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INTRODUCTION: Radiation exposure in medical settings stands as the primary source of artificial radiation, compounded by the yearly rise in healthcare worker numbers. Ensuring radiation protection is crucial for safeguarding their occupational health. Nevertheless, existing studies on radiation protection behavior exhibit considerable heterogeneity due to various factors. OBJECTIVE: This scoping review aims to explore the current status of research on radiation protection behavior and identify research gaps, intending to guide future research directions. METHODS AND ANALYSIS: The scoping review will follow the Arksey and O'Malley framework and the Joanna Briggs Institute methodology. A systematic search will be conducted across English databases including PubMed, Web of Science, Embase, and Medline, as well as Chinese databases such as CNKI, Wanfang, VIP, and China Biomedical Literature Database. Two independent reviewers will screen the studies based on predefined eligibility criteria and extract the data. Any disagreements will be resolved through discussion by a third reviewer. The review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. STRENGTHS AND LIMITATIONS OF THIS STUDY: A stakeholder consultation will provide an opportunity to validate the findings and address any potential gaps in the article. In this scoping review, all types of studies will be considered. The effectiveness of the methodological quality of the included studies will not be reported, which may lead to some studies of poor quality being included. Only studies published in English or Chinese after 2010 will be considered in this review, potentially leading to the omission of relevant papers.
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Personal de Salud , Protección Radiológica , Humanos , Protección Radiológica/métodos , Exposición Profesional/prevención & control , Exposición a la Radiación/efectos adversos , Exposición a la Radiación/prevención & controlAsunto(s)
Exposición a la Radiación , Traumatismos por Radiación , Humanos , Traumatismos por Radiación/prevención & control , Traumatismos por Radiación/tratamiento farmacológico , Exposición a la Radiación/efectos adversos , Exposición a la Radiación/prevención & control , Contramedidas Médicas , Protectores contra Radiación/uso terapéutico , Desarrollo de Medicamentos , Salud Global , AnimalesRESUMEN
PURPOSE OF REVIEW: In this review, we discuss the status of novel radiation shielding and other methods to reduce radiation exposure and its associated health risks within the CCL. RECENT FINDINGS: There are many devices on the market each with its unique advantages and inherent flaws. Several are available for widespread use with promising data, while others still in development. The field of percutaneous transcatheter interventions includes complex procedures often involving significant radiation exposure. Increased radiation exposes the proceduralist and CCL staff to potential harm from both direct effects of radiation but also from the ergonomic consequences of daily use of heavy personal protective equipment. Here we discuss several innovative efforts to reduce both radiation exposure and orthopedic injury within the CCL that are available, leading to a safer daily routine in a "lead [apron]-free" environment.
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Cateterismo Cardíaco , Exposición Profesional , Exposición a la Radiación , Humanos , Cateterismo Cardíaco/métodos , Exposición Profesional/prevención & control , Exposición a la Radiación/prevención & control , Protección Radiológica/métodos , Protección Radiológica/instrumentación , Equipo de Protección Personal , Ropa de ProtecciónRESUMEN
BACKGROUND: Neck computed tomography (NCT) is essential for diagnosing suspected neck tumors and abscesses, but radiation exposure can be an issue. In conventional reconstruction techniques, limiting radiation dose comes at the cost of diminished diagnostic accuracy. Therefore, this study aimed to evaluate the effects of an AI-based denoising post-processing software solution in low-dose neck computer tomography. MATERIALS AND METHODS: From 01 September 2023 to 01 December 2023, we retrospectively included patients with clinically suspected neck tumors from the same single-source scanner. The scans were reconstructed using Advanced Modeled Iterative Reconstruction (Original) at 100% and simulated 50% and 25% radiation doses. Each dataset was post-processed using a novel denoising software solution (Denoising). Three radiologists with varying experience levels subjectively rated image quality, diagnostic confidence, sharpness, and contrast for all pairwise combinations of radiation dose and reconstruction mode in a randomized, blinded forced-choice setup. Objective image quality was assessed using ROI measurements of mean CT numbers, noise, and a contrast-to-noise ratio (CNR). An adequately corrected mixed-effects analysis was used to compare objective and subjective image quality. RESULTS: At each radiation dose level, pairwise comparisons showed significantly lower image noise and higher CNR for Denoising than for Original (p < 0.001). In subjective analysis, image quality, diagnostic confidence, sharpness, and contrast were significantly higher for Denoising than for Original at 100 and 50 % (p < 0.001). However, there were no significant differences in the subjective ratings between Original 100 % and Denoising 25 % (p = 0.906). CONCLUSIONS: The investigated denoising algorithm enables diagnostic-quality neck CT images with radiation doses reduced to 25% of conventional levels, significantly minimizing patient exposure.
