Radiation exposure in interventional procedures

Abstract

The aim of this study was to estimate radiation doses patients and staff are exposed to during interventional procedures (IPs), compare them with the international diagnostic reference levels and to develop initial National Diagnostic Reference Levels. The IP survey was undertaken as the initial task of which, retrospective data were collected from the only four Kenyan hospitals carrying out interventional radiology and cardiology procedures at the time of the study. Real-time measurement of radiation dose to patients and staff during these procedures was done. To the patients, kerma-area product (KAP) and fluoroscopy time measurements were done using an in-built KAP meter, while peak skin dose (PSD) was measured using slow Extended Dose Range (EDR2(®)) radiographic films. The staff occupational doses were measured using individual thermoluminescence dosemeters. The maximum and minimum KAP values were found to be 137.1 and 4.2 Gy cm(2), while the measured PSD values were 740 and 52 mGy, respectively. The fluoroscopic time range was between 3.3 and 70 min. The staff doses per procedure ranged between 0.05 and 1.41 mSv for medical doctors, 0.03 and 1.16 mSv for nurses, 0.04 and 0.78 mSv for radiographers and 0.04 and 0.88 mSv for clinical staff. The measured patient PSDs were within the threshold limit for skin injuries. However, with the current few IP specialists, an annual increase in workload as determined in the study will result in the International Commission on Radiation Protection annual eye lens dose limit being exceeded by 10 %. A concerted effort is required to contain these dose levels through use of protective gear, optimisation of practice and justification.

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

“…This resulted in a decrease in annual effective dose from 1.33 to 0.47 mSv, which corresponds to similar studies . Several authors articulated the need for appropriate training to heighten staff awareness to ideally result in the active participation of staff in optimizing occupational exposure …”

“…reported that a single monitored nurse, due to her proximity to the x‐ray tube and her habit of bowing her head during procedures, resulted in a similar eye exposure as the operator . If findings of nursing dose measured of 0.27 mSv per case at the collar in Korir et al . study were extrapolated, nurses would exceed the eye dose after only 75 cases.…”

“…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 .…”

“…It has been demonstrated that the dose to nursing staff during fluoroscopic procedures can be similar or higher than that received by the physician with evidence of an increasing trend toward higher dose levels to nurses working in this environment . It is therefore important to quantify the radiation exposure to individuals working within fluoroscopic departments …”

“…Nursing staff may undertake several roles within fluoroscopic suites, and the in‐room location of the nurse may vary during procedures. In many of the reviewed articles, the role of the nurse was not well‐defined and it was unclear whether staff were performing the scrub or scout role and consequently reported data may represent an average of the dose of both duties.…”