Radiation exposure of radiologists during different types of CT-guided interventions: an evaluation using dosimeters placed above and under lead protection

Background Computed tomography (CT) is widely used not only for diagnostic purposes but also for image guidance during different types of interventions. Therefore, radiation exposure of both patients and interventional radiologists remains a much-discussed topic. Purpose To quantify radiation exposure of interventional radiologists during multiple CT-guided interventions using dosimeters placed under and outside standard protective lead clothing. Material and Methods A total of 113 consecutive interventions covering three different types of procedures (grouped as periradicular infiltration therapy, biopsies, and drain placement) and performed using routine clinical protocols were prospectively analyzed. The interventions were performed by two radiologists of different experience levels with identically placed dosimeters outside and underneath their protective clothing. Personal doses (right hand, eye lens, thyroid gland, thorax, gonads) were cumulatively measured for each type of intervention and separately for the two radiologists. Results Personal dose was below the detection limit of the dosimeters during periradicular infiltration therapy. In the biopsy and drain placement groups, the highest dose was found for the right hand (maximum cumulative dose = 1.84 ± 1.30 mSv in 19 consecutive drain placements). Under the protective gear, exposure was only observed for drain placements performed by the less experienced radiologist (maximum = 0.05 ± 0.04 mSv for the eye lens). Conclusion Personal doses measured here were far below annual thresholds published by the International Commission on Radiological Protection. Therefore, performing multiple CT-guided interventions appears to be safe for interventional radiologists in terms of radiation exposure.

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MINIMIZING THE EXPOSURE TO THE EYE LENS OF RADIOLOGIC TECHNOLOGISTS ASSISTING PATIENTS DURING CHEST X RAYS: A PHANTOM STUDY

Radiation Protection Dosimetry ◽

10.1093/rpd/ncab019 ◽

2021 ◽

Vol 193 (1) ◽

pp. 43-54

Author(s):

Yasuda Mitsuyoshi ◽

Funada Tomoya ◽

Sato Hisaya ◽

Kato Kyoichi

Keyword(s):

Radiation Protection ◽

Phantom Study ◽

International Commission ◽

Eye Lens ◽

Radiological Protection ◽

X Rays ◽

Radiologic Technologists ◽

Maximum Reduction ◽

The Right

Abstract As chest x rays involve risks of patients falling, radiologic technologists (technologists) commonly assist patients, and as the assistance takes place near the patients, the eye lenses of the technologists are exposed to radiation. The recommendations of the International Commission on Radiological Protection suggest that the risk of developing cataracts due to lens exposure is high, and this makes it necessary to reduce and minimize the exposure. The present study investigated the positions of technologists assisting patients that will minimize exposure of the eye lens to radiation. The results showed that it is possible to reduce the exposure by assisting from the following positions: 50% at the sides rather than diagonally behind, 10% at the right side of the patient rather than the left and 40% at 250 mm away from the patient. The maximum reduction with radiation protection glasses was 54% with 0.07 mmPb and 72% with 0.88 mmPb.

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Radiation Exposure to the Hand of a Spinal Interventionalist during Fluoroscopically Guided Procedures

Asian Spine Journal ◽

10.4184/asj.2017.11.1.75 ◽

2017 ◽

Vol 11 (1) ◽

pp. 75-81 ◽

Cited By ~ 4

Author(s):

Kazuta Yamashita ◽

Hisanori Ikuma ◽

Takuya Tokashiki ◽

Takashi Maehara ◽

Akihiro Nagamachi ◽

...

Keyword(s):