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Aprendizaje Profundo , Neoplasias de Cabeza y Cuello , Exposición a la Radiación , Interpretación de Imagen Radiográfica Asistida por Computador , Tomografía Computarizada por Rayos X , Humanos , Tomografía Computarizada por Rayos X/métodos , Masculino , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Estudios Retrospectivos , Exposición a la Radiación/prevención & control , Exposición a la Radiación/análisis , Persona de Mediana Edad , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Dosis de Radiación , Anciano , Adulto , Relación Señal-Ruido , Cuello/diagnóstico por imagenRESUMEN
During the radiographic examination of the chest and bones in hospitals, communicating and maintaining posture is difficult for some patients, and movement before or during X-ray irradiation may necessitate re-exposure owing to body wobbling movements or breathing movements. To prevent the need for re-exposure during radiography and to determine the exposure timing, a body movement detection system that considers breathing movements was developed in this study. The posture of a patient was monitored using an RGB camera. The acquired video data was analyzed to detect body movement using either an inter-frame difference method or an optical flow estimation method. The performance of the system was evaluated by detecting the body and breathing movements during positioning. Consequently, the inter-frame difference method detected 179.8-1222.2 pixels during body movements, and the optical flow estimation method confirmed that the feature points moved by 5.5-26.6 mm (4.2-20.3 pixels). When detecting breathing movements, 82-585 pixels were detected by the inter-frame difference method, and the optical flow estimation method showed that the feature points moved by 5.2 mm (2-4 pixels). Therefore, the proposed method can detect body movements during radiography to prevent re-exposure due to body wobble and breathing movements. For healthcare providers, it will lead to reduce not only concerns about patient exposure but also unnecessary radiographic workload.
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Movimiento , Humanos , Radiografía/instrumentación , Radiografía/métodos , Respiración , Postura , Exposición a la Radiación/prevención & control , Exposición a la Radiación/análisisRESUMEN
OBJECTIVE: Ionizing radiation has long been used in the medical field. Catheter laboratories (cath labs) are recognized as areas where radiation exposure is notably high. This study aims to examine the levels of radiation exposure during various interventional procedures to raise awareness of this issue in Türkiye. METHODS: This study evaluated the procedure radiation doses (n = 2804) in the cath labs of four public hospitals with distinct characteristics. Radiation dose evaluation was conducted using Cumulative Air Kerma (CAK). The Kolmogorov-Smirnov test, Kruskal-Wallis H test, independent T-test, and Pearson correlation coefficient were utilized to analyze the data. A p-value of < 0.05 was considered statistically significant. Data were analyzed using IBM® Statistical Package for the Social Sciences (SPSS®) STATISTICS Version 26.0.0.0 (IBM Corporation, Armonk, New York, USA). RESULTS: The procedure radiation doses in the cath labs were documented. The findings are largely consistent with the literature. Notably, several outlier cases with extremely high radiation doses were identified [CAK (min-max) = 0.12 - 9.9 Gy]. Procedures such as chronic total occlusion (CTO) [Mean CAK: 3.8 (± 1.5) Gy] and percutaneous coronary interventions (PCI) [Mean CAK: 1.5 (± 1.4) Gy] were associated with high doses. Additionally, personnel attitudes toward radiation optimization in cath labs were found to be inadequate. CONCLUSION: The incidence of high radiation exposure during interventional procedures may be higher than expected in Türkiye. Further research is necessary to identify predictors and implement preventive measures to reduce these rates. For this purpose, establishing diagnostic radiation reference levels (DRLs) could help monitor national radiation levels.
