Radiation Protection in Interventional Radiology/Cardiology—Is State-of-the-Art Equipment Used?

Abstract

Interventional radiology/cardiology is one of the fields with the highest radiation doses for workers. For this reason, the International Commission on Radiological Protection (ICRP) published new recommendations in 2018 to shield staff from radiation. This study sets out to establish the extent to which these recommendations are observed in Germany. For the study, areas were selected which are known to have relatively high radiation exposure along with good conditions for radiological protection—interventional cardiology, radiology and vascular surgery. The study was advertised with the aid of an information flyer which was distributed via organisations including the German Cardiac Society (Deutsche Gesellschaft für Kardiologie- Herz- und Kreislaufforschung e. V.). Everyone who participated in our study received a questionnaire to record their occupational medical history, dosimetry, working practices, existing interventional installations and personal protective equipment. The results were compared with international recommendations, especially those of the ICRP, based on state-of-the-art equipment. A total of 104 respondents from eight German clinics took part in the survey. Four participants had been medically diagnosed with cataracts. None of the participants had previously worn an additional dosimeter over their apron to determine partial-body doses. The interventional installations recommended by the ICRP have not been fitted in all examination rooms and, where they have been put in place, they are not always used consistently. Just 31 participants (36.6%) stated that they “always” wore protective lead glasses or a visor. This study revealed considerable deficits in radiological protection—especially in connection with shielding measures and dosimetric practices pertaining to the head and neck—during a range of interventions. Examination rooms without the recommended interventional installations should be upgraded in the future. According to the principle of dose minimization, there is considerable potential for improving radiation protection. Temporary measurements should be taken over the apron to determine the organ-specific equivalent dose to the lens of the eye and the head.

Efficacy and User Experience of a Novel X-Ray Shield on Operator Radiation Exposure During Cardiac Catheterization: A Randomized Controlled Trial

“…Although it is widely known that shielding can reduce operator exposure, available measures are not sufficiently used. 20 Cardiac catheterization labs are high-paced environments with many constraints and requirements. Therefore, to ensure uptake among operators, it is vital that any new measure does not add significant logistic and ergonomic issues and has minimal impact on procedure time and cost.…”

“…Although it is widely known that shielding can reduce operator exposure, available measures are not sufficiently used. 20 Cardiac catheterization labs are high-paced…”

Lead Cap Use in Interventional Cardiology: Time to Protect Our Head in the Cardiac Catheterisation Laboratory?

“…A study in Germany was conducted to assess compliance to International Commission on Radiation Protection recommendations regarding radiation protection, and included workers from fields of interventional cardiology, radiology and vascular surgery. 31 The study included 104 respondents, out of which 54.8% were cardiologists. 31 Out of the 104 respondents, only 29.7% reported using caps.…”

“… 31 The study included 104 respondents, out of which 54.8% were cardiologists. 31 Out of the 104 respondents, only 29.7% reported using caps. 31 Of those who wore caps, the proportion of those wearing caps with a lead equivalence of 0.25, 0.35 and 0.5 mm was 43.5%, 39.1% and 17.4%, respectively.…”

Use of secondary air kerma from dose area product and fluoroscopy time for preventive effective dose estimation in interventional radiology procedures for staff

“…Nowadays, interventional radiology (IR) is involved in regular development regarding new imaging applications and technological innovations, leading to an increased use of these procedures [1,2]. This approach is one of those most frequently performed to treat many types of conditions due to the possibility to reduce the recovery time and risk to patients, improving the surgical outcome in comparison with traditional surgery [3,4]. Although technological improvements help to upgrade patient safety by reducing the dose delivered during surgery (and so reducing the operator exposure), the amount of delivered dose is still relevant for long fluoroscopy times (FTs) or requirements for high image quality [4,5].…”