluminal coronary angioplasty (PTCA), percutaneous transluminal angioplasty (PTA) and endoscopic retrograde cholangio- and pancreatio-graphy (ERCP). A total of 281 PTCA procedures, 304 PTA procedures and 147 ERCP procedures are included in the study. The results from this survey are presented as a first attempt to set guidance levels.
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