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Exposición Profesional , Dosis de Radiación , Humanos , Exposición Profesional/prevención & control , Exposición a la Radiación/prevención & control , Turquía , Cardiología , Actitud del Personal de Salud , Femenino , MasculinoRESUMEN
This study provides a comprehensive evaluation of the occupational radiation exposure faced by healthcare professionals during Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. Utilizing an anthropomorphic RANDO phantom equipped with Thermoluminescent Dosimeters (TLDs), we replicated ERCP scenarios to measure radiation doses received by medical staff. The study meticulously assessed radiation exposure in various corresponding body regions typically occupied by medical staff during ERCP, with a focus on eyes, thyroid, hands, and reproductive corresponding organ regions. The findings revealed significant variations in radiation doses across different body parts, highlighting areas of higher exposure and underscoring the need for improved protective measures and procedural adjustments. The effective radiation doses were calculated using standard protocols, considering the varying levels of protection offered by lead aprons and thyroid shields. The results demonstrate the substantial radiation exposure experienced by healthcare staff, particularly in regions not adequately shielded. This study emphasizes the necessity for enhanced radiation safety protocols in clinical settings, advocating for advanced protective equipment, training in radiation safety, and the exploration of alternative imaging modalities. The findings have crucial implications for both patient and staff safety, ensuring the continued efficacy and safety of ERCP and similar interventional procedures. This research contributes significantly to the field of occupational health and safety in interventional radiology, providing vital data for the development of safer medical practices.
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Colangiopancreatografia Retrógrada Endoscópica , Exposición Profesional , Fantasmas de Imagen , Dosis de Radiación , Exposición a la Radiación , Protección Radiológica , Dosimetría Termoluminiscente , Humanos , Exposición Profesional/prevención & control , Exposición a la Radiación/prevención & control , Protección Radiológica/instrumentación , Protección Radiológica/métodos , Personal de SaludRESUMEN
OBJECTIVE: The International Commission on Radiological Protection has highlighted the large number of medical specialties that use fluoroscopy outside diagnostic imaging departments without radiation protection programmes for patients and staff. Vascular surgery is one of these specialties. Thoracic endovascular aortic repair (TEVAR) is a complicated procedure requiring radiation protection guidance and optimisation. The recent EU Basic Safety Standards Directive requires the use and periodic updating of diagnostic reference levels (DRLs) for interventional procedures. The aim of this study was to determine doses for patients undergoing TEVAR with mobile Xray systems and hybrid rooms (fixed Xray systems) to obtain national DRLs and to suggest optimisation actions. METHODS: This was a retrospective cross sectional study. The Spanish Chapter of Endovascular Surgery conducted a national survey in 11 autonomous communities representing around 77.6% of the Spanish population (47.33 million inhabitants). A total of 266 TEVAR procedures from 17 Spanish centres were analysed, of which 53.0% were performed in hybrid operating rooms. National DRLs were obtained and defined as the third quartile of the median values from the different participating centres. RESULTS: The proposed national DRLs are: for kerma area product (KAP), 113.81 Gy·cm2 for mobile Xray systems and 282.59 Gy·cm2 for hybrid rooms; and for cumulative air kerma (CAK) at the patient entry reference point, 228.38 mGy for mobile systems and 910.64 mGy for hybrid rooms. CONCLUSION: Based on the requirement to know radiation doses for standard endovascular procedures, this study of TEVARs demonstrated that there is an increased factor of 2.48 in DRLs for KAP when the procedure is performed in a hybrid room compared with mobile C-arm systems, and an increased factor of 3.98 in DRLs for CAK when the procedure is performed with hybrid equipment. These results will help to optimise strategies to reduce radiation doses during TEVAR procedures.
