Radiation exposure to the personnel in the operating room and in the pathology due to SLN detection with Tc-99m-nanocolloid in breast cancer patients

2000 ◽  
Vol 39 (05) ◽  
pp. 142-145 ◽  
Author(s):  
H. Ostertag ◽  
E. Peppert ◽  
N. Czech ◽  
W. U. Kampen ◽  
C. Muhle ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Exposure ◽  
Operating Room ◽  
Radiation Risk ◽  
Breast Cancer Patients ◽  
Team Members ◽  
Staff Members ◽  
Dose Rates ◽  
Peritumoral Injection ◽  
Work Up

Summary Aim of this study was to assess the radiation exposure for the personnel in the operating room and in the pathology laboratories caused by radioguided SLN localization in breast cancer. Methods: In 15 patients dose rates were measured at various distances from the breast and tumor specimens during operation and pathological work-up at 3-5 h after peritumoral injection of 30 MBq Tc-99m-nanocolloid. Results: The dose rates were 84.1 ± 46.4 μGy/h at 2.5 cm, 3.57 ± 2.14 μGy/h at 30 cm, 0.87 ± 0.51 μGy/h at 100 cm, and 0.40 ± 0.20 μGy/h at 150 cm in the operating room and 44.4 ± 27.8 μGy/h at 2.5 cm, and 1.66 ± 1.34 μGy/h at 30 cm in the pathology laboratories. From these data the radiation exposure was calculated for 250 operations per year assuming a mean exposure time of 30 min for the surgical team members and of 10 min for the pathology staff. Under these conditions the finger dose is 10.5 mGy for the surgeon, and 5.55 mGy for the pathologist. The wholebody doses are 0.45 mSv, 0.11 mSv, 0.05 mSv, and 0.21 mSv for the surgeon, the operating room nurse, the anesthetist, and the pathologist, respectively. Conclusion: Since the radiation risk to staff members is low, a classification of the personnel in the operating room and in the pathology laboratories as occupational radiation exposed workers is not necessary.

Radiation risk amongst orthopaedic surgeons – Do we know the risk?

2018 ◽  
Vol 29 (5) ◽  
pp. 115-121 ◽  
Author(s):  
Sushmith R Gowda ◽  
Chris J Mitchell ◽  
Sherif Abouel-Enin ◽  
Charlotte Lewis
Keyword(s):  
Radiation Exposure ◽  
Operating Room ◽  
Radiation Risk ◽  
Healthcare Personnel ◽  
Orthopaedic Surgeons ◽  
Increased Risk ◽  
Medullary Nailing ◽  
Specific Safety ◽  
Effects Of Radiation ◽  
Harmful Effects

Radiation risk amongst orthopaedic surgeons and theatre personnel is increasing with increased use of fluoroscopy imaging. Increased radiation risk has been shown to be associated with an increased risk of malignancies, ocular and thyroid disorders. Very high exposures have been reported in spinal surgery and during intra-medullary nailing. With an increase in modern and percutaneous methods, the use of intra-operative fluoroscopy has increased as well. The aim of this article was to review the available evidence of radiation risk amongst healthcare personnel. A systematic search was carried out in PubMED, CINAHL and Cochrane on intra-operative radiation in trauma and orthopaedic operating room. Inclusion criteria were clinical studies and systematic reviews reporting on radiation exposure, fluoroscopy time and references to specific safety guidelines. This article highlights the safety aspects of radiation protection and harmful effects of radiation during orthopaedic procedures. The responsibility to minimise radiation exposure in operating theatre lies with the team within the operating room.

scholarly journals Surgical caps displaying team members' names and roles improve effective communication in the operating room: a pilot study

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ned Douglas ◽  
Sophie Demeduik ◽  
Kate Conlan ◽  
Priscilla Salmon ◽  
Brian Chee ◽  
...  
Keyword(s):  
Operating Room ◽  
Pilot Project ◽  
Median Number ◽  
Operating Theatre ◽  
Post Intervention ◽  
Team Members ◽  
Medical Practitioners ◽  
Staff Members ◽  
Cooperative Relationships ◽  
Theatre Staff

