Ionizing Radiation Dose Exposure to the Ocular
Region of Pain Physicians During C-arm Guided
Pain Interventions

Background: The growth of interventional pain medicine in recent years has resulted in more procedures being carried out under fluoroscopic guidance. The proximity of the pain physician (PP) to ionization radiation (IR) potentially increases the risk of radiation exposure to the ocular region. A European directive has reduced the limits of occupational ocular dose 7.5-fold. Objectives: The objectives of this study are to quantify the typical IR exposure in the ocular region of PP and to compare it to recommended international guidelines. Study Design: Three consultants involved in the pain unit service were enrolled in the study to reflect the dose implications involved with different caseloads, training obligations, and procedure types. All 3 consultants were experienced primary operators. Setting: The study was undertaken at the pain management suite in the South Infirmary Victoria University Hospital (SIVUH). Annually, this unit performs 2,800 fluoroscopic guide pain procedures. Methods: Thermoluminescent dosimeters (TLDs) calibrated to measure eye lens doses [Hp (0.07)] and whole-body doses (WBDs) were fitted to 3 pain consultants while they undertook imaging-guided pain procedures using mobile C-arm fluoroscopy over a 3-month period. The duration of radiation exposure, screening time (seconds), and procedure type were recorded. Radiation dose was calculated to estimate the effective radiation dose to the ocular region using (i) dose-area product (DAP) in milliGray per centimeter squared (mGycm2 ) and (ii) Air Kerma (AK) values in mGy. Results: IR doses were effectively recorded in 682 cases over 3 months and the data extrapolated. The estimated annual lens dose experienced by pain physicians performing fluoroscopy-guided procedures is less than the recommended international guidelines. A significant linear relationship between screening time and IR exposure was estimated (rs = 0.93, P < 0.01) Limitations: In many centers, including our own, fluoroscopy procedures are undertaken by nonconsultant staff. Therefore, a small single-center cohort recruiting experienced consultant staff and not including pain fellows or registrars/residents with varying levels of experience is a limitation. Conclusion: While IR to the ocular region was significantly less than the recommended European safety guidelines, the annual dose needs to be confirmed in pain physicians with a lesser degree of clinical experience. Key words: Ionizing radiation, ocular, radiation protection, pain medicine, interventional

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Simulated Radiation Dose Reduction in Whole-Body CT on a 3rd Generation Dual-Source Scanner: An Intraindividual Comparison

Diagnostics ◽

10.3390/diagnostics11010118 ◽

2021 ◽

Vol 11 (1) ◽

pp. 118

Author(s):

Andreas S. Brendlin ◽

Moritz T. Winkelmann ◽

Phuong Linh Do ◽

Vincent Schwarze ◽

Felix Peisen ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Dose Reduction ◽

Whole Body ◽

Reference Standard ◽

Diagnostic Confidence ◽

Effective Radiation Dose ◽

Intraindividual Comparison ◽

Dual Source ◽

Effective Radiation

To evaluate the effect of radiation dose reduction on image quality and diagnostic confidence in contrast-enhanced whole-body computed tomography (WBCT) staging. We randomly selected March 2016 for retrospective inclusion of 18 consecutive patients (14 female, 60 ± 15 years) with clinically indicated WBCT staging on the same 3rd generation dual-source CT. Using low-dose simulations, we created data sets with 100, 80, 60, 40, and 20% of the original radiation dose. Each set was reconstructed using filtered back projection (FBP) and Advanced Modeled Iterative Reconstruction (ADMIRE®, Siemens Healthineers, Forchheim, Germany) strength 1–5, resulting in 540 datasets total. ADMIRE 2 was the reference standard for intraindividual comparison. The effective radiation dose was calculated using commercially available software. For comparison of objective image quality, noise assessments of subcutaneous adipose tissue regions were performed automatically using the software. Three radiologists blinded to the study evaluated image quality and diagnostic confidence independently on an equidistant 5-point Likert scale (1 = poor to 5 = excellent). At 100%, the effective radiation dose in our population was 13.3 ± 9.1 mSv. At 20% radiation dose, it was possible to obtain comparably low noise levels when using ADMIRE 5 (p = 1.000, r = 0.29). We identified ADMIRE 3 at 40% radiation dose (5.3 ± 3.6 mSv) as the lowest achievable radiation dose with image quality and diagnostic confidence equal to our reference standard (p = 1.000, r > 0.4). The inter-rater agreement for this result was almost perfect (ICC ≥ 0.958, 95% CI 0.909–0.983). On a 3rd generation scanner, it is feasible to maintain good subjective image quality, diagnostic confidence, and image noise in single-energy WBCT staging at dose levels as low as 40% of the original dose (5.3 ± 3.6 mSv), when using ADMIRE 3.

