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

Abstract

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.

Taller staff occupationally exposed to less radiation to the temple in cardiac procedures, but risk higher doses during vascular cases

“…BMI was found to affect dose levels to staff. This is unsurprising as the greater thickness of tissue an X-ray beam has to traverse, the higher number of X-rays are required, with a proportionally more substantial amount of scattered radiation incident on staff, which has been demonstrated previously 28 . When relatively large volumes of contrast were used, this was also shown to alter the trends of occupational dose as a predictor of temple dose, and this effect is understandable as larger volumes of contrast administered during an angiogram may be an indicator of greater procedural complexity.…”

“…Scrub nurses are generally positioned further away from the most significant source of x-ray scatter, which suppositionally reduces their level of exposure compared to the doctor. Still, it has been reported that nursing staff may be exposed to higher levels of radiation than the doctor due to the shelter provided by the CMLS 28 – 30 , and this may be a contributing factor in the increased dose to scrub nurses. The presence of the X-ray detector has also been identified as providing an incidental protective barrier to doctors’ heads by absorbing X-ray photons, depending on the position of the doctor 18 , 31 .…”

Impact of dose reducing software on patient and staff temple dose during fluoroscopically guided pacemaker insertion, closure devices implantation and coronary angiography procedures

“…It has been previously reported that if the movable lead shield is located directly in front of the fluoroscopic operator, it may afford protection only to that person. Hence, although the scrub nurse is positioned further away from the maximum area of scattered radiation, the absence of a physical barrier may result in a higher dose than the operator[ 39 ]. Another possible reason for increased dose during diagnostic coronary angiography is the inclusion of cases performed by non-interventional cardiologists, who may be less aware of radiation minimization strategies, leading to increased patient and staff dose.…”

Occupational and Patient Radiation Dose and Quality Implications of Femoral Access Imaging During Coronary Angiography

“…12 , 21 It has been previously reported that scrub or assistant dose is lower than that of the cardiologist ( table 6 ), 22 but this study has demonstrated a higher average dose received by the scrub nurse compared to the cardiologist, confirming the previous results published by our group. 23 This is postulated to be a result of the positioning of the ceiling-mounted lead directly in front of the cardiologist, providing a protective effect for them, but not staff adjacent to them. 23 Given the greater number of procedures, a nurse is typically involved in compared with a dr, this is cause for concern.…”

“… 23 This is postulated to be a result of the positioning of the ceiling-mounted lead directly in front of the cardiologist, providing a protective effect for them, but not staff adjacent to them. 23 Given the greater number of procedures, a nurse is typically involved in compared with a dr, this is cause for concern. Procedures performed on the angiographic system without the dose reducing software was associated with a significant increase in dose to staff, which has been demonstrated previously.…”