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Aorta Torácica , Reparación Endovascular de Aneurismas , Dosis de Radiación , Femenino , Humanos , Masculino , Aorta Torácica/cirugía , Aorta Torácica/diagnóstico por imagen , Estudios Transversales , Reparación Endovascular de Aneurismas/efectos adversos , Reparación Endovascular de Aneurismas/normas , Fluoroscopía/normas , Exposición a la Radiación/prevención & control , Exposición a la Radiación/efectos adversos , Protección Radiológica/normas , Radiografía Intervencional/efectos adversos , Radiografía Intervencional/normas , Valores de Referencia , Estudios Retrospectivos , EspañaAsunto(s)
Dosis de Radiación , Exposición a la Radiación , Protección Radiológica , Radiografía Intervencional , Humanos , Protección Radiológica/instrumentación , Fluoroscopía , Radiografía Intervencional/efectos adversos , Radiografía Intervencional/instrumentación , Exposición a la Radiación/prevención & control , Exposición a la Radiación/efectos adversos , Exposición Profesional/prevención & control , Exposición Profesional/efectos adversos , Plomo , Traumatismos por Radiación/prevención & control , Traumatismos por Radiación/etiología , Diseño de Equipo , Tomografía Computarizada por Rayos X , Factores de Riesgo , Salud LaboralRESUMEN
Fluoroscopy-guided gastrointestinal procedures, including gastrointestinal stenting, balloon-assisted endoscopy (BAE), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS), are essential for diagnosis and treatment in gastroenterology. Such procedures involve radiation exposure that necessitates strict safety measures to protect patients, doctors, and medical staff. The April 2020 update to Japan's Ionizing Radiation Injury Prevention Regulations for occupational exposure reduced the lens exposure dose limit to approximately one-seventh of its previous level. This change highlights the need for improved safety protocols. Without adaptation, the sustainability of fluoroscopy-based endoscopic techniques could be at risk due to the potential to exceed these new limits. This review examines the current state of medical radiation exposure in the field of gastroenterology in Japan and discusses the findings of the REX-GI study.
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Gastroenterología , Exposición Profesional , Exposición a la Radiación , Protección Radiológica , Humanos , Japón , Gastroenterología/métodos , Gastroenterología/normas , Exposición Profesional/prevención & control , Exposición Profesional/efectos adversos , Protección Radiológica/métodos , Exposición a la Radiación/prevención & control , Exposición a la Radiación/efectos adversos , Fluoroscopía/efectos adversos , Fluoroscopía/métodos , Traumatismos por Radiación/prevención & control , Dosis de RadiaciónRESUMEN
PURPOSE: Fluoroscopy is usually required during retrograde intrarenal surgery (RIRS). Although fluoroscopy is considered necessary for effective and safe RIRS, there is growing awareness regarding radiation exposure risk to patients and surgeons. We conducted a multicenter-based, randomized, controlled trial to compare the safety and effectiveness of radiation-free (RF) RIRS with radiation-usage (RU) RIRS for kidney stone management. MATERIALS AND METHODS: From August 2020 to April 2022, patients with a unilateral kidney stone (≤20 mm) eligible for RIRS were prospectively enrolled in 5 tertiary medical centers after randomization and divided into the RF and RU groups. RIRS was performed using a flexible ureteroscope with a holmium:YAG laser. The primary end point of this study was the success rate, defined as complete stone-free or residual fragments with asymptomatic kidney stones ≤ 3 mm. The secondary end point of this study was ascertaining the safety of RF RIRS. The success rates were analyzed using a noninferiority test. RESULTS: Of the 140 consecutive randomized participants, 128 patients completed this study (RF: 63; RU: 65). The success rates (78% vs 80%, P = .8) were not significantly different between the groups. The rate of high-grade (grade 2-4) ureter injury was not significantly higher in the RF group compared to the RU group (RF = 3 [4.8%] vs RU = 2 [3.1%], P = .6). In RF RIRS, the success rate was noninferior compared to RU RIRS (the difference was 2.2% [95% CI, 0.16-0.12]). CONCLUSIONS: This study demonstrated that the surgical outcomes of RF RIRS were noninferior to RU RIRS.