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Estimation of Radiation Exposure in the Pediatric Cath Lab in Ain Shams University; Cross-Sectional Observational Study

QJM ◽

10.1093/qjmed/hcab090.003 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ahmed Abdelrazik ◽

Youssef Amin ◽

Alaa Roushdy ◽

Maiy El Sayed

Keyword(s):

Radiation Exposure ◽

Radiation Dosage ◽

University Hospital ◽

Heart Catheterization ◽

Radiation Doses ◽

Device Closure ◽

Cross Sectional ◽

Dose Area Product ◽

Area Product ◽

Hospital Pediatric

Abstract Aim and objectives The aim of the study is to assess the average radiation doses recorded per procedure in Ain Shams University Hospital pediatric cath lab to set benchmarks of radiation exposure in our institute. Patients and Methods The study included 198 patients who presented to Ain Shams cardiac pediatric cath lab who undergone interventional (BPV, BAV, ASD device closure, VSD device closure, PDA coil/device closure, Coarctation Stent/balloon) and diagnostic (Hemodynamics study, Diagnostic cath) heart catheterization. Radiation doses were measured without any interference with the operator’s preferences. Results Radiation dosages were measured in total AirKerma, Dose area product (DAP), and fluoroscopy time to set the benchmarks for radiation exposure in our institute per procedure. VSD device closure showed the highest radiation exposure followed by Coarctation stenting. Lowest radiation dosage was in PDA coil closure followed by ASD device closure then BPV. Conclusion Benchmarks for radiation exposure per procedure in pediatric cath lab in our institute were set and compared to each other.

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Value of whole-body low-dose computed tomography in patients with ventriculoperitoneal shunts: a retrospective study

Journal of Neurosurgery ◽

10.3171/2017.7.jns17476 ◽

2018 ◽

Vol 129 (6) ◽

pp. 1598-1603 ◽

Cited By ~ 1

Author(s):

Andrej Pala ◽

Fadi Awad ◽

Michael Braun ◽

Michal Hlavac ◽

Arthur Wunderlich ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Radiation Exposure ◽

Low Dose ◽

Whole Body ◽

Consecutive Series ◽

Dose Length Product ◽

Shunt System ◽

Distal Catheter ◽

Vp Shunt

OBJECTIVEThe gold standard for evaluation of ventriculoperitoneal (VP) shunt position, dislocation, or disconnection is conventional radiography. Yet, assessment with this modality can be challenging because of low image quality and can result in repetitive radiation exposure with high fluctuation in the radiation dose. Recently, CT-based radiation doses have been significantly reduced by using low-dose protocols. Thus, whole-body low-dose CT (LDCT) has become applicable for routine use in VP shunt evaluation. The authors here compared image quality and approximate radiation dose between radiography and LDCT in patients with implanted VP shunt systems.METHODSVentriculoperitoneal shunt systems have been investigated with LDCT scanning at the authors’ department since 2015. A consecutive series of 57 patients (70 investigations) treated between 2015 and 2016 was retrospectively assessed. A historical patient cohort that had been evaluated with radiography was compared with the LDCT patients in terms of radiation dose and image quality. Three independent observers evaluated projection of the valve pressure level and correct intraperitoneal position, as well as complete shunt projection, using a Likert-type scale of 1–5, where 1 indicated “not assessable” and 5 meant “assessable with high accuracy.” Descriptive statistics and the Mann-Whitney U-test were used for analysis.RESULTSTwenty-seven radiographs (38.6%) and 43 LDCT scans (61.4%) were analyzed. The median dose-length product (DLP) of the LDCT scans was 100 mGy·cm (range 59.9–183 mGy·cm). The median total dose-area product (DAP) of the radiographic images was 3177 mGy·cm2 (range 641–13,833 mGy·cm2). The estimated effective dose (EED) was significantly lower with the LDCT scan (p < 0.001). The median EED was 4.93 and 1.90 mSv for radiographs and LDCT, respectively. Significantly better identification of the abdominal position of the distal shunt catheter was achieved with LDCT (p < 0.001). Simultaneously, significantly improved visualization of the entire shunt system was realized with this technique (p < 0.001). On the contrary, identification of the valve settings was significantly worse with LDCT (p < 0.001).CONCLUSIONSWhole-body LDCT scanning allows good visualization of the distal catheter after VP shunt placement. Despite the fact that only a rough estimation of effective doses is possible in a direct comparison of LDCT and radiography, the data showed that shunt assessment via LDCT does not lead to greater radiation exposure. Thus, especially in difficult anatomical conditions, as in patients who have undergone multiple intraabdominal surgeries, have a high BMI, or are immobile, the use of LDCT shunt evaluation has high clinical value. Further data are needed to determine the value of LDCT for the evaluation of complications or radiation dose in pediatric patients.

