Occupational radiation exposure to the lens of the eyes and its protection during endoscopic retrograde cholangiopancreatography

Ikezawa, Kenji; Hayashi, Shiro; Takenaka, Mamoru; Yakushijin, Takayuki; Nagaike, Koji; Takada, Ryoji; Yamai, Takuo; Matsumoto, Kengo; Yamamoto, Masashi; Omoto, Shunsuke; Minaga, Kosuke; Ishii, Shuji; Shimizu, Takeshi; Nagai, Kengo; Hosono, Makoto; Nishida, Tsutomu

doi:10.1038/s41598-023-34740-5

Cited by 14 publications

(7 citation statements)

References 32 publications

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“…The European Society of Gastrointestinal Endoscopy (ESGE) suggests DAP dose reference levels of 20-50 Gy*m 2 for conventional ERCP procedures, and comparable average DAP (13-66 Gy*m 2 ) values were suggested in a recent review [5,9]. In the current study, the mean DAP for C-ERCP was 16.31 Gy*m 2 (or 1631 ± 135 µGy*cm 2 ) which is in accordance with these guidelines and with recent data from the literature, illustrating the correct use of fluoroscopy during the C-ERCP procedures in the current study [5,9,18,19]. The obtained DAP data are even at the lower end of the acceptable dose reference levels range.…”

Section: Discussionsupporting

confidence: 89%

Patient Radiation Exposure during Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy (with Video)

Monino,

Moreels

2024

Diagnostics

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Background: Fluoroscopy must be used cautiously during endoscopic retrograde cholangiopancreatography (ERCP). Radiation exposure data in patients with surgically altered anatomy undergoing enteroscopy-assisted ERCP (EA-ERCP) are scarce. Methods: 34 consecutive EA-ERCP procedures were compared with 68 conventional ERCP (C-ERCP) procedures. Patient and procedure characteristics and radiation data were collected. Results: Surgical reconstructions were gastrojejunostomy, Roux-en-Y hepaticojejunostomy, Roux-en-Y total gastrectomy, Roux-en-Y gastric bypass and Whipple’s duodenopancreatectomy. Procedures were restricted to biliary indications. Mean fluoroscopy time was comparable in both groups (370 ± 30 s EA-ERCP vs. 393 ± 40 s C-ERCP, p = 0.7074), whereas total mean radiation dose was lower in EA-ERCP (83 ± 6 mGy) compared to C-ERCP (110 ± 11 mGy, p = 0.0491) and dose area product (DAP) was higher in EA-ERCP (2216 ± 173 µGy*m2) compared to C-ERCP (1600 ± 117 µGy*m2, p = 0.0038), as was total procedure time (77 ± 5 min vs. 39 ± 3 min, p < 0.0001). Enteroscope insertion to reach the bile duct during EA-ERCP took 28 ± 4 min, ranging from 4 to 90 min. These results indicate that C-ERCP procedures are generally more complex, needing magnified fluoroscopy, whereas EA-ERCP procedures take more time for enteroscope insertion under wide field fluoroscopic guidance (increased DAP) with less complex ERCP manipulation (lower total radiation dose). Conclusions: Radiation exposure during EA-ERCP in surgically altered anatomy is different as compared to C-ERCP. EA-ERCP takes longer with a higher DAP because of the enteroscope insertion, but with lower total radiation dose because these ERCP procedures are usually less complex.

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Section: Discussionsupporting

confidence: 89%

Patient Radiation Exposure during Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy (with Video)

Monino,

Moreels

2024

Diagnostics

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“…If the over-couch X-ray tube geometry is unavoidable, it is essential to use radioprotective curtains with a curtain length of 75% or greater. Ikezawa et al [ 31 ] performed multi-center, prospective observational study, and the median estimated annual radiation doses to the eye lens during ERCP was shown to be 3.7 mSv for operators, which was approximately equivalent to the H p (3) for the left eye surface of the operator phantom at the curtain lengths of 75% and 100% in the present study (3.47 and 3.08 mSv, respectively).…”

Section: Discussionsupporting

confidence: 52%

Effect of radioprotective curtain length on the scattered dose rate distribution and endoscopist eye lens dose with an over-couch fluoroscopy system

