The interdependence of staff and patient doses in interventional radiology.

Abstract

Staff doses arising from the use of X-rays are principally due to scattered radiation. This is related to the dose received by the patient expressed as the dose-area product (DAP). Doses to patients in interventional radiology are generally higher than for other fluoroscopically guided procedures. Doses to interventional radiologists are, therefore, amongst the highest associated with the use of diagnostic X-rays. The results of staff dose monitoring normalized to DAP should provide an indicator of those procedures which are associated with particularly high radiation exposures to staff, and should help to identify those radiologists whose practice may result in unnecessarily high doses to themselves. A study has been made of patient doses in two X-ray rooms used for interventional procedures associated with vascular and liver diseases. Doses to radiologists in these rooms were normalized to DAP. It was found that the average doses to the body, neck and hands were 0.05, 0.89 and 2.45 microSv/(Gy cm2), respectively for those radiologists with no significant involvement in hepatobiliary procedures. Higher doses were found for one radiologist whose workload included biliary drainage. The whole body dose was 0.17 microSv/(Gy cm2) or 5.8 mSv per year. It was shown that the doses to the neck and hands for the biliary drainage work was 6.59 and 29.0 microSv/(Gy cm2), respectively. This study has demonstrated the value of DAP as a measure of radiologist workload in respect of its significance in terms of staff dose.

Evaluation of a Suspended Personal Radiation Protection System vs. Conventional Apron and Shields in Clinical Interventional Procedures

“…Similar to our LAS group, other reports showed high case-to-case variance of DAP-standardized operator exposures due to the dynamic factors of clinical practice [29]. Figure 6 shows our LAS group used shielding very effectively compared to other DAP-standardized reports, attributable to rigorous optimization of shielding when not using the ZeroGravity system.…”

“…Pure primary operator exposures are difficult to obtain in teaching institutions and unconfirmed in many reports, but are important since secondary operators are farther from the source and partially shielded by the primary operator, showing relative reductions of 50% [29]. DAP Standardized wrist exposures were similar to other reports.…”

“…To facilitate comparison across the literature, operator exposure was standardized to Total Patient DAP, which is a widely accepted reporting method that reflects the protective power of the shielding, and minimizes effects of uncontrolled variables [22,29,32,33]. Similar to our LAS group, other reports showed high case-to-case variance of DAP-standardized operator exposures due to the dynamic factors of clinical practice [29].…”

“…Although phantom studies provide preliminary information, application to clinical practice is problematic due to many dynamic factors including large patients, interference with operator's hands or arms from accessory shields, and inability to use shielding in certain image receptor obliquities or operator stances. Results with phantoms showing significantly reduced eye exposures using shields are not fully corroborated by clinical studies using the same shielding, with one study documenting high clinical eye doses and recommending protective eyewear in addition to the suspended shield [20][21][22][23][27][28][29]. A feasibility study of an earlier prototype of the suspended personal radiation protection system using phantoms showed 16 -78 fold decreases in exposure to various body areas compared to a lead apron due to thicker lead and greater surface area covered [30].…”

MR‐guided intravascular interventions: Techniques and applications

“…The lack of ionizing radiation is an important argument to use MRI, especially during PTCD and percutaneous nephrostomies, since x-ray fluoroscopy exposes the interventionalist and in particular the fingers to high radiation doses (18). When one is using a transfemoral approach, as with most of the endovascular procedures, the physicians operate far away from the primary radiation, thus reducing the exposure.…”