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Evaluation of Ionizing Radiation in Five Private Radiology Centers in Khuzestan

Archives of Occupational Health ◽

10.18502/aoh.v4i1.2254 ◽

2020 ◽

Author(s):

Behzad Fouladi Dehaghi ◽

Jamileh Deris ◽

Maryam Mosavi Qahfarokhi ◽

Ameneh Golbaghi ◽

Leila Nematpour

Keyword(s):

Radiation Dose ◽

Ionizing Radiation ◽

Gamma Spectroscopy ◽

Surface Radiation ◽

Annual Dose ◽

Waiting Room ◽

X Ray ◽

Medicine Research ◽

Ionization Radiation ◽

Diagnostic Radiography

Background: Nowadays ionizing radiation is widely used in medicine, research and industry. In medicine, ionizing radiation is used to diagnose diseases and in high doses to treat diseases such as cancer. Undoubtedly, most exposure to artificial sources is in the field of medical and diagnostic radiology. Therefore, practitioners in the field of diagnostic radiography and patients are exposed to ionizing radiation and its risks. On the other hand, despite the advantages and efficacy of diagnostic radiation in the medical field, overall less attention is paid to optimizing and controlling protection in medical radiation. Therefore, the aim of this study was to evaluate the background ionizing radiation in Ahwaz diagnostic radiography centers. Methods: Ionization radiation levels were measured in and out of each center using gamma spectroscopy (Radiation Alert Inspector-EXP 15109) at a, b, c, d and e radiographic centers within one meter above the Earth's surface. Radiation levels within each center were measured at four locations (outside of center, secretary desk, and patient waiting room and behind the radiology room) both in X-ray machine operating and non-operating condition. The obtained data were analyzed by SPSS software. Results: The inside ionization radiation dose in a, b, c, d and e radiographic centers were 0.121, 0.119, 0.126, 0132 and 0.128 μSv/h respectively. The outside ionization radiation dose in a, b, c, d and e radiographic centers were 0.094, 0.092, 0.093, 0.112 and 0.101 μSv/h respectively. Equivalent annual dose within and outside selected radiology centers were lower than the threshold (1 mSv / year). Conclusion: The results show that the ionizing radiation dose of the X-ray equipment examined in the radiology centers of Ahwaz is lower than the global standard.

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Radiation Medical Countermeasures and Use of EPR Biodosimetry to Facilitate Effectiveness of Applied Clinical Procedures

Applied Magnetic Resonance ◽

10.1007/s00723-021-01444-w ◽

2021 ◽

Author(s):

Vijay K. Singh ◽

Harold M. Swartz ◽

Thomas M. Seed

Keyword(s):

