International project on individual monitoring and radiation exposure levels in interventional cardiology

Padovani, R.; Heron, John Le; Cruz-Suarez, R.; Durán, Ana C.; Lefaure, C.; Miller, Donald L.; Sim, H K; Vañó, Eliseo; Rehani, Madan M.; Czarwinski, Renate

doi:10.1093/rpd/ncq326

Cited by 37 publications

(27 citation statements)

References 5 publications

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“…In the absence of such a registry, it is often not possible to obtain complete film badge data for individual operators. Another critical problem limiting determination of cumulative doses is the likely underestimation of doses for the unknown but non-trivial proportion of physicians who do not wear film badges consistently (Marx et al 1992, Padovani et al 2011). …”

Section: Discussionmentioning

confidence: 99%

“…The International Atomic Energy Agency (IAEA) has begun an Information System on Occupational Exposure in Medicine, Industry and Research (ISEMIR). Its Working Group on Interventional Cardiology (WGIC) has proposed establishment of an international database of occupational exposures of staff working in interventional cardiology facilities (Padovani et al 2011). …”

Section: Introductionmentioning

confidence: 99%

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Occupational Radiation Doses to Operators Performing Fluoroscopically-Guided Procedures

Kim

Miller²,

González³

et al. 2012

Health Physics

147

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In the past 30 years, the numbers and types of fluoroscopically-guided (FG) procedures have increased dramatically. The objective of the present study is to provide estimated radiation doses to physician specialists, other than cardiologists, who perform FG procedures. We searched Medline to identify English-language journal articles reporting radiation exposures to these physicians. We then identified several primarily therapeutic FG procedures that met specific criteria: well-defined procedures for which there were at least five published reports of estimated radiation doses to the operator, procedures performed frequently in current medical practice, and inclusion of physicians from multiple medical specialties. These procedures were percutaneous nephrolithotomy (PCNL), vertebroplasty, orthopedic extremity nailing for treatment of fractures, biliary tract procedures, transjugular intrahepatic portosystemic shunt creation (TIPS), head/neck endovascular therapeutic procedures, and endoscopic retrograde cholangiopancreatography (ERCP). We abstracted radiation doses and other associated data, and estimated effective dose to operators. Operators received estimated doses per patient procedure equivalent to doses received by interventional cardiologists. The estimated effective dose per case ranged from 1.7 – 56μSv for PCNL, 0.1 – 101 μSv for vertebroplasty, 2.5 – 88μSv for orthopedic extremity nailing, 2.0 – 46μSv for biliary tract procedures, 2.5 – 74μSv for TIPS, 1.8 – 53μSv for head/neck endovascular therapeutic procedures, and 0.2 – 49μSv for ERCP. Overall, mean operator radiation dose per case measured over personal protective devices at different anatomic sites on the head and body ranged from 19 – 800 (median = 113) μSv at eye level, 6 – 1180 (median = 75)μSv at the neck, and 2 – 1600 (median = 302) μSv at the trunk. Operators’ hands often received greater doses than the eyes, neck or trunk. Large variations in operator doses suggest that optimizing procedure protocols and proper use of protective devices and shields might reduce occupational radiation dose substantially.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Occupational Radiation Doses to Operators Performing Fluoroscopically-Guided Procedures

Kim

Miller²,

González³

et al. 2012

Health Physics

147

View full text Add to dashboard Cite

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“…Due to the aforementioned challenges, we chose not to include estimated lens dose, which cannot be considered in such circumstances as objectively quantifiable, and we therefore chose to simply register presence or absence of radiation exposure status (yes or no) as the categorical variable. Individual dosimetry remains problematic, and alternative strategies will be needed [20] in order to more precisely evaluate the effects of radiation in specific occupational situations, since strict individual monitoring and strategic management will be necessary.…”

Section: Discussionmentioning

confidence: 99%

Quantitative evaluation of light scattering intensities of the crystalline lens for radiation related minimal change in interventional radiologists: a cross-sectional pilot study

Abe

Furui

Sekiya

et al. 2012

Journal of Radiation Research

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To evaluate low-dose X-ray radiation effects on the eye by measuring the amount of light scattering in specific regions of the lens, we compared exposed subjects (interventional radiologists) with unexposed subjects (employees of medical service companies), as a pilot study. According to numerous exclusionary rules, subjects with confounding variables contributing to cataract formation were excluded. Left eye examinations were performed on 68 exposed subjects and 171 unexposed subjects. The eye examinations consisted of an initial screening examination, followed by Scheimpflug imaging of the lens using an anterior eye segment analysis system. The subjects were assessed for the quantity of light scattering intensities found in each of the six layers of the lens. Multiple stepwise regression analyses were performed with the stepwise regression for six variables: age, radiation exposure, smoking, drinking, wearing glasses and workplace. In addition, an age-matched comparison between exposed and unexposed subjects was performed. Minimal increased light scattering intensity in the posterior subcapsular region showed statistical significance. Our results indicate that occupational radiation exposure in interventional radiologists may affect the posterior subcapsular region of the lens. Since by its very nature this retrospective study had many limitations, further well-designed studies concerning minimal radiation-related lens changes should be carried out in a low-dose exposure group.

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“…Decreasing patient dose will result in a proportional decrease in scatter dose to the operator [34]. Therefore, techniques that reduce patient dose will generally also reduce the occupational dose [35].…”

Section: Cardiologist the Contemporary Radiologistmentioning

confidence: 99%

The Radiation Issue in Cardiology: the time for action is now

Picaño

Vañó

2011

Cardiovasc Ultrasound

137

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The "radiation issue" is the need to consider possible deterministic effects (e.g., skin injuries) and long-term cancer risks due to ionizing radiation in the risk-benefit assessment of diagnostic or therapeutic testing. Although there are currently no data showing that high-dose medical studies have actually increased the incidence of cancer, the "linear-no threshold" model in radioprotection assumes that no safe dose exists; all doses add up in determining cancer risks; and the risk increases linearly with increasing radiation dose. The possibility of deterministic effects should also be considered when skin or lens doses may be over the threshold. Cardiologists have a special mission to avoid unjustified or non-optimized use of radiation, since they are responsible for 45% of the entire cumulative effective dose of 3.0 mSv (similar to the radiological risk of 150 chest x-rays) per head per year to the US population from all medical sources except radiotherapy. In addition, interventional cardiologists have an exposure per head per year two to three times higher than that of radiologists. The most active and experienced interventional cardiologists in high volume cath labs have an annual exposure equivalent to around 5 mSv per head and a professional lifetime attributable to excess cancer risk on the order of magnitude of 1 in 100. Cardiologists are the contemporary radiologists but sometimes imperfectly aware of the radiological dose of the examination they prescribe or practice, which can range from the equivalent of 1-60 mSv around a reference dose average of 10-15 mSv for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multi-detector coronary angiography, or a myocardial perfusion imaging scintigraphy. A good cardiologist cannot be afraid of life-saving radiation, but must be afraid of radiation unawareness and negligence.

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International project on individual monitoring and radiation exposure levels in interventional cardiology

Cited by 37 publications

References 5 publications

Occupational Radiation Doses to Operators Performing Fluoroscopically-Guided Procedures

Occupational Radiation Doses to Operators Performing Fluoroscopically-Guided Procedures

Quantitative evaluation of light scattering intensities of the crystalline lens for radiation related minimal change in interventional radiologists: a cross-sectional pilot study

The Radiation Issue in Cardiology: the time for action is now

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