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Cálculos Renales , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Cálculos Renales/cirugía , Resultado del Tratamiento , Fluoroscopía , Anciano , Adulto , Ureteroscopía/métodos , Ureteroscopía/efectos adversos , Láseres de Estado Sólido/uso terapéutico , Exposición a la Radiación/prevención & control , Riñón/cirugíaRESUMEN
BACKGROUND: The risk of radiation exposure in the surgical operating room (OR) and/or catheterization laboratory is now well established. Complex endovascular procedures often require multiple approaches and different positioning of the staff members around the patient, potentially increasing the levels of radiations exposure. Our goal was to evaluate the levels of radiation exposure of the members of the staff during endovascular aortic procedures in order to propose radioprotection optimization. METHODS: We included 41 aortic endovascular procedures out of 114 procedures performed between January 12, 2014, and August 31, 2015, including 24 standard endovascular aortic aneurysm repair (EVAR), 7 EVAR with iliac branch (EVARib), 8 complex fenestrated/branched EVAR (F/B EVAR), and 2 thoracic EVAR (TEVAR). Procedures were performed in an OR equipped with a carbon fiber table and a mobile fluoroscopy C-arm. We collected the usual dosimetry data given by the C-arm as well as the patient's peak skin dose (PSD). In all staff members, radiation exposure was measured with thermoluminescent chip dosimeters placed on both temples, on posterior sides of both hands, and on both lower legs. RESULTS: PSD levels were low for EVAR because 24 patients had values below the reading threshold. PSD significantly increased with more complex procedures. Main operator (MO) received the higher level of irradiation on whole body, hands, and ankles. Eye lenses irradiation was higher on both assistant operators (AOs). Other members received low levels of irradiation. We found a high ranges of radiation exposure with a high risk of exposure for the AO, mainly for F/B EVAR and EVARib. CONCLUSIONS: Even if all personal protections are used, staff positioning is a major point that must be considered. If MO is supposed to be the most exposed to X-rays, specific conditions of positioning of the AO may be at risk of exposure.
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Procedimientos Endovasculares , Exposición Profesional , Salud Laboral , Quirófanos , Dosis de Radiación , Exposición a la Radiación , Radiografía Intervencional , Humanos , Exposición Profesional/prevención & control , Exposición Profesional/efectos adversos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Exposición a la Radiación/prevención & control , Exposición a la Radiación/efectos adversos , Factores de Riesgo , Radiografía Intervencional/efectos adversos , Medición de Riesgo , Femenino , Masculino , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Dosimetría Termoluminiscente , Monitoreo de Radiación , Anciano , Traumatismos por Radiación/prevención & control , Traumatismos por Radiación/etiología , Protección Radiológica/instrumentación , Persona de Mediana EdadRESUMEN
Medical imaging is both valuable and essential in the care of patients. Much of this imaging depends on ionizing radiation with attendant responsibilities for judicious use when performing an examination. This responsibility applies in settings of both individual as well as multiple (recurrent) imaging with associated repeated radiation exposures. In addressing the roles and responsibilities of the medical communities in the paradigm of recurrent imaging, both the International Atomic Energy Agency (IAEA) and the American Association of Physicists in Medicine (AAPM) have issued position statements, each affirmed by other organizations. The apparent difference in focus and approach has resulted in a lack of clarity and continued debate. Aiming towards a coherent approach in dealing with radiation exposure in recurrent imaging, the IAEA convened a panel of experts, the purpose of which was to identify common ground and reconcile divergent perspectives. The effort has led to clarifying recommendations for radiation exposure aspects of recurrent imaging, including the relevance of patient agency and the provider-patient covenant in clinical decision-making. CLINICAL RELEVANCE STATEMENT: An increasing awareness, generating some lack of clarity and divergence in perspectives, with patients receiving relatively high radiation doses (e.g., ≥ 100 mSv) from recurrent imaging warrants a multi-stakeholder accord for the benefit of patients, providers, and the imaging community. KEY POINTS: ⢠Recurrent medical imaging can result in an accumulation of exposures which exceeds 100 milli Sieverts. ⢠Professional organizations have different perspectives on roles and responsibilities for recurrent imaging. ⢠An expert panel reconciles differing perspectives for addressing radiation exposure from recurrent medical imaging.