Radiation Dose ◽

Ionizing Radiation ◽

Radiation Exposure ◽

Medical Management ◽

Clinical Findings ◽

In Vivo Dosimetry ◽

Clinical Procedures ◽

Clinically Significant ◽

Medical Countermeasures

AbstractThe utility for electron paramagentic resonance (EPR or ESR)-based radiation biodosimetry has received increasing recognition concerning its potential to assist in guiding the clinical management of medical countermeasures in individuals unwantedly exposed to injurious levels of ionizing radiation. Similar to any of the standard physical dosimetric methods currently employed for screening clinically significant radiation exposures, the EPR-based in vivo dosimetry approach would serve to complement and extend clinical assessments (e.g., blood analyses, cytogenetics, etc.), specifically to more accurately assign the extent of ionizing radiation exposure that individuals might have received. In the case of EPR biodosimetry of biological samples such as nails, teeth, and bones, the method has the capability of providing information on the physical dose at several specific bodily sites and perhaps additonal information on the homogeneity of the exposure as well as its overall magnitude. This information on radiation dose and distribution would be of significant value in providing medical management to given individuals at health risk due to radiation exposure. As these measurements provide information solely on physical measures of the radiation dose and not on the potential biological impact of a particular dose, they are complementary, albeit supplemental, to the array of currently available biologically based biodosimetry and clinical findings. In aggregate, these physical and biological measures of radiation exposure levels (dose) would most certainly provide additional, useful information for the effective medical management of radiation exposed individuals.

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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 doses deriving from patients treated with 166Ho-ferric hydroxide

Nuklearmedizin ◽

10.1055/s-0038-1625736 ◽

2003 ◽

Vol 42 (06) ◽

pp. 251-254

Author(s):

C. Pirich ◽

P. John ◽

S. Ofluoglu ◽

H. Sinzinger ◽

E. Havlik ◽

...

Keyword(s):

Radiation Exposure ◽

Radiation Protection ◽

Ferric Hydroxide ◽

Medical Personnel ◽

Whole Body ◽

Radiation Doses ◽

Annual Dose ◽

Tracer Injection ◽

Dose Rates ◽

Protection Devices

Summary Aim: To estimate radiation doses deriving from patients treated with 166Ho ferric hydroxide. Methods: For radiation synoviorthesis about 900 ± 100 MBq 166Ho ferric hydroxide was injected into the knee joint of 16 patients. To estimate the radiation exposure of persons in the neighbourhood of the patients measurements of the dose rates were performed at 0.5 m, 1 m and 2 m distance of the treated joint 10 min after tracer injection. Measurements were carried out with and without radiation protection devices of the syringe. Results: The initial values of the dose rate were 11.9 μSv/h at 0.5 m, 3.5 μSv/h at 1 m and 1 μSv/h at 2 m distance, respectively. The whole body doses were 2.9 μSv for the physician and 4.6 μSv for the technologist. The finger doses for the technologist and the physician were ranging from 65 to 111 μSv. After discharge at home other persons might receive 118 μSv. Conclusion: Our results, under very strict assumptions, clearly demonstrate that the calculated radiation exposure to medical and non medical personnel is well below the maximum annual dose limit. The use of any additional radiation protection device as syringe shielding does not significantly lower radiation exposure.

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Radiation load of the personnel of the Samara region during medical procedures for the period 2016-2018

Russian Journal of Occupational Health and Industrial Ecology ◽

10.31089/1026-9428-2019-59-9-759-760 ◽

2020 ◽

pp. 759-759

Author(s):

S. S. Somov ◽

K. V. Yakusheva

Keyword(s):

Comparative Analysis ◽

Radiation Dose ◽

Ionizing Radiation ◽

Radiation Exposure ◽

Medical Procedures ◽

Individual Dose ◽

Dose Limit ◽

Radiation Load ◽

Dose Rates

A comparative analysis of the radiation dose rates of medical workers of the Samara region during medical procedures for the period from 2016 to 2018 was carried out. The results of the average annual individual dose of personnel working with sources of ionizing radiation showed stable values of radiation exposure comparable to the dose limit for the population.

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Management of personnel of fire and rescue garrisons taking into account radiation exposure

Technology of technosphere safety ◽

10.25257/tts.2021.2.92.94-105 ◽

2021 ◽

Vol 92 ◽

pp. 94-105

Author(s):

A. G. Zavorotnyy ◽

Keyword(s):

