Radiation doses to the legs of radiologists performing interventional procedures: are they a cause for concern?

Abstract

The purpose of this study was to ascertain the magnitude and distribution of doses to the legs of radiologists when performing interventional procedures. LiF:Mg,Ti TLD100 chips were used to measure simultaneously doses to the lower limbs and, for comparison, the hands during 100 interventional procedures. Results show leg dose was dependent upon type and complexity of procedure, equipment used and whether lead protection was available. Where no lead protection was used, the doses to the lower limbs were frequently similar to or higher than those received by the hands. The mean dose to the legs ranged from 0.19 mSv to 2.61 mSv per procedure, compared with 0.04 mSv to 1.25 mSv to the hands. During transjugular intrahepatic portosystemic shunt and embolisation procedures the leg dose could be as much as 2-3 times greater than that to the hands. When lead protection was used, the dose to the legs was reduced significantly to 0.02 mSv to 0.5 mSv per procedure. A clear linear relationship was shown between the dose-area product (DAP) reading and the dose to the feet of the radiologist. As a "rule of thumb", a DAP reading of 100 Gy cm(2) will give a dose of 1 mSv to the legs, if no lead protection was used, dropping to approximately 0.02 mSv if lead protection was present. This study demonstrates that the dose to the legs of radiologists can be higher than that to the hands when no lead protection is used. The inclusion of a lead screen to protect the legs is an effective method of dose reduction when performing interventional procedures.

Occupational radiation doses to the extremities and the eyes in interventional radiology and cardiology procedures

“…In IR, the highest doses were recorded in vertebroplasty (5239 mSv at the left wrist and 1129 mSv at the eyes) and TIPSS (1959 mSv at the left leg). However, doses associated with these procedures are likely to be high, as they are commonly the longest procedures undertaken and require the use of several different projections [17,18]. Additionally, in these procedures the physicians need to be close to the patient's side in an area of relatively high scatter dose rate in order to manipulate the catheter effectively [17].…”

“…However, doses associated with these procedures are likely to be high, as they are commonly the longest procedures undertaken and require the use of several different projections [17,18]. Additionally, in these procedures the physicians need to be close to the patient's side in an area of relatively high scatter dose rate in order to manipulate the catheter effectively [17]. Because of the nature of the interventional procedures, which involve manipulation of devices through catheters, it is impossible to avoid the hands being exposed to radiation scattered from the patient.…”

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

“…Readers are directed to the extensive work in the literature [2,[54][55][56]. The magnitude and distribution of scattered radiation are affected by many factors, including patient size, gantry angulation, patient position, filtration, fluoroscopic settings, and the use of shielding.…”

An overview on extremity dosimetry in medical applications

“…Although some studies found some good correlation between staff doses and DAP values (3,8,11) , generally a wide range of radiation exposure relative to patient dose is found (5,10,12) . The bad correlation can be explained by different parameters that affect the extremity doses such as protective devices and especially different protocols followed by the staff.…”

“…For other interventional procedures (embolisation, stent placements and vertebroplasty), following range of hand doses are reported (6 -9) : 50-630 mSv per procedure. If lead protection is not used, the dose to the feet may range from 320 to 2640 mSv per procedure, which exceeds the hand exposure during the same procedure (8) . Studies (3,4,7,10) on IC procedures (CA, PTCA and ablations) report shoulder doses between 10 and 100 mSv per procedure, feet doses between 10 and 200 mSv per procedure and hand doses between 260 and 350 mSv per procedure.…”