Abstract Background Teamwork in the operating theatre is a complex emergent phenomenon and is driven by cooperative relationships between staff. A foundational requirement for teamwork is the ability to communicate effectively, and in particular, knowing each other’s name. Many operating theatre staff do not know each other’s name, even after formal team introductions. The use of theatre caps to display a staff member’s name and role has been suggested to improve communication and teamwork. Methods We hypothesized that the implementation of scrub hats with individual team members' names and roles would improve the perceived quality and effectiveness of communication in the operating theatre. A pilot project was designed as a pre-/post-implementation questionnaire sent to 236 operating room staff members at a general hospital in suburban Melbourne, Victoria, Australia, between November 6 to December 18, 2018. Participants included medical practitioners (anaesthetists, surgeons, obstetricians and gynaecologists), nurses (anaesthetic, scrub/scout and paediatric nurses), midwives and theatre technicians. The primary outcome was a change in perceived teamwork score, measured using a five position Likert scale. Results Of 236 enrolled participants, 107 (45%) completed both the pre and post intervention surveys. The median perceived teamwork response of four did not change after the intervention, though the number of low scores was reduced (p = 0.015). In a pre-planned subgroup analysis, the median perceived teamwork score rose for midwives from three to four (p < 0.001), while for other craft groups remained similar. The median number of staff members in theatre that a participant did not know the name of reduced from three to two (p < 0.001). Participants reported knowing the names of all staff members present in the theatre more frequently after the intervention (31% vs 15%, p < 0.001). The reported rate of formal team introductions was not significantly different after the intervention (34.7% vs 47.7% p = 0.058). Conclusions In this study, we found that wearing caps displaying name and role appeared to improve perceived teamwork and improve communication between staff members working in the operating theatre.

Recruiting breast cancer patients for mHealth research: Obstacles to clinic-based recruitment for a mobile phone app intervention study

2020 ◽  
Vol 17 (6) ◽  
pp. 675-683
Author(s):  
Alisha Gupta ◽  
Gabrielle Ocker ◽  
Philip I Chow
Keyword(s):  
Breast Cancer ◽  
Mental Health ◽  
Pilot Study ◽  
Cancer Patients ◽  
Large Scale ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Pilot Studies ◽  
Staff Members ◽  
The Impact

Background Nearly half of newly diagnosed breast cancer patients will report clinically significant symptoms of depression and/or anxiety within the first year of diagnosis. Research on the trajectory of distress in cancer patients suggests that targeting patients early in the diagnostic pathway could be particularly impactful. Given the recent rise of smartphone adoption, apps are a convenient and accessible platform from which to deliver mental health support; however, little research has examined their potential impact among newly diagnosed cancer patients. One reason is likely due to the obstacles associated with in-clinic recruitment of newly diagnosed cancer patients for mHealth pilot studies. Methods This article draws from our experiences of a recently completed pilot study to test a suite of mental health apps in newly diagnosed breast cancer patients. Recruitment strategies included in-clinic pamphlets, flyers, and direct communication with clinicians. Surgical oncologists and research staff members approached eligible patients after a medical appointment. Research team members met with patients to provide informed consent and review the study schedule. Results Four domains of in-clinic recruitment challenges emerged: (a) coordination with clinic staff, (b) perceived burden among breast cancer patients, (c) limitations regarding the adoption and use of technology, and (d) availability of resources. Potential solutions are provided for each challenge. Conclusion Recruitment of newly diagnosed cancer patients is a major challenge to conducting mobile intervention studies for researchers on a pilot-study budget. To realize the impact of mobile interventions for the most vulnerable cancer patient populations, health researchers must address barriers to in-clinic recruitment to provide vital preliminary data in proposals of large-scale research projects.

scholarly journals Room staff radiation dose in a vascular surgery hybrid operating room and evaluation of a real-time radiation dosimeter

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
S Jungi ◽  
V Schweizer ◽  
M Ante ◽  
P Geisbüsch ◽  
D Böckler
Keyword(s):  
Radiation Exposure ◽  
Real Time ◽  
Operating Room ◽  
Comparative Trial ◽  
Occlusive Disease ◽  
Median Dose ◽  
Hybrid Operating Room ◽  
Staff Members ◽  
Lineal Regression ◽  
The Right