Matsubara,

Nakajima,

Hirosawa

et al. 2024

Phys Eng Sci Med

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Sufficient dose reduction may not be achieved if radioprotective curtains are folded. This study aimed to evaluate the scattered dose rate distribution and physician eye lens dose at different curtain lengths. Using an over-couch fluoroscopy system, dH*(10)/dt was measured using a survey meter 150 cm from the floor at 29 positions in the examination room when the curtain lengths were 0% (no curtain), 50%, 75%, and 100%. The absorbed dose rates in the air at the positions of endoscopist and assistant were calculated using a Monte Carlo simulation by varying the curtain length from 0 to 100%. The air kerma was measured by 10 min fluoroscopy using optically stimulated luminescence dosimeters at the eye surfaces of the endoscopist phantom and the outside and inside of the radioprotective goggles. At curtain lengths of 50%, 75%, and 100%, the ratios of dH*(10)/dt relative to 0% ranged from 80.8 to 104.1%, 10.5 to 61.0%, and 11.8 to 24.8%, respectively. In the simulation, the absorbed dose rates at the endoscopist’s and assistant’s positions changed rapidly between 55 and 75% and 65% and 80% of the curtain length, respectively. At the 0%, 50%, 75%, and 100% curtain lengths, the air kerma at the left eye surface of the endoscopist phantom was 237 ± 29, 271 ± 30, 37.7 ± 7.5, and 33.5 ± 6.1 μGy, respectively. Therefore, a curtain length of 75% or greater is required to achieve a sufficient eye lens dose reduction effect at the position of the endoscopist.

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“…In general, IVR physicians have a higher radiation dose on the left than right side, because it is nearer to the source of scattered radiation [ 60 , 61 , 62 , 63 , 64 , 65 ]; therefore, IVR physicians wear the lens dosimeter near the left eye.…”

Section: Discussionmentioning

confidence: 99%

Eye Lens Radiation Dose to Nurses during Cardiac Interventional Radiology: An Initial Study

Yamada,

Haga,

Sota

et al. 2023

Diagnostics

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Although interventional radiology (IVR) is preferred over surgical procedures because it is less invasive, it results in increased radiation exposure due to long fluoroscopy times and the need for frequent imaging. Nurses engaged in cardiac IVR receive the highest lens radiation doses among medical workers, after physicians. Hence, it is important to measure the lens exposure of IVR nurses accurately. Very few studies have evaluated IVR nurse lens doses using direct dosimeters. This study was conducted using direct eye dosimeters to determine the occupational eye dose of nurses engaged in cardiac IVR, and to identify simple and accurate methods to evaluate the lens dose received by nurses. Over 6 months, in a catheterization laboratory, we measured the occupational dose to the eyes (3 mm dose equivalent) and neck (0.07 mm dose equivalent) of nurses on the right and left sides. We investigated the relationship between lens and neck doses, and found a significant correlation. Hence, it may be possible to estimate the lens dose from the neck badge dose. We also evaluated the appropriate position (left or right) of eye dosimeters for IVR nurses. Although there was little difference between the mean doses to the right and left eyes, that to the right eye was slightly higher. In addition, we investigated whether it is possible to estimate doses received by IVR nurses from patient dose parameters. There were significant correlations between the measured doses to the neck and lens, and the patient dose parameters (fluoroscopy time and air kerma), implying that these parameters could be used to estimate the lens dose. However, it may be difficult to determine the lens dose of IVR nurses accurately from neck badges or patient dose parameters because of variation in the behaviors of nurses and the procedure type. Therefore, neck doses and patient dose parameters do not correlate well with the radiation eye doses of individual IVR nurses measured by personal eye dosimeters. For IVR nurses with higher eye doses, more accurate measurement of the radiation doses is required. We recommend that a lens dosimeter be worn near the eyes to measure the lens dose to IVR nurses accurately, especially those exposed to relatively high doses.

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Occupational radiation exposure to the lens of the eyes and its protection during endoscopic retrograde cholangiopancreatography

Cited by 14 publications

References 32 publications

Patient Radiation Exposure during Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy (with Video)

Patient Radiation Exposure during Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy (with Video)

Effect of radioprotective curtain length on the scattered dose rate distribution and endoscopist eye lens dose with an over-couch fluoroscopy system

Eye Lens Radiation Dose to Nurses during Cardiac Interventional Radiology: An Initial Study

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