Radiation Protection in Interventional Radiology: Survey Results of Attitudes and Use

Lynskey, G.; Powell, Daniel K.; Dixon, Robert G.; Silberzweig, James E.

doi:10.1016/j.jvir.2013.05.039

Cited by 64 publications

(44 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, data pertaining to differences between the responding population and the nonresponding population are unavailable. Nevertheless, it is common to see similar response rates in other cross-sectional studies within radiology, and some studies proposed that such a bias is relatively minute (35,36). …”

Section: Discussionmentioning

confidence: 88%

A Cross-Sectional Survey of Interventional Radiologists and Vascular Surgeons Regarding the Cost and Reimbursement of Common Devices and Procedures

Wang

Dybul

Patel

et al. 2016

Journal of Vascular and Interventional Radiology

View full text Add to dashboard Cite

Purpose To evaluate knowledge of interventional radiologists (IRs) and vascular surgeons (VSs) on the cost of common devices and procedures and to determine factors associated with differences in understanding. Materials and Methods An online survey was administered to US faculty IRs and VSs. Demographic information and physicians’ opinions on hospital costs were elicited. Respondents were asked to estimate the average price of 15 commonly used devices and to estimate the work relative value units (wRVUs) and average Medicare reimbursements for 10 procedures. Answer estimates were deemed correct if values were ± 25% of the actual costs. Multivariate logistical regression was used to calculate odds ratios and 95% confidence intervals. Results Of the 4,926 participants contacted, 1,090 (22.1%) completed the questionnaire. Overall, 19.8%, 22.8%, and 31.9% were accurate in price estimations of devices, Medicare reimbursement, and wRVUs for procedures. Physicians who thought themselves adequately educated about wRVUs were more accurate in predicting procedural costs in wRVUs than physicians who responded otherwise (odds ratio = 1.40, 95% confidence interval, 1.29–1.52; P < .0001). Estimation accuracies for procedures showed a positive trend in more experienced physicians (≥ 16 y), private practice physicians, and physicians who practice in rural areas. Conclusions This study suggests that IRs and VSs have limited knowledge regarding device costs. Given the current health care environment, more attention should be placed on cost education and awareness so that physicians can provide the most cost-effective care.

show abstract

Section: Discussionmentioning

confidence: 88%

A Cross-Sectional Survey of Interventional Radiologists and Vascular Surgeons Regarding the Cost and Reimbursement of Common Devices and Procedures

Wang

Dybul

Patel

et al. 2016

Journal of Vascular and Interventional Radiology

View full text Add to dashboard Cite

show abstract

“…Nevertheless, in daily practice most interventional radiologists do not wear lead glasses, mainly because they are uncomfortable and no gain in using them is immediately perceived. 12 In fact, all these confirmatory studies were performed with phantoms, 7-10 and studies with real interventional procedures were only conducted in the interventional cardiology setting. [13][14][15] To our knowledge, no study has ever been conducted during real neuroradiological procedures, which could considerably have more impact on the neuroradiologists' perception of radiation exposure in daily practice.…”

Section: Introductionmentioning

confidence: 99%

The importance of protection glasses during neuroangiographies: A study on radiation exposure at the lens of the primary operator

Tavares

Sacadura-Leite²,

Matoso

et al. 2016

Interv Neuroradiol

View full text Add to dashboard Cite

Background In interventional neuroradiology, few operators routinely use radiation protection glasses. Moreover, in most centers, radiation dose data only accounts for whole body dose without specific information on lens dose. In 2012, the International Commission on Radiological Protection advised that the threshold limit value for the lens should be 20 mSv/year instead of the previous 150 mSv/year limit. The purpose of this study was to compare the radiation dose in the operator’s lens during real diagnostic and interventional neuroangiographies, either using or without lead protection glasses. Methods Using the Educational Direct Dosimeter (EDD30 dosimeter), accumulated radiation dose in the lens was measured in 13 neuroangiographies: seven diagnostic and six interventional. Operators with and without radiation protection glasses were included and the sensor was placed near their left eye, closest to the radiation beam. Results Without glasses, the corrected mean dose of radiation in the lens was 8.02 µSv for diagnostic procedures and 168.57 µSv for interventional procedures. Using glasses, these values were reduced to 1.74 µSv and 33.24 µSv, respectively. Conclusion Considering 20 mSv as the suggested annual limit of equivalent dose in the lens, neuroradiologists may perform up to 2,494 diagnostic procedures per year without protecting glasses, a number that increases to 11,494 when glasses are used consistently. Regarding intervention, a maximum of 119 procedures per year is advised if glasses are not used, whereas up to 602 procedures/year may be performed using this protection. Therefore, neuroradiologists should always wear radiation protection glasses.

