What Is Worth Knowing in Interventional Practices about Medical Staff Radiation Exposure Monitoring: A Review of Recent Outcomes of EURADOS Working Group 12

Abstract

EURADOS (European Radiation Dosimetry Group) Working Group 12 (WG12) SG1 activities are aimed at occupational radiation protection and individual monitoring in X-ray and nuclear medicine practices. In recent years, many studies have been carried out in these fields, especially for interventional radiology and cardiology workplaces (IC/IR). The complexity of the exposure conditions of the medical staff during interventional practices makes the radiation protection and monitoring of the exposed workers a challenging task. The scope of the present work is to review some of the main results obtained within WG12 activities about scattered field characterization and personal dosimetry that could be very useful in increasing the quality of radiation protection of the personnel, safety, and awareness of radiation risk. Two papers on Monte Carlo modelling of interventional theater and three papers on active personal dosimeters (APDs) for personnel monitoring were considered in the review. More specifically, Monte Carlo simulation was used as the main tool to characterize the levels of exposure of the medical staff, allowing to determine how beam energy and direction can have an impact on the doses received by the operators. Indeed, the simulations provided information about the exposure of the operator’s head, and the study concluded with the determination of an eye-lens protection factor when protection goggles and a ceiling shielding are used. Moreover, the review included the results of studies on active personal dosimeters, their use in IC/IR workplaces, and how they respond to calibration fields, with X-ray standard and pulsed beams. It was shown that APDs are insensitive to backscatter radiation, but some of them could not respond correctly to the very intense pulsed fields (as those next to the patient in interventional practices). The measurements during interventional procedures showed the potential capability of the employment of APDs in hospitals.

Synthesis of the European ALARA network 20th workshop ‘ALARA for interventional radiology and nuclear medicine’

“…The European ALARA network (EAN 11 ) is a not for profit association under French law founded in 1996 with the objective of promoting a wider and more uniform implementation of the optimisation principle-or 'ALARA principle'-for radiation protection (RP) in all exposure situations. As part of this overall objective, the EAN aims to provide a focus point for the exchange and dissemination of information from practical ALARA experience, particularly via the constitution of WGs and the organisation of workshops on topical RP issues, whose results are published either as memoranda [1] or articles [2].…”

“…hands), eyes and brain of staff located near to the patient. The use of personal dosimetry methods to estimate or calculate individual dose is complicated by the intrinsic variabilities of the inhomogeneous irradiation fields (including the scattered radiation profile due to other staff present in the room [11]), uncertainties in dosimetry [14]), the position of where the dosimeter is worn (even before factoring in the lack of adherence to local monitoring procedures) [13]. Staff doses show a large variability as exposure also depends on the specific clinical practice (e.g.…”

“…radial vs. femoral access), individual workload (number and complexity of procedures performed), x-ray equipment settings, image quality and clinician experience. It was also highlighted that the future change of ICRU quantities will impact the reported dose values [11], which may also present a challenge around the communication of risk and compliance with dosimetry arrangements.…”

“…room-based shielding such as ceiling suspended shields, mobile or fixed screens, drapes) or individual protection equipment (radiation protective garments and eyewear). Collective shielding is very efficient if used correctly and gaps in the shielding covered for lateral exposures [11]. The efficiency of five common individual protection shielding devices was evaluated in a systematic manner involving Monte-Carlo simulation, staff monitoring, and phantom measurements.…”

“…Different strategies for staff monitoring are available. Good practices presented during the workshop include use of two whole body dosimeters, ring or wrist dosimeters and close-to-the-eyes dosimeters or a valid correction factor [11]. Permanent (active) monitoring should be in place for the most-exposed staff.…”