Eye lens dose in interventional cardiology

Principi, Sara; Soler, Concepció; Ginjaume, M.; Beltran, M.; Rovira-Escutia, Juan J.; Duch, M.A.

doi:10.1093/rpd/ncv051

Cited by 47 publications

(37 citation statements)

References 9 publications

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“…Professional cataract is a well-known problem in invasive cardiology workers and is distinguished from naturally occurring cataract forms as it occurs in the posterior pole of the lens [33][34][35]. Since recognition of this issue, the permitted dose to the lens of the eye had been dramatically reduced from 150 mSv yr −1 to 20 mSv yr −1 in 2011 [36]. As standard shielding does not completely eliminate the measurable radiation scatter at the operator's head level nor reduce the secondary radiation reflected from the operating room walls, the use of protective eyewear (leaded glasses with side panels or a 180° helmet) is highly recommended [8,32,36].…”

Section: Discussionmentioning

confidence: 99%

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

2016

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Ionizing radiation management is among the most important safety issues in interventional cardiology. Multiple radiation protection measures allow the minimization of x-ray exposure during interventional procedures.Our purpose was to assess the utilization and effectiveness of radiation protection and optim ization techniques among interventional cardiologists in Lithuania.Interventional cardiologists of five cardiac centres were interviewed by anonymized questionnaire, addressing personal use of protective garments, shielding, table/detector positioning, frame rate (FR), resolution, field of view adjustment and collimation. Effective patient doses were compared between operators who work with and without x-ray optimization.Thirty one (68.9%) out of 45 Lithuanian interventional cardiologists participated in the survey. Protective aprons were universally used, but not the thyroid collars; 35.5% (n = 11) operators use protective eyewear and 12.9% (n = 4) wear radio-protective caps; 83.9% (n = 26) use overhanging shields, 58.1% (n = 18)-portable barriers; 12.9% (n = 4)-abdominal patient's shielding; 35.5% (n = 11) work at a high table position; 87.1% (n = 27) keep an image intensifier/receiver close to the patient; 58.1% (n = 18) reduce the fluoroscopy FR; 6.5% (n = 2) reduce the fluoro image detail resolution; 83.9% (n = 26) use a 'store fluoro' option; 41.9% (N = 13) reduce magnification for catheter transit; 51.6% (n = 16) limit image magnification; and 35.5% (n = 11) use image collimation. Median effective patient doses Practical Matter Society for Radiological ProtectionOriginal content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI. were significantly lower with x-ray optimization techniques in both diagnostic and therapeutic interventions. Many of the ionizing radiation exposure reduction tools and techniques are underused by a considerable proportion of interventional cardiology operators. The application of basic radiation protection tools and techniques effectively reduces ionizing radiation exposure and should be routinely used in practice.

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Section: Discussionmentioning

confidence: 99%

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

2016

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“…This may be the premise for much of the current literature focusing on the dose to operators as they are positioned closer to the patient while performing examinations. Of the authors that have investigated the dose to nursing staff in vascular procedures, many have identified that nurses receive less dose than operators (Antic et al, ; Domienik et al, ; Omar et al, ; Principi et al, ). The advantage of the scout nurse being able to maximize their distance from the source is reflected in the lower doses received when compared with the doctor and scrub nurse.…”

Section: Discussionmentioning

confidence: 99%

“…This may be the premise for much of the current literature focusing on the dose to operators as they are positioned closer to the patient while performing examinations. Of the authors that have investigated the dose to nursing staff in vascular procedures, many have identified that nurses receive less dose than operators (Antic et al, 2013;Domienik et al, 2012;Omar et al, 2017;Principi et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Occupational radiation exposure to the head is higher for scrub nurses than cardiologists during cardiac angiography

Wilson‐Stewart

Härtel

Fontanarosa

2019

Journal of Advanced Nursing

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Aims This study aimed to compare the head dose of a cardiologist to scrub and scout nurses during cardiac angiography. Design A correlational longitudinal quantitative design was used to examine the relationship between the variable of occupational dose to the medical operator when compared with the dose to the scrub and scout nurses. Methods A quantitative analysis was performed on data collected during coronary angiograms (N = 612) for one cardiologist and 22 nurses performing either the scrub or scout role between May 2015 and February 2017. Analysis was based on log‐transformed dose levels and reported as geometric means and associated 95% confidence intervals. Results It was found that scrub nurses received on average 41% more head dose than the cardiologist during diagnostic procedures and 52% higher doses during interventional cases. Conclusion Nurses working in fluoroscopic cardiovascular procedures should be provided with appropriate training and protective equipment, notably lead skull caps, to minimize their occupational radiation exposure. Impact There is a notable lack of research evaluating the occupational head and eye exposure to nurses involved in fluoroscopic procedures. This study found that during diagnostic coronary angiograms, the scrub nurses received 41% more occupational head dose than the cardiologist and 52% higher head doses during interventional cases. Radial access resulted in higher doses to scrub nurses than femoral artery access. It is advisable that staff wear protective lead glasses and skull caps and use appropriately positioned ceiling mounted lead shields to minimize the risk of adverse effects of occupational exposure to ionizing radiation.

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“…The importance of careful positioning of the movable ceiling mounted lead shield has been previously reported especially when using biplane equipment, and this was echoed in the reviewed literature . Several authors declared the absence of ceiling and table‐mounted lead shields when no other additional lead protection such as lead glasses or skull caps were worn by staff .…”

Section: Methodsmentioning

confidence: 98%

“…Variations in accessibility and utilization of lead shielding devices by staff in fluoroscopic suites have been well documented and this has been reflected in reported use of personal protection in the reviewed studies (Table ). Thyroid shields were either not worn or inconsistently worn by staff at some centers . Only one reviewed article specifically articulated the use of a lead skull cap during fluoroscopic procedures and was utilized by the operator only .…”

Section: Methodsmentioning

confidence: 99%

Occupational radiation exposure to nursing staff during cardiovascular fluoroscopic procedures: A review of the literature

Wilson‐Stewart

Shanahan

Fontanarosa

et al. 2018

J Applied Clin Med Phys

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Fluoroscopy is a method used to provide real time x‐ray imaging of the body during medical procedures to assist with medical diagnosis and treatment. Recent technological advances have seen an increase in the number of fluoroscopic examinations being performed. Nurses are an integral part of the team conducting fluoroscopic investigations and are often located close to the patient resulting in an occupational exposure to radiation. The purpose of this review was to examine recent literature which investigates occupational exposure received by nursing staff during cardiovascular fluoroscopic procedures. Articles published between 2011 and 2017 have been searched and comprehensively reviewed on the referenced medical search engines. Twenty‐four relevant studies were identified among which seventeen investigated nursing dose comparative to operator dose. Seven researched the effectiveness of interventions in reducing occupational exposure to nursing staff. While doctors remain at the highest risk of exposure during procedures, evidence suggests that nursing staff may be at risk of exceeding recommended dose limits in some circumstances. There is also evidence of inconsistent use of personal protection such as lead glasses and skull caps by nursing staff to minimize radiation exposure. Conclusions: The review has highlighted a lack of published literature focussing on dose to nurses. There is a need for future research in this area to inform nursing staff of factors which may contribute to high occupational doses and of methods for minimizing the risk of exposure, particularly regarding the importance of utilizing radiation protective equipment.

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Eye lens dose in interventional cardiology

Cited by 47 publications

References 9 publications

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

Occupational radiation exposure to the head is higher for scrub nurses than cardiologists during cardiac angiography

Occupational radiation exposure to nursing staff during cardiovascular fluoroscopic procedures: A review of the literature

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