Radiation-Induced Cataractogenesis: A Critical Literature Review for the Interventional Radiologist

Abstract

Extensive research supports an association between radiation exposure and cataractogenesis. New data suggests that radiation-induced cataracts may form stochastically, without a threshold and at low radiation doses. We first review data linking cataractogenesis with interventional work. We then analyze the lens dose typical of various procedures, factors modulating dose, and predicted annual dosages. We conclude by critically evaluating the literature describing techniques for lens protection, finding that leaded eyeglasses may offer inadequate protection and exploring the available data on alternative strategies for cataract prevention.

Influences of operator head posture and protective eyewear on eye lens doses in interventional radiology: A Monte Carlo Study

“…It is important to note that other aspects such as comfort and convenience should be considered as well. It is reported that because of discomfort, <30% of operators wear protective eyewear . There is a tradeoff between efficacy and comfort when choosing appropriate eyewear.…”

“…When the integrity of the epithelial cell layer is disrupted — such as through ionizing radiation interactions — cataracts may form as the lens loses its transparency. Although radiation‐induced cataracts are a well‐known effect of exposure to radiation, recent debates focus on whether they are formed deterministically or stochastically . In previous studies, it was believed that radiation‐induced cataracts develop deterministically and a threshold dose was required for detectable lens opacities.…”

“…Although radiation-induced cataracts are a well-known effect of exposure to radiation, recent debates focus on whether they are formed deterministically or stochastically. [1][2][3] In previous studies, [4][5][6] it was believed that radiation-induced cataracts develop deterministically and a threshold dose was required for detectable lens opacities. Recent data reveal that radiation-induced cataracts may occur stochastically; they may develop at a lower dose level or potentially with no dose threshold.…”

Minimally invasive lag screw fixation of sacroiliac luxation/fracture using a dedicated novel instrument system: Apparatus and technique description

“…The protective benefits of this simple yet highly effective method was originally assessed in a cadaveric hip‐pinning study in which a 750‐fold decrease in radiation was noted when the recording equipment was moved 45 cm away from the C‐arm . Although radiation exposure during fluoroscopically assisted procedures typically remains below acceptable levels, repeated exposure to low level radiation is a serious concern in the medical community because of its insidious, cumulative effects and its correlation with increased risk of malignant neoplasia (stochastic effect) or cataracts (nonstochastic effect) . This concern is exacerbated when the C‐arm is used in cine mode (also referred to as live fluoroscopy ).…”

Radiation and cataract risk: Impact of recent epidemiologic studies on ICRP judgments

“…The IVC studies have had to utilize retrospective dose reconstructions based on self-reports of numbers of IVC procedures, use of protective leaded glasses or shields, percent of time dosimeters were unworn or worn beneath leaded aprons, etc., so there are substantial individual dose uncertainties as well. Other limitations of the studies include: possible underreporting of exposures [46,47], inadequate age matching of the exposed and unexposed groups [25,45], mostly low grade opacities, and for some studies, little information on other cataract risk factors. Keeping in mind those caveats, lens opacity risks for IVC personnel are presented in Table 3, with approximate risks per Gy calculated for this table, assuming a linear dose response based on the rough study dose estimates.…”