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Diagnóstico por Imagen , Exposición a la Radiación , Humanos , Diagnóstico por Imagen/métodos , Exposición a la Radiación/prevención & control , Dosis de Radiación , Protección Radiológica/métodosRESUMEN
The Periacetabular Osteotomy is a technically demanding procedure that requires precise intraoperative evaluation of pelvic anatomy. Fluoroscopic images pose a radiation risk to operating room staff, scrubbed personnel, and the patient. Most commonly, a Standard Fluoroscope with an Image Intensifier is used. Our institution recently implemented the novel Fluoroscope with a Flat Panel Detector. The purpose of this study was to compare radiation dosage and accuracy between the two fluoroscopes. A retrospective review of a consecutive series of patients who underwent Periacetabular Osteotomy for symptomatic hip dysplasia was completed. The total radiation exposure dose (mGy) was recorded and compared for each case from the standard fluoroscope (n = 27) and the flat panel detector (n = 26) cohorts. Lateral center edge angle was measured and compared intraoperatively and at the six-week postoperative visit. A total of 53 patients (96% female) with a mean age and BMI of 17.84 (± 6.84) years and 22.66 (± 4.49) kg/m2 (standard fluoroscope) and 18.23 (± 4.21) years and 21.99 (± 4.00) kg/m2 (flat panel detector) were included. The standard fluoroscope averaged total radiation exposure to be 410.61(± 193.02) mGy, while the flat panel detector averaged 91.12 (± 49.64) mGy (p < 0.0001). The average difference (bias) between intraoperative and 6-week postoperative lateral center edge angle measurement was 0.36° (limits of agreement: - 3.19 to 2.47°) for the standard fluoroscope and 0.27° (limits of agreement: - 2.05 to 2.59°) for the flat panel detector cohort. Use of fluoroscopy with flat panel detector technology decreased the total radiation dose exposure intraoperatively and produced an equivalent assessment of intraoperative lateral center edge angle. Decreasing radiation exposure to young patients is imperative to reduce the risk of future comorbidities.
