Assessment of radiation protection of patients and staff in interventional procedures in four Algerian hospitals

Abstract

This study was aimed to assess patient dosimetry in interventional cardiology (IC) and radiology (IR) and radiation safety of the medical operating staff. For this purpose, four major Algerian hospitals were investigated. The data collected cover radiation protection tools assigned to the operating staff and measured radiation doses to some selected patient populations. The analysis revealed that lead aprons are systematically worn by the staff but not lead eye glasses, and only a single personal monitoring badge is assigned to the operating staff. Measured doses to patients exhibited large variations in the maximum skin dose (MSD) and in the dose area product (DAP). The mean MSD registered values are as follows: 0.20, 0.14 and 1.28 Gy in endoscopic retrograde cholangiopancreatography (ERCP), coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures, respectively. In PTCA, doses to 3 out of 22 patients (13.6 %) had even reached the threshold value of 2 Gy. The mean DAP recorded values are as follows: 21.6, 60.1 and 126 Gy cm(2) in ERCP, CA and PTCA procedures, respectively. Mean fluoroscopic times are 2.5, 5 and 15 min in ERCP, CA and PTCA procedures, respectively. The correlation between DAP and MSD is fair in CA (r = 0.62) and poor in PTCA (r = 0.28). Fluoroscopic time was moderately correlated with DAP in CA (r = 0.55) and PTCA (r = 0.61) procedures. Local diagnostic reference levels (DRLs) in CA and PTCA procedures have been proposed. In conclusion, this study stresses the need for a continuous patient dose monitoring in interventional procedures with a special emphasis in IC procedures. Common strategies must be undertaken to substantially reduce radiation doses to both patients and medical staff.

Musculoskeletal disorders in interventional radiology workers: an integrative review

“…Wilson-Stewart et al 11 ressaltam que a não utilização, ou a utilização incorreta destes dispositivos, pode favorecer o excesso de dose recomendado à equipe. Uma pesquisa argelina feita em 2016 indica que o uso da vestimenta correta pode reduzir para menos de 10% a exposição de dose efetiva anual em cardiologistas intervencionistas e o conjunto de avental e protetor de tireoide reduz a menos de 4% essa exposição 12 . A pesquisa ainda aponta como erro principal do profissional, a baixa adesão ao uso de óculos de proteção, contribuindo para extrapolar o limite de dose anual para o cristalino.…”

“…Segundo Klein et al 13 , existe uma associação entre o uso das vestimentas de chumbo e dor nas costas, quadris, joelhos e tornozelos, ultrapassando um quarto dos profissionais estudados. Outra relação encontrada no estudo americano é associação do tempo de trabalho com problemas na coluna de profissionais que trabalham no laboratório intervencionista 12 . O estudo de Benjamim & Meisinger 9 aponta que as queixas relacionadas à coluna ultrapassam 40% dos intervencionistas com mais de 10 anos de trabalho.…”

Comprehensive assessment of radiation dose in patients undergoing percutaneous coronary intervention: the effect of beam angulation on patient dose optimization

“…In recent years, invasive cardiovascular procedures have increased (3,(16)(17)(18) . At present, PCI is carried out in multi-vessel disease, small vessel disease, chronic total occlusion or even complete occlusion in acute myocardial infarction, which leads to longer irradiation time and eventually increased patient radiation exposure.…”

“…The discrepancy with here could be due to the following reasons: less complexity of the procedures (single stent), use of one X-ray system with the same technical parameters and similar clinical protocols. There has been a wide range of patients' doses for the same type of cardiac intervention procedures, where these variations can be explained by differences in operators' experience, complexity of procedures, clinical protocols, as well as differences in the X-ray system, image intensifier, and catheterization laboratory equipment (3,18,26,27) .…”

“…PCI is a non-surgical procedure used to open significantly narrowed or blocked coronary arteries and restore arterial blood flow to the heart tissue. Over the past few decades, the number of IC procedures has been steadily increasing for the following reasons: improvement in X-ray equipment, enhanced cardiologists' clinical skill levels, and advances in stent technologies (1)(2)(3). Nowadays, interventional cardiologists perform more complex PCI procedures which were previously impossible or required open surgery.…”