Cataract risk in US radiologic technologists assisting with fluoroscopically guided interventional procedures: a retrospective cohort study

Abstract

ObjectivesTo assess radiation exposure-related work history and risk of cataract and cataract surgery among radiologic technologists assisting with fluoroscopically guided interventional procedures (FGIP).MethodsThis retrospective study included 35 751 radiologic technologists who reported being cataract-free at baseline (1994–1998) and completed a follow-up questionnaire (2013–2014). Frequencies of assisting with 21 types of FGIP and use of radiation protection equipment during five time periods (before 1970, 1970–1979, 1980–1989, 1990–1999, 2000–2009) were derived from an additional self-administered questionnaire in 2013–2014. Multivariable-adjusted relative risks (RRs) for self-reported cataract diagnosis and cataract surgery were estimated according to FGIP work history.ResultsDuring follow-up, 9372 technologists reported incident physician-diagnosed cataract; 4278 of incident cases reported undergoing cataract surgery. Technologists who ever assisted with FGIP had increased risk for cataract compared with those who never assisted with FGIP (RR: 1.18, 95% CI 1.11 to 1.25). Risk increased with increasing cumulative number of FGIP; the RR for technologists who assisted with >5000 FGIP compared with those who never assisted was 1.38 (95% CI 1.24 to 1.53; p trend <0.001). These associations were more pronounced for FGIP when technologists were located ≤3 feet (≤0.9 m) from the patient compared with >3 feet (>0.9 m) (RRs for >5000 at ≤3 feet vs never FGIP were 1.48, 95% CI 1.27 to 1.74 and 1.15, 95% CI 0.98 to 1.35, respectively; pdifference=0.04). Similar risks, although not statistically significant, were observed for cataract surgery.ConclusionTechnologists who reported assisting with FGIP, particularly high-volume FGIP within 3 feet of the patient, had increased risk of incident cataract. Additional investigation should evaluate estimated dose response and medically validated cataract type.

Occupational Doses to Medical Staff Performing or Assisting with Fluoroscopically Guided Interventional Procedures

“…1. The H p (10) collar -to-H p (10) waist ratio should be greater than 4. A ratio of 4 or less is expected if the badge locations are reversed or if the badges are inconsistently used.…”

“…The dosimetry information included operational quantities of personal dose equivalent at a reference depth of 10 mm and 3 mm, H p (10) and H p (3), respectively, and a calculated estimate of the protection quantity of effective dose equivalent, H E . Dose readings came from Luxel+ dosimeters (Landauer).…”

“…where H E is the effective dose equivalent and H p (10) collar is the personal dose equivalent at a reference depth of 10 mm measured at the collar level above the lead apron. For workers monitored with the two-badge protocol, we used the equation (2), where H p (10) waist is the personal dose equivalent at a reference depth of 10 mm measured at the waist underneath the lead apron.…”

“…Working in this environment for a prolonged period without proper radiation safety training or the use of personal protective equipment may lead to occupational doses in excess of regulatory limits. Highquality dosimetry information pertaining to occupational exposure levels is needed to better inform radiation protection practices and for application in epidemiologic studies designed to study radiation-related risks of cataracts, cancer, and other serious diseases (7)(8)(9)(10)(11)(12). However, past studies of occupational exposures for this group of workers reported doses on a per-procedure basis.…”

Catheter strategy to ease the procedure and reduce radiation exposure when requiring neck access

“…This is remarkable because not all body parts can be leadprotected, and there is evidence that unprotected parts of the body carry an increased risk of certain cancers. [20][21][22][23] Most cardiac catheter laboratories are set up so that the PO stands on the patient's right side. Most fixed radiation barriers are therefore positioned accordingly.…”