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Osteotomía , Dosis de Radiación , Exposición a la Radiación , Humanos , Fluoroscopía/métodos , Femenino , Masculino , Exposición a la Radiación/prevención & control , Estudios Retrospectivos , Osteotomía/instrumentación , Osteotomía/métodos , Adolescente , Adulto Joven , Acetábulo/cirugía , Acetábulo/diagnóstico por imagen , Adulto , Luxación de la Cadera/prevención & control , Luxación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/etiología , NiñoRESUMEN
AIMS: The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey on radiation exposure in interventional echocardiography. The survey aimed to collect data on local practices for radioprotection in interventional echocardiography and to assess the awareness of echocardiography operators about radiation-related risks. METHODS AND RESULTS: A total of 258 interventional echocardiographers from 52 different countries (48% European) responded to the survey. One hundred twenty-two (47%) participants were women. Two-thirds (76%) of interventional echocardiographers worked in tertiary care/university hospitals. Interventional echocardiography was the main clinical activity for 34% of the survey participants. The median time spent in the cath-lab for the echocardiographic monitoring of structural heart procedures was 10 (5-20) hours/month. Despite this, only 28% of interventional echocardiographers received periodic training and certification in radioprotection and 72% of them did not know their annual radiation dose. The main adopted personal protection devices were lead aprons and thyroid collars (95% and 92% of use, respectively). Dedicated architectural protective shielding was not available for 33% of interventional echocardiographers. Nearly two-thirds of responders thought that the radiation exposure of interventional echocardiographers was higher than that of interventional cardiologists and 72% claimed for an improvement in the radioprotection measures. CONCLUSION: Radioprotection measures for interventional echocardiographers are widely variable across centres. Radioprotection devices are often underused by interventional echocardiographers, portending an increased radiation-related risk. International scientific societies working in the field should collaborate to endorse radioprotection training, promote reliable radiation dose assessment, and support the adoption of radioprotection shielding dedicated to interventional echocardiographers.
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Ecocardiografía , Exposición Profesional , Exposición a la Radiación , Protección Radiológica , Humanos , Femenino , Exposición Profesional/prevención & control , Exposición a la Radiación/prevención & control , Masculino , Europa (Continente) , Encuestas y Cuestionarios , Dosis de Radiación , Adulto , Persona de Mediana Edad , Ultrasonografía IntervencionalRESUMEN
PURPOSE: To summarize dose trends from 1980 to 2020 for 19,651 U.S. Radiologic Technologists who reported assisting with fluoroscopically guided interventional procedures (FGIPs), overall and by work history characteristics. MATERIALS AND METHODS: A total of 762,310 annual personal dose equivalents at a 10-mm reference depth (doses) during 1980-2020 for 43,823 participants of the U.S. Radiologic Technologists (USRT) cohort who responded to work history questionnaires administered during 2012-2014 were summarized. This population included 19,651 technologists who reported assisting with FGIP (≥1 time per month for ≥12 consecutive months) at any time during the study period. Doses corresponding to assistance with FGIP were estimated in terms of proximity to patients, monthly procedure frequency, and procedure type. Box plots and summary statistics (eg, medians and percentiles) were used to describe annual doses and dose trends. RESULTS: Median annual dose corresponding to assistance with FGIP was 0.65 mSv (interquartile range [IQR], 0.60-1.40 mSv; 95th percentile, 6.80). Higher occupational doses with wider variability were associated with close proximity to patients during assistance with FGIP (median, 1.20 mSv [IQR, 0.60-4.18 mSv]; 95th percentile, 12.66), performing ≥20 FGIPs per month (median, 0.75 mSv [IQR, 0.60-2.40 mSv]; 95th percentile, 9.44), and assisting with high-dose FGIP (median, 0.70 mSv [IQR, 0.60-1.90 mSv]; 95th percentile, 8.30). CONCLUSIONS: Occupational doses corresponding to assistance with FGIP were generally low but varied with exposure frequency, procedure type, and proximity to patients. These results highlight the need for vigilant dose monitoring, radiation safety training, and proper protective equipment.
