Occupational eye lens dose in endoscopic retrograde cholangiopancreatography using a dedicated eye lens dosimeter

Abstract

Increased x-ray exposure to physicians’ eye lenses during radiology procedures is a significant concern. In this study, x-ray exposure to the eye was measured using an anthropomorphic head phantom, with and without radiation-protective devices, to examine the dose of x-ray radiation that physicians are exposed to during endoscopic retrograde cholangiopancreatography (ERCP). X-ray exposure of the eye was measured using novel dedicated direct eye lens dosimeters that could specifically measure H p(3) during the ERCP procedure. The spatial dose in the height direction of the physician was measured using an ionization chamber dosimeter. Eye dosimeters were attached inside and outside the lead (Pb) glasses attached to the head of the human phantom to demonstrate its protective effect. Irradiation from the system lasted for 30 min. When the overcouch x-ray tube system is used, the cumulative radiation dose over the 30 min x-ray fluoroscopy time, without the use of radiation-protective devices, to the left and right eyes was 3.7 and 1.5 mSv, respectively. This dose was estimated to be the dose to the lens per therapeutic ERCP examination. With radiation-protective glasses, the dose reduced to 1.8 and 1.0 mSv for the left and right eye, respectively. The results of our study indicated that radiation exposure to the eye was reduced by up to 80.0% using Pb glasses and by 96.8% using radiation-protective curtains. Our study indicates that a physician’s maximum radiation exposure to the eyes during an ERCP procedure may be above the level recommended by the International Commission on Radiological Protection when the physician does not use radiation-protective devices. The eyewear, which is larger and fitted more closely to the face, provided a better protection effect even with a low lead equivalence, demonstrating that the shape of eyewear is important for protective function.

Radiation exposure to staff during fluoroscopic endoscopic procedures

“…A recent meta‐analysis found that the dose to the lens of the eye was even higher, 18 µSv/procedure for fixed effect analysis and 139 µSv/procedure for random effect analysis. 12 Based on our results and those found in the literature, 11 , 12 , 13 , 14 , 15 approaching or exceeding the annual dose constraint for the lens of the eye may be possible. Thus, the authors recommend that staff within 1m of the patient utilize radioprotective eyewear.…”

Evaluation of a New Real-Time Dosimeter Sensor for Interventional Radiology Staff

“…Dosimeters placed in the vicinity of the lens, such as the Eye-D and DOSIRIS, can also be used [ 26 , 48 , 49 , 50 , 51 , 52 ]; the passive DOSIRIS dosimeter, which does not provide real-time monitoring, was designed to measure the lens dose, but the real-time i3 system may be more effective for reducing occupational doses. The use of dosimeters such as the i3 will be valuable in situations such as IVR, in which exposure doses are high and instantaneous monitoring is required [ 53 , 54 , 55 , 56 , 57 , 58 ].…”

Occupational radiation dose from gastrointestinal endoscopy procedures with special emphasis on eye lens doses in endoscopic retrograde cholangiopancreatography

“…Regarding these essential dose aspects, the occupational exposure in gastrointestinal endoscopy procedures may be kept very low when proper optimization practices are followed. However, some of the previous studies focused on operator ocular doses have anticipated that the given annual dose limit for the eye lenses may be exceeded in surgeons who frequently perform ERCP procedures [15][16][17]. Based on the measured personal dose equivalents of this study, monitoring interventionists' eye lens doses with a specific dosimeter is not required in dose-optimized gastrointestinal endoscopy procedures.…”

“…Similarly, the eye lens doses were measured by positioning TLDs outside the leaded eyewear. As protective glasses typically lower the eye lens dose by 50-80 %, a conversion factor of 0.5 may be used to estimate H p (3) under the glasses to account for the effect of protective glasses [17,20,24,25]. Regarding these essential dose aspects, the occupational exposure in gastrointestinal endoscopy procedures may be kept very low when proper optimization practices are followed.…”

“…Previous studies have shown occupational radiation dose to eyes to vary in ERCP from 10 to > 100 µSv, depending especially on operator, the fluoroscopy system used, and x-ray tube position during the procedure [14][15][16]. Some studies have also anticipated that the annual dose limits for eye lenses could be exceeded in medical staff who frequently perform ERCP procedures [15][16][17].…”