Usefulness of an additional lead shielding device in reducing occupational radiation exposure during interventional endoscopic procedures

Abstract

Adoption of interventional endoscopic procedures is increasing with increasing prevalence of diseases. However, medical radiation exposure is concerning; therefore, radiation protection for medical staff is important. However, there is limited information on the usefulness of an additional lead shielding device during interventional endoscopic procedures. Therefore, we aimed to determine whether an additional lead shielding device protects medical staff from radiation. An X-ray unit (CUREVISTA; Hitachi Medical Systems, Tokyo, Japan) with an over-couch X-ray system was used. Fluoroscopy-associated scattered radiation was measured using a water phantom placed at the locations of the endoscopist, assistant, nurse, and clinical engineer. For each location, measurements were performed at the gonad and thyroid gland/eye levels. Comparisons were performed between with and without the additional lead shielding device and with and without a gap in the shielding device. Additionally, a clinical study was performed with 27 endoscopic retrograde cholangiopancreatography procedures. The scattered radiation dose was lower with than without additional lead shielding at all medical staff locations and decreased by 84.7%, 82.8%, 78.2%, and 83.7%, respectively, at the gonad level and by 89.2%, 86.4%, 91.2%, and 87.0%, respectively, at the thyroid gland/eye level. Additionally, the scattered radiation dose was lower without than with a gap in the shielding device at all locations. An additional lead shielding device could protect medical staff from radiation during interventional endoscopic procedures. However, gaps in protective equipment reduce effectiveness and should be eliminated.

A follow‐up questionnaire survey 2022 on radiation protection among 464 medical staff from 34 endoscopy–fluoroscopy departments in Japan

“…Radiation exposure is particularly high between the irradiation and the target. In over couch, the use of a protective shield is effective 15–18 . However, in endoscopic procedures, there are many situations where staff manually control dangerous body movements to ensure patient safety because the patient is sedated.…”

“…In over couch, the use of a protective shield is effective. [15][16][17][18] However, in endoscopic procedures, there are many situations where staff manually control dangerous body movements to ensure patient safety because the patient is sedated. In such cases, all staff members need to be aware of the high risk of irradiation, especially, without a protective shield over the couch.…”

Minimizing radiation exposure in endoscopic retrograde cholangiopancreatography: a review for medical personnel

“…The use of protective lead shields with over-couch systems is beneficial [ 17 , 21 , 22 ]. A phantom study conducted by Morishima et al [ 23 ] showed that radiation scattering was decreased by 89.1% with the use of an additional protective shield.…”

Effect of radioprotective curtain length on the scattered dose rate distribution and endoscopist eye lens dose with an over-couch fluoroscopy system

“…Minami et al [ 12 ] showed that the radiation dose to the endoscopist and other staff members during one ERCP procedure decreased by 87.5 and 68–85%, respectively, when radioprotective curtains were used. Yamada et al [ 16 ] showed that the scattered radiation dose at the medical staff location decreased by 86.4–91.2% at the height of 150 cm. On the other hand, radioprotective curtains can be folded in the middle, and a case of their inappropriate use has been reported [ 17 ].…”