show abstract

“…40 Below table lead shielding is particularly important for minimizing scatter radiation. 41 The stark findings of the present study specifically highlight the importance of using legleaded pads by demonstrating that the markers of DNA damage detected in operators' circulating lymphocytes were absent when the operator wore additional lower leg lead shielding.…”

mentioning

confidence: 99%

Radiation Induced DNA Damage in Operators Performing Endovascular Aortic Repair

El-Sayed¹,

Patel²,

Cho³

et al. 2018

Journal of Vascular Surgery

View full text Add to dashboard Cite

BACKGROUND:Radiation exposure during fluoroscopically guided interventions such as endovascular aortic repair (EVAR) is a growing concern for operators. This study aimed to measure DNA damage/repair markers in operators perfoming EVAR. METHODS:Expression of the DNA damage/repair marker, γ-H2AX and DNA damage response marker, phosphorylated ataxia telangiectasia mutated (pATM), were quantified in circulating lymphocytes in operators during the peri-operative period of endovascular (infrarenal, branched, and fenestrated) and open aortic repair using flow cytometry. These markers were separately measured in the same operators but this time wearing leg lead shielding in addition to upper body protection and compared with those operating with unprotected legs. Susceptibility to radiation damage was determined by irradiating operators' blood in vitro.RESULTS: γ-H2AX and pATM levels increased significantly in operators immediately after branched endovascular aortic repair/fenestrated endovascular aortic repair (P<0.0003 for both). Only pATM levels increased after infrarenal endovascular aortic repair (P<0.04). Expression of both markers fell to baseline in operators after 24 hours (P<0.003 for both). There was no change in γ-H2AX or pATM expression after open repair. Leg protection abrogated γ-H2AX and pATM response after branched endovascular aortic repair/fenestrated endovascular aortic repair. The expression of γ-H2AX varied significantly when operators' blood was exposed to the same radiation dose in vitro (P<0.0001).CONCLUSIONS: This is the first study to detect an acute DNA damage response in operators performing fluoroscopically guided aortic procedures and highlights the protective effect of leg shielding. Defining the relationship between this response and cancer risk may better inform safe levels of chronic low-dose radiation exposure. 1,2 The growing number and complexity of procedures means that interventionists are exposed to higher amounts of radiation, a subject that is becoming increasingly topical. Radiation-Induced3-7 A recently published 15-year follow-up study of the EVAR trial, comparing endovascular and open aortic repair, reported an increased incidence of malignancy in patients treated by EVAR. 8 There is, rightly so, a significant focus currently on reducing the patients' exposure to radiation, but mounting evidence suggests that recurrent lowdose exposure to the practitioner is equally as important. Robust data collection to assess the risks posed to the interventionist is in its infancy, but a number of studies suggest a link to adverse health effects, including a higher risk of posterior subcapsular lens changes and malignancy.9-11 One recent study found a higher incidence of malignancy, including brain cancer, breast cancer, and melanoma, in interventionists who performed fluoroscopically guided procedures compared with those who had never performed these.12 A better understanding of the hazards of occupational radiation exposure requires sensitive tools to measure exposure at an individu...

show abstract

Radiation Protection in Interventional Radiology: Survey Results of Attitudes and Use

Cited by 64 publications

References 24 publications

A Cross-Sectional Survey of Interventional Radiologists and Vascular Surgeons Regarding the Cost and Reimbursement of Common Devices and Procedures

A Cross-Sectional Survey of Interventional Radiologists and Vascular Surgeons Regarding the Cost and Reimbursement of Common Devices and Procedures

The importance of protection glasses during neuroangiographies: A study on radiation exposure at the lens of the primary operator

Radiation Induced DNA Damage in Operators Performing Endovascular Aortic Repair

Contact Info

Product

Resources

About