Abstract Objective Real-time radiation dosimeter have been shown to decrease radiation exposure of the staff. This effect is mainly explained by increased awareness of the radiation due to direct radiation exposure feedback to the operator. We aimed to measure the radiation exposure of all staff members working in a hybrid operating room and wanted to compare the equivalent doses of real-time radiation dosimeters with thermoluminescence dosimeters. Methods Prospective non-randomized comparative trial. From April – October 2019, all staff members working in a hybrid operating room were equipped with real-time radiation dosimeters (Unfors RaySafe i3). The table positions of all staff members were documented. In addition, the first operator was equipped with a thermoluminescence Hp(3) eye lens dosimeter (TLD) placed outside the lead glasses to validate the real-time radiation dosimeter. Results The median dose of the operator / the first assistant was 73.6 µSv / 21.8 µSv for EVAR (n = 30); 57.25 µSv / 18.2 µSv for TEVAR (n = 23); 207.0 µSv / 76.65 µSv for more complex aortic procedures (f/bEVAR etc.; n = 15); 14.85 µSv / 8.5 µSv for occlusive disease of the iliac arteries (n = 27) and 6.1 µSv / 3.4 µSv for occlusive disease of the peripheral arteries (n = 53). The anesthesiologist’s median dose was 0.3 µSv, with highest values in f/bEVAR (3.9µSv). The scrub nurse’s median dose was 2 µSv with highest values in f/bEVAR (24 µSv). The position of any staff member at the left arm for transbrachial cannulation in f/bEVAR was associated with higher median equivalent radiation doses compared to the right femoral position (272.5 vs. 207 µSv for the operator (p=ns), 175.3 vs. 27.8 µSv for the first assistant (p = 0.027) and 45.55 vs. 8.0 µSv for the scrub nurse (p = 0.14)). The equivalent doses of the TLD and RaySafe did not correlate well using simple lineal regression analysis (r2 0.1713, p = 0.0014). Conclusion With the RaySafe real-time radiation dosimeter, table positions with increased radiation exposure can be identified. This allows for improvement in shielding at these positions, possibly leading to lower radiation exposure of the staff.

Коэффициент эффективности (DDREF) дозы и мощноcти доз: ненужные, спорные и противоречивые вопросы

2017 ◽  
Vol 62 (2) ◽  
pp. 13-27
Author(s):  
Julio Abel ◽  
Julio Abel
Keyword(s):  
Radiation Exposure ◽  
Dose Rate ◽  
Radiation Protection ◽  
Radiation Effects ◽  
Radiation Risk ◽  
Mathematical Formulation ◽  
Indirect Evidence ◽  
Dose Rates ◽  
Radiation Risks ◽  
Risk Estimates

Purpose: The aim of the paper is to review the genesis and evolution of the concept termed dose and dose rate effectiveness factor or DDREF, to expose critiques on the concept and to suggest some curse of action on its use. Material and methods: Mainly using the UNSCEAR reporting and ICRP recommendations as the main reference material, the paper describes the evolution (since the 70’s) of the conundrum of inferring radiation risk at low dose and dose-rate. People are usually exposed to radiation at much lower doses and dose rates than those for which quantitative evaluations of incidence of radiation effects are available – a situation that tempted experts to search for a factor relating the epidemiological attribution of effects at high doses and dose-rates with the subjective inference of risk at low doses and dose-rates. The formal introduction and mathematical formulation of the concept by UNSCEAR and ICRP (in the 90’s), is recalled. It is then underlined that the latest UNSCEAR radiation risk estimates did not use a DDREF concept, making it de facto unneeded for purposes of radiation risk attribution. The paper also summarizes the continuous use of the concept for radiation protection purposes and related concerns as well as some current public misunderstandings and apprehension on the DDREF (particularly the aftermath of the Fukushima Dai’ichi NPP accident). It finally discusses epistemological weaknesses of the concept itself. Results: It seems that the DDREF has become superseded by scientific developments and its use has turned out to be unneeded for the purposes of radiation risk estimates. The concept also appears to be arguable for radiation protection purposes, visibly controversial and epistemologically questionable Conclusions: It is suggested that: (i) the use of the DDREF can be definitely abandoned for radiation risk estimates; (ii) while recognizing that radiation protection has different purposes than radiation risk estimation, the discontinuation of using a DDREF for radiation protection might also be considered; (iii) for radiation exposure situations for which there are available epidemiological information that can be scientifically tested (namely which is confirmable and verifiable and therefore falsifiable), radiation risks should continue to be attributed in terms of frequentistic probabilities; and, (iv) for radiation exposure situations for which direct scientific evidence of effects is unavailable or unfeasible to obtain, radiation risks may need to be inferred on the basis of indirect evidence, scientific reasoning and professional judgment aimed at estimating their plausibility in terms of subjective probabilities.