Radiation Dose ◽

Prospective Study ◽

Radiation Exposure ◽

Radiological Protection ◽

Dominant Hand ◽

Annual Dose ◽

Lead Apron ◽

Left Chest ◽

Glass Dosimeter ◽

The Right

<sec><title>Study Design</title>Prospective study.</sec><sec><title>Purpose</title>During fluoroscopically guided spinal procedure, the hands of spinal surgeons are placed close to the field of radiation and may be exposed to ionizing radiation. This study directly measured the radiation exposure to the hand of a spinal interventionalist during fluoroscopically guided procedures.</sec><sec><title>Overview of Literature</title>Fluoroscopically guided spinal procedures have been reported to be a cause for concern due to the radiation exposure to which their operators are exposed.</sec><sec><title>Methods</title>This prospective study evaluated the radiation exposure of the hand of one spinal interventionalist during 52 consecutive fluoroscopic spinal procedures over a 3-month period. The interventionalist wore three real-time dosimeters secured to the right forearm, under the lead apron over the chest, and outside the lead apron over the chest. Additionally, one radiophotoluminescence glass dosimeter was placed under the lead apron over the left chest and one ring radiophotoluminescence glass dosimeter was worn on the right thumb. The duration of exposure and radiation dose were measured for each procedure.</sec><sec><title>Results</title>The average radiation exposure dose per procedure was 14.9 µSv, 125.6 µSv, and 200.1 µSv, inside the lead apron over the chest, outside the lead apron over the chest, and on the right forearm, respectively. Over the 3-month period, the protected radiophotoluminescence glass dosimeter over the left chest recorded less than the minimum reportable dose, whereas the radiophotoluminescence glass ring dosimeter recorded 368 mSv for the thumb.</sec><sec><title>Conclusions</title>Our findings indicated that the cumulative radiation dose measured at the dominant hand may exceed the annual dose limit specified by the International Commission on Radiological Protection. Spinal interventionalists should take special care to limit the duration of fluoroscopy and radiation exposure.</sec>

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Radiation exposure of the radiologist’s eye lens during CT-guided interventions

Acta Radiologica ◽

10.1177/0284185113493222 ◽

2014 ◽

Vol 55 (1) ◽

pp. 86-90 ◽

Cited By ~ 10

Author(s):

Philipp Heusch ◽

Patric Kröpil ◽

Christian Buchbender ◽

Joel Aissa ◽

Rotem S Lanzman ◽

...

Keyword(s):

Radiation Exposure ◽

Eye Lens ◽

Ct Guided

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Surgeon’s radiation exposure during percutaneous vertebroplasty

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.2.106 ◽

2006 ◽

Vol 4 (2) ◽

pp. 106-109 ◽

Cited By ~ 53

Author(s):

Michael Synowitz ◽

Juergen Kiwit

Keyword(s):

Radiation Exposure ◽

Percutaneous Vertebroplasty ◽

Prospective Trial ◽

Reduction Rate ◽

Dose Area Product ◽

Left Hand ◽

Right Hand ◽

The Mean ◽

Area Product ◽

The Right

Object In this study the authors evaluated levels of radiation exposure to surgeons’ protected and unprotected hands during fluoroscopically assisted vertebroplasty. Methods The amount of radiation administered to 30 patients during 41 procedures in a controlled prospective trial over 6 months was assessed, comparing radiation exposure to the right and left hands in two neurosurgeons. Effective skin doses were evaluated using thermoluminescent finger dosimeters (ring dosimeters). The ratios of finger dosimeter exposure were compared between the glove-protected and unprotected left hands of two surgeons and both unprotected right hands. In addition, dose-area product (DAP) and fluoroscopy times were recorded in all patients. The mean treatment-effective dose to the surgeons’ hands was 0.49 ± 0.4 mSv in the glove-protected left hand and 1.81 ± 1.31 mSv in the unprotected left hand (p < 0.05). The mean effective hand doses were 0.59 ± 0.55 mSv in the unprotected right hand of the glove-protected surgeon and 0.62 ± 0.55 mSv in the unprotected right hand of the control surgeon. The total corresponding fluoroscopy time was 38.55 minutes for the protected surgeon and 41.23 minutes for the unprotected one (p > 0.05). Lead glove shielding resulted in a radiation dose reduction of 75%. The total DAP for all procedures was 256,496 mGy/cm2 and 221,408 mGy/cm2 (p >0.05) for the protected and unprotected surgeons, respectively. Conclusions This study emphasizes the importance of surgeons wearing lead glove protection on their leading hands during percutaneous vertebroplasty procedures and demonstrates a 75% reduction rate of exposure to radiation.

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Bestimmung der Augenlinsen - exposition bei Patienten nach einer Radioi odtherapie

Nuklearmedizin ◽

10.3413/nukmed-0426-11-08 ◽

2012 ◽

Vol 51 (03) ◽

pp. 79-83 ◽

Cited By ~ 1

Author(s):

J. Claußnitzer ◽

L. Oehme ◽

R. Freudenberg ◽

J. Kotzerke ◽

M. Andreeff

Keyword(s):

