Occupational Radiation Protection in Interventional Radiology: A Joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology

Miller, Donald L.; Vañó, Eliseo; Bartal, Gabriel; Balter, Stephen; Dixon, Robert G.; Padovani, R.; Schueler, Beth A.; Cardella, John F.; Baère, Thierry De

doi:10.1016/j.jvir.2010.01.007

Cited by 158 publications

(120 citation statements)

References 48 publications

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“…Techniques that reduce patient dose also reduce the occupational dose to the operator. If adequate shielding is applied, the amount of scattered radiation under the protective operator garments can be considered minimal or even negligible [27,28]. The 0.5 mm lead equivalent absorbs up to 98% of scatter radiation [28,29].…”

Section: Discussionmentioning

confidence: 99%

“…If adequate shielding is applied, the amount of scattered radiation under the protective operator garments can be considered minimal or even negligible [27,28]. The 0.5 mm lead equivalent absorbs up to 98% of scatter radiation [28,29]. Protective personal garments should be inspected fluoroscopically on a regular basis to detect deterioration and defects in the protective material.…”

Section: Discussionmentioning

confidence: 99%

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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%

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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“…Current national and international guidelines 14 , 15 , 17 recommend against the use of RRG when the hands are placed in the FOV, primarily owing to limited hand protection they provide. While these guidelines also mention that the use of RRG in the FOV may result in an increase in patient dose, this work quantified the expected increase.…”

Section: Resultsmentioning

confidence: 99%

“…In the end, multiple authors 6 , 11 , 12 , 13 have recommended against the use of RRG owing to the fact that they offer only modest dose reduction. Published recommendations of the National Council on Radiation Protection, (14) the International Commission on Radiation Protection, 15 , 16 and guidelines of interventional radiology and cardiology professional societies (17) have made similar recommendations, discouraging the use of RRG, particularly when the hand is placed in the FOV.…”

Section: Introductionmentioning

confidence: 99%

Time to take the gloves off: the use of radiation reduction gloves can greatly increase patient dose

Pasciak

Jones

2014

J Applied Clin Med Phys

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Sterile radiation reduction gloves have been widely used over the past several decades in an effort to reduce hand doses during fluoroscopically guided procedures. While multiple studies have quantified the potential dose reduction to the fluoroscope operator from the use of such gloves, possible effects on the patient have not yet been quantified. The aim of this study was to examine the impact on patient dose when radiation reduction gloves are used. The impact on patient dose when using radiation reduction gloves in the field of view (FOV) was evaluated by measuring patient entrance surface dose rates (ESDR) using three C‐arm fluoroscopes for a range of patient sizes and different operating and magnification modes. Multiple measuring fields were used in combination with both peripheral and central glove placement. ESDR were measured with no glove in the FOV, with one radiation reduction glove, and with double gloves in the FOV, to replicate the actions of some fluoroscope operators. Compared to an ungloved hand, the use of a single radiation reduction glove in the measuring field resulted in up to a 2.8‐fold increase in ESDR. The use of double radiation reduction gloves resulted in up to a 4.9‐fold increase in ESDR. In both cases, the increase in ESDR was dependent on the size of the patient and on the operating and magnification modes used, and ranged from no increase up to the aforementioned maximum. When used in the FOV, and particularly within the measuring field, radiation reduction gloves can substantially increase ESDR. This increase in dose, when considered against the relatively small published reduction in dose to the operator's hands, may mean that the increased risks from the use of radiation reduction gloves outweigh the benefits. In any case, hands should not be placed in the FOV if not required by the goals of the procedure.PACS number: 87.59.C‐

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“…In the statement of the German Commission on Radiological Protection regarding the topic of "dose limits for occupational skin exposure to ionizing radiation", the above calculations are dismissed and surface personal dose measurement is greatly overestimated [31,32]. With the following additional radiation protection tools/ measures, the hand dose can be greatly minimized: Use of a needle holder, fluoroscopy with low tube current intensity (possibly with incremental adjustment, start thorax: 10 mA; abdomen: 30 mA) or lower tube voltage (≤ 120 kV), low collimation (≤ 4 mm to lower the scattered radiation), restrictive use of continuous fluoroscopy, "angular beam modulation", and, if possible, use of radiation protection gloves [17,20,33,35]. However, radiation protection gloves can give a false sense of security thus resulting in higher hand dose values [35].…”

Section: Biological Effect Of Radiation Exposure On the Handmentioning

confidence: 99%

Prospective Evaluation of the Radiologist's Hand Dose in CT-Guided Interventions

Rogits

Jungnickel

Löwenthal

et al. 2013

Fortschr Röntgenstr

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!Purpose: Assessment of radiologist's hand dose in CT-guided interventions and determination of influencing factors. Materials and Methods:The following CTguided interventions were included: Core biopsy, drainage, periradicular therapy, and celiac plexus neurolysis. The hand dose was measured with an immediately readable dosimeter, the EDD-30 (Unfors, Sweden). The default parameters for CT fluoroscopy were 120 kV, 90 mA and a 4 mm slice thickness. All interventions were performed on a 16-slice CT unit (Aquilion 16 Toshiba, Japan). The tumor size, degree of difficulty (1 -3), level of experience and device parameters (mAs, dose-length product, scan time) were documented. Results: 138 CT-guided interventions (biopsy n = 99, drainage n = 23, pain therapy n = 16) at different locations (lung n = 41, retroperitoneum n = 53, liver n = 25, spine n = 19) were included. The lesion size was 4 -240 mm (median: 23 mm). The fluoroscopy time per intervention was 4.6 -140.2 s (median: 24.2 s). The measured hand dose ranged from 0.001 -3.02 mSv (median: 0.22 mSv). The median hand dose for lung puncture (n = 41) was slightly higher (median: 0.32 mSv, p = 0.01) compared to that for the liver, retroperitoneum and other. Besides physical influencing factors, the degree of difficulty (p = 0.001) and summed puncture depth (p = 0.004) correlated significantly with the hand dose. Conclusion: The median hand dose for different CT-guided interventions was 0.22 mSv. Therefore, the annual hand dose limit would normally only be reached with about 2000 interventions. Key Points:▶ The hand dose exposure during CT fluoroscopically guided interventions was situated on a low level.▶ Due to the ambigious radiation risk estimates, additional radiation protection measures/tools should be provided.

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Occupational Radiation Protection in Interventional Radiology: A Joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology

Cited by 158 publications

References 48 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

Time to take the gloves off: the use of radiation reduction gloves can greatly increase patient dose

Prospective Evaluation of the Radiologist's Hand Dose in CT-Guided Interventions

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