scholarly journals Operation Experiences of Women with Breast Cancer

2020 ◽  
Vol 27 (2) ◽  
pp. 129-140
Author(s):  
Hyeon-Young Kim ◽  
Sun Hwa Shin
Keyword(s):  
Breast Cancer ◽  
Operating Room ◽  
Breast Cancer Surgery ◽  
Nursing Interventions ◽  
Breast Cancer Patients ◽  
The Gaze ◽  
Mixed Feelings ◽  
Care Requirements ◽  
Experiences Of Women

Purpose: In order to implement effective nursing interventions in operative procedures, it is necessary to understand the patients' care requirements. The aim of this study was to investigate the operating room experiences of patients with breast cancer. Methods: The study was conducted from November 15, to December 28, 2018. Participants were recruited through an objective sampling method and included eight women who had undergone breast cancer surgery within the last 10 years. Interviews were conducted with the participants until no new data were obtained. Qualitative data were analyzed using the 6-stage phenomenological analysis method of Colaizzi.Results: Three categories were identified across 18 themes and 8 theme clusters. For the category “before entering the operating room”, participants experienced crossing the threshold of death, mixed feelings of regret and resentment, and discomfort due to the gaze of unfamiliar people. With regard to “when entering the operating room”, participants experienced uneasiness owing to the cold environment and the medical procedures. However, they felt comforted with the attentiveness of the medical staff. Finally, regarding the category “after leaving the operating room”, participants experienced a sense of relief that the cancer cells were removed but expressed distress concerning the obstacles in follow-up care. Conclusion: The results indicate the necessity of understanding the experiences of breast cancer patients undergoing surgery and developing effective nursing interventions for these patients.

Standardizing coordination between surgical oncology and reconstructive surgery for breast cancer patients undergoing mastectomy with immediate reconstruction.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 110-110
Author(s):  
Mehra Golshan ◽  
Charles A. Hergrueter ◽  
Kristen Camuso ◽  
Nancy U. Lin ◽  
Linda Cutone ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Operating Room ◽  
Reconstructive Surgery ◽  
Surgical Oncology ◽  
Care Quality ◽  
Cancer Center ◽  
Breast Cancer Patients ◽  
Immediate Reconstruction ◽  
Definitive Surgery ◽  
Surgical Teams

110 Background: Timely diagnosis and treatment of breast cancer, endorsed by organizations such as ASCO and NCCN, are essential to ensure optimal clinical outcomes and patient satisfaction. Inefficient care coordination may adversely affect care quality. At our cancer center, 75% of patients who undergo mastectomy seek a reconstructive surgery consult and over 60% elect mastectomy with immediate reconstruction. We sought to evaluate and reduce the time to reconstructive surgery consult and first definitive surgery (FDS) by streamlining coordination between services. Methods: We studied 330 patients who underwent mastectomy with immediate reconstruction between January 2011 and April 2013. Time intervals between initial surgical consult, reconstruction consult, and FDS were calculated. After examining existing best practices in patient referral and scheduling, we established targets of 7 days from initial consult to reconstruction consult and 28 days from initial consult to FDS. To achieve these targets, facilitated sessions were held with administrative and clinical experts to create a standard referral and scheduling process, including a referral template and establishing surgical teams based on clinic and operating room alignment. The interventions were implemented over a 6-month period. Results: Mean days from initial consult to reconstructive surgery consult decreased, with significant improvement in reaching the 7 day target. No significant changes from time of initial consult to FDS were observed. Conclusions: Standardizing coordination has led to timelier reconstructive surgery consults for patients undergoing mastectomy with immediate reconstruction. Other factors, such as operating room availability, pre-operative testing and patient preference should be explored to reduce the time to FDS. [Table: see text]

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