Radiation Exposure ◽

Radioiodine Therapy ◽

Cumulative Exposure ◽

Whole Body ◽

Eye Lens ◽

Radiological Protection ◽

Radiation Induced ◽

Group 3 ◽

Group 2 ◽

Group 1

SummaryAim: Current reports for the radiation cataracts contained a warning for deterministic effects at 1–2 Gy radiation single exposure for lens. Recently, the German Radiation Protection Board (SSK) published a document (234. SSK-Board) in that threshold dose for radiation cataracts is claimed at 0.5 Gy. The lens of the eye is recognized as one of the most radiosensitive tissues in the human body, and the International Commission on Radiological Protection (ICRP 103) has defined a limit of 150 mSv for its exposure. Recently, the ICRP lowered this limit down to 20 mSv per year. However, this limit does not apply to patients. Therefore, the question of the lens radiation exposure for patients underwent a radioiodine therapy (RIT) is a point at issue. Patients, methods: A total of 41 patients (age: 22–92 years) underwent a radioiodine therapy were included in the study. Optical stimulated luminescence dosimeters were used to measure the radiation exposure. The dosimeters were fastened nearby the patient’s eye lens. The measurement was carried out up to 48 h after radioiodine application and the patients were divided into three groups. Group 1: patients underwent a diagnostic 131I whole body scan (mean activity: 370 MBq); group 2: thyriod carcinoma patients under RIT (mean activity: 3700 MBq); group 3: hyperthyroid patients under RIT (activity: 180–1237 MBq). Results: The cumulative exposure of the eye lens during the stay at the therapy unit (48 h) was 4.8 ± 0.7 mGy in group 1, 24.5–50.5 mGy in group 2 and 2.7–26.3 mGy in group 3, respectively. For the calculation of the expected cumulative dose, including follow-up after patient's dismissal, the effective half-lives were involved. The cumulative doses were obtained to be 6 ± 1 mGy in the first group, 63 ± 15 mGy in the second and 5–148 mGy in the third. Conclusion: The results show that there exists a low risk for radiation cataract in a nuclear medicine therapy unit. After serial radioiodine therapies radiation-induced lens opacity cannot be expected.

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Editorial Note

Journal of Speech Disorders ◽

10.1044/jshd.1101.02 ◽

1946 ◽

Vol 11 (1) ◽

pp. 2-2

Keyword(s):

Editorial Note ◽

Speech Sounds ◽

Left Hand ◽

Hand Column ◽

Right Hand ◽

Infant Speech ◽

The Right

In the article “Infant Speech Sounds and Intelligence” by Orvis C. Irwin and Han Piao Chen, in the December 1945 issue of the Journal, the paragraph which begins at the bottom of the left hand column on page 295 should have been placed immediately below the first paragraph at the top of the right hand column on page 296. To the authors we express our sincere apologies.

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Eosinophilic vasculitis: an inhabitual and resistant manifestation of a vasculitis

VASA ◽

10.1024/0301-1526/a000060 ◽

2010 ◽

Vol 39 (4) ◽

pp. 344-348 ◽

Cited By ~ 3

Author(s):

Jandus ◽

Bianda ◽

Alerci ◽

Gallino ◽

Marone

Keyword(s):

Skin Biopsy ◽

Intravenous Iron ◽

Small Vessel Vasculitis ◽

High Dose ◽

Raynaud Phenomenon ◽

The Third ◽

Left Elbow ◽

Right Hand ◽

The Right ◽

Trunk Skin

A 55-year-old woman was referred because of diffuse pruritic erythematous lesions and an ischemic process of the third finger of her right hand. She was known to have anaemia secondary to hypermenorrhea. She presented six months before admission with a cutaneous infiltration on the left cubital cavity after a paravenous leakage of intravenous iron substitution. She then reported a progressive pruritic erythematous swelling of her left arm and lower extremities and trunk. Skin biopsy of a lesion on the right leg revealed a fibrillar, small-vessel vasculitis containing many eosinophils.Two months later she reported Raynaud symptoms in both hands, with a persistent violaceous coloration of the skin and cold sensation of her third digit of the right hand. A round 1.5 cm well-delimited swelling on the medial site of the left elbow was noted. The third digit of her right hand was cold and of violet colour. Eosinophilia (19 % of total leucocytes) was present. Doppler-duplex arterial examination of the upper extremities showed an occlusion of the cubital artery down to the palmar arcade on the right arm. Selective angiography of the right subclavian and brachial arteries showed diffuse alteration of the blood flow in the cubital artery and hand, with fine collateral circulation in the carpal region. Neither secondary causes of hypereosinophilia nor a myeloproliferative process was found. Considering the skin biopsy results and having excluded other causes of eosinophilia, we assumed the diagnosis of an eosinophilic vasculitis. Treatment with tacrolimus and high dose steroids was started, the latter tapered within 12 months and then stopped, but a dramatic flare-up of the vasculitis with Raynaud phenomenon occurred. A new immunosupressive approach with steroids and methotrexate was then introduced. This case of aggressive eosinophilic vasculitis is difficult to classify into the usual forms of vasculitis and constitutes a therapeutic challenge given the resistance to current immunosuppressive regimens.