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Exposición Profesional , Salud Laboral , Dosis de Radiación , Exposición a la Radiación , Radiografía Intervencional , Humanos , Exposición Profesional/prevención & control , Fluoroscopía , Radiografía Intervencional/efectos adversos , Radiografía Intervencional/tendencias , Estados Unidos , Exposición a la Radiación/efectos adversos , Exposición a la Radiación/prevención & control , Factores de Tiempo , Masculino , Femenino , Factores de Riesgo , Medición de Riesgo , Persona de Mediana Edad , Tecnología Radiológica/tendencias , Adulto , Técnicos Medios en Salud , Monitoreo de Radiación , Protección RadiológicaRESUMEN
OBJECTIVE: Ventriculoperitoneal shunt implantation has become standard treatment for cerebrospinal fluid diversion, besides endoscopic third ventriculostomy for certain indications. Postoperative X-ray radiography series of skull, chest and abdomen combined with cranial CT are obtained routinely in many institutions to document the shunt position and valve settings in adult patients. Measures to reduce postoperative radiation exposure are needed, however, there is only limited experience with such efforts. Here, we aim to compare routine postoperative cranial CT plus conventional radiography series (retrospective arm) with cranial CT and body scout views only (prospective arm) concerning both diagnostic quality and radiation exposure. PATIENTS AND METHODS: After introduction of an enhanced CT imaging protocol, routine skull and abdomen radiography was no longer obtained after VP shunt surgery. The image studies of 25 patients with routine postoperative cranial CT and conventional radiography (retrospective arm of study) were then compared to 25 patients with postoperative cranial CT and CT body scout views (prospective arm of study). Patient demographics such as age, sex and primary diagnosis were collected. The image quality of conventional radiographic images and computed tomography scout views images were independently analyzed by one neurosurgeon and one neuroradiologist. RESULTS: There were no differences in quality assessments according to three different factors determined by two independent investigators for both groups. There was a statistically significant difference, however, between the conventional radiography series group and the CT body scout view imaging group with regard to radiation exposure. The effective dose estimation calculation yielded a difference of 0.05â¯mSv (two-tailed t-test, pâ¯=â¯0.044) in favor of CT body scout view imaging. Furthermore, the new enhanced protocol resulted in a reduction of cost and the use of human resources. CONCLUSION: CT body scout view imaging provides sufficient imaging quality to determine shunt positioning and valve settings. With regard to radiation exposure and costs, we suggest that conventional postoperative shunt series may be abandoned.
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Exposición a la Radiación , Tomografía Computarizada por Rayos X , Derivación Ventriculoperitoneal , Humanos , Femenino , Masculino , Tomografía Computarizada por Rayos X/métodos , Persona de Mediana Edad , Derivación Ventriculoperitoneal/métodos , Adulto , Exposición a la Radiación/prevención & control , Anciano , Estudios Prospectivos , Estudios Retrospectivos , Dosis de RadiaciónRESUMEN
ABSTRACT: The linear no-threshold (LNT) model may be useful as a simple basis for developing radiation protection regulations and standards, but it bears little resemblance to scientific reality and is probably overly conservative at low doses and low dose rates. This paper is an appeal for a broader view of radiation protection that involves more than just optimization of radiation dose. It is suggested that the LNT model should be replaced with a risk-informed, targeted approach to limitation of overall risks, which include radiation and other types of risks and accidents/incidents. The focus should be on protection of the individual. Limitation of overall risk does not necessarily always equate to minimization of individual or collective doses, but in some cases it might. Instead, risk assessment (hazards analysis) should be performed for each facility/and or specific job or operation (straightforward for specialized work such as radiography), and this should guide how limited resources are used to protect workers and the public. A graded approach could be used to prioritize the most significant risks and identify exposure scenarios that are unlikely or non-existent. The dose limits would then represent an acceptable level of risk, below which no further reduction in dose would be needed. Less resources should be spent on ALARA and tracking small individual and collective doses. Present dose limits are thought to be conservative and should suffice in general. Two exceptions are possibly the need for a lower (lifetime) dose limit for lens of the eye for astronauts and raising the public limit to 5 mSv y -1 from 1 mSv y -1 . This would harmonize the public limit with the current limit for the embryo fetus of the declared pregnant worker. Eight case studies are presented that emphasize how diverse and complex radiation risks can be, and in some cases, chemical and industrial risks outweigh radiation risks. More focus is needed on prevention of accidents and incidents involving a variety of types of risks. A targeted approach is needed, and commitments should be complied with until they are changed or exemptions are granted. No criticism of regulators or nuclear industry personnel is intended here. Protection of workers and the public is everyone's goal. The question is how best to accomplish that.