Mathematical Model ◽

Radiation Dose ◽

Radiation Exposure ◽

The State ◽

Reference Points ◽

Effective Radiation Dose ◽

Risk Of Death ◽

Radiation Accidents ◽

Stochastic Effect ◽

Effective Radiation

Introduction. At present, despite the efforts made by the state, the state of radiation protection does not reach the level at which there is no unacceptable risk of harm to the life or health of people, the environment, the property of individuals and legal entities, state and municipal property on the territory of the Russian Federation in the event of implementation of radiation treats. The readiness of management bodies, forces and means of fire and rescue garrisons to eliminate the consequences of radiation accidents is a very urgent problem. Goals and objectives. The aim of the work is to improve the management of the personnel of fire and rescue garrisons, taking into account the radiation exposure in preparation for liquidation and during the elimination of radiation accidents. Tasks include the creation and justification of a model that allows you to convert the exit risks of the deterministic effects into the risks of stochastic effects. Methods. To create a model for the management of fire and rescue garrisons’ personnel, taking into account the radiation exposure, we used the literature experimental data and used the probabilistic-statistical method and the method of least squares. Results and discussion. The calculated model of management of the fire and rescue garrisons’ personnel, taking into account radiation exposure in preparation for liquidation and in the course of liquidation of radiation accidents, is developed. The probabilistic mathematical model allows us to estimate the exit of stochastic and deterministic effects depending on the effective radiation dose. The excellent convergence of the predicted (calculated) value EAR1 = 0,000607 and the statistical value EAR0 = 0,000724 is due to the fact that the reference points LD10 = 2 Gy , LD50/60 = 4 Gy , LD90 = 6 Gy are based on repeatedly verified statistical data on radiation accidents and deaths of more than 1000 people in radiation accidents [1]. This indicates that the mathematical model adequately reflects the exit of stochastic and deterministic effects observed during the operation of nuclear facilities both in normal mode and in radiation accidents. Conclusions. The probability of exit of stochastic and deterministic effects depending on the radiation dose received by the personnel of fire and rescue garrisons is presented. The threshold of the stochastic effect for humans is in the vicinity of the equivalent dose of 10 mSv for radiation with low linear energy transfer. At the same time, the probability of a stochastic effect is 3 · 10-6 on average after 15 years. This model of radiation exposure management for the personnel of fire and rescue garrisons could be a good tool for the emergency response manager (fire extinguishing manager) during preparation for the elimination and during the elimination of radiation accidents. Keywords: management, personnel, fire and rescue garrison, radiation exposure, effective radiation dose, risk of death

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The radiation doses and radiation protection on the endoscopic retrograde cholangiopancreatography procedures

British Journal of Radiology ◽

10.1259/bjr.20210399 ◽

2021 ◽

pp. 20210399

Author(s):

Mamoru Takenaka ◽

Makoto Hosono ◽

Shiro Hayashi ◽

Tsutomu Nishida ◽

Masatoshi Kudo

Keyword(s):

Radiation Dose ◽

Radiation Exposure ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Radiation Doses ◽

Average Dose ◽

Endoscopic Retrograde ◽

X Ray ◽

Endoscopic Procedures ◽

Dose Area Product ◽

Therapeutic Ercp

Although many interventions involving radiation exposure have been replaced to endoscopic procedure in the gastrointestinal and hepatobiliary fields, there remains no alternative for enteroscopy and endoscopic retrograde cholangiopancreatography (ERCP), which requires the use of radiation. In this review, we discuss the radiation doses and protective measures of endoscopic procedures, especially for ERCP. For the patient radiation dose, the average dose area product for diagnostic ERCP was 14–26 Gy.cm², while it increased to as high as 67–89 Gy.cm² for therapeutic ERCP. The corresponding entrance skin doses for diagnostic and therapeutic ERCP were 90 and 250 mGy, respectively. The mean effective doses were 3– 6 mSv for diagnostic ERCP and 12–20 mSv for therapeutic ERCP. For the occupational radiation dose, the typical doses were 94 μGy and 75 μGy for the eye and neck, respectively. However, with an over-couch-type X-ray unit, the eye and neck doses reached as high as 550 and 450 μGy, with maximal doses of up to 2.8 and 2.4 mGy/procedure, respectively. A protective lead shield was effective for an over couch X-ray tube unit. It lowered scattered radiation by up to 89.1% in a phantom study. In actual measurements, the radiation exposure of the endoscopist closest to the unit was reduced to approximately 12%. In conclusion, there is a clear need for raising awareness among medical personnel involved endoscopic procedures to minimise radiation risks to both the patients and staff.

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