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Detection of Sarcoidosis Based on Subcutaneous Nodules in the Dorsum of the Right Hand

Nishi Nihon Hifuka ◽

10.2336/nishinihonhifu.76.14 ◽

2014 ◽

Vol 76 (1) ◽

pp. 14-17

Author(s):

Yoshiyuki KUWAE ◽

Kunitaka HARUNA ◽

Yasushi SUGA

Keyword(s):

Subcutaneous Nodules ◽

Right Hand ◽

The Right

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Requesting physicians’ knowledge of X-radiation exposure from computed tomography scan examinations: A case study of two Nigerian tertiary hospitals

Calabar Journal of Health Sciences ◽

10.25259/cjhs_9_2019 ◽

2020 ◽

Vol 3 ◽

pp. 36-39

Author(s):

Samson O. Paulinus ◽

Benjamin E. Udoh ◽

Bassey E. Archibong ◽

Akpama E. Egong ◽

Akwa E. Erim ◽

...

Keyword(s):

Computed Tomography ◽

Ionizing Radiation ◽

Ct Scan ◽

Radiation Exposure ◽

Work Experience ◽

Radiation Risk ◽

Radiological Protection ◽

X Ray ◽

Tertiary Hospitals ◽

Medical Exposure

Objective: Physicians who often request for computed tomography (CT) scan examinations are expected to have sound knowledge of radiation exposure (risks) to patients in line with the basic radiation protection principles according to the International Commission on Radiological Protection (ICRP), the Protection of Persons Undergoing Medical Exposure or Treatment (POPUMET), and the Ionizing Radiation (Medical Exposure) Regulations (IR(ME)R). The aim is to assess the level of requesting physicians’ knowledge of ionizing radiation from CT scan examinations in two Nigerian tertiary hospitals. Materials and Methods: An 18-item-based questionnaire was distributed to 141 practicing medical doctors, excluding radiologists with work experience from 0 to >16 years in two major teaching hospitals in Nigeria with a return rate of 69%, using a voluntary sampling technique. Results: The results showed that 25% of the respondents identified CT thorax, abdomen, and pelvis examination as having the highest radiation risk, while 22% said that it was a conventional chest X-ray. Furthermore, 14% concluded that CT head had the highest risk while 9% gave their answer to be conventional abdominal X-ray. In addition, 17% inferred that magnetic resonance imaging had the highest radiation risk while 11% had no idea. Furthermore, 25.5% of the respondents have had training on ionizing radiation from CT scan examinations while 74.5% had no training. Majority (90%) of the respondents were not aware of the ICRP guidelines for requesting investigations with very little (<3%) or no knowledge (0%) on the POPUMET and the IR(ME)R respectively. Conclusion: There is low level of knowledge of ionizing radiation from CT scan examinations among requesting physicians in the study locations.

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Hepatic brucelloma: a rare complication of a common zoonotic disease

BMJ Case Reports ◽

10.1136/bcr-2020-237076 ◽

2020 ◽

Vol 13 (12) ◽

pp. e237076

Author(s):

George Vatidis ◽

Eirini I Rigopoulou ◽

Konstantinos Tepetes ◽

George N Dalekos

Keyword(s):

Rare Complication ◽

Surgical Excision ◽

Coombs Test ◽

Inflammation Markers ◽

Laboratory Findings ◽

Ct Guided ◽

Rare Manifestation ◽

Bone Marrow Cultures ◽

History Of ◽

The Right

Hepatic brucelloma (HB), a rare manifestation of brucellosis, refers to liver involvement in the form of abscess. A 35-year-old woman stockbreeder was admitted due to 1-month history of evening fever, sweating and weight loss, while she was on 3-week course of rifampicin/doxycycline for suspected brucellosis. On admission, she had hepatosplenomegaly and a systolic murmur, while cholestasis, increased inflammation markers and a strong-positive Wright-Coombs test were the main laboratory findings. As blood and bone marrow cultures were unrevealing, further investigation with CT imaging showed a central liver calcification surrounded by heterogeneous hypodense area being compatible with HB. Material from CT-guided drainage tested negative for Brucella spp. After failure to improve on a 10-week triple regiment, surgical excision was decided and Brucella spp were identified by PCR. Our case highlights challenges in establishing HB diagnosis, which should be considered on the right epidemiological context and when serological and radiological evidence favour its diagnosis.

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