RESUMEN
This study presented a model applied for potential risk assessment in an interventional radiology setting. The model of potential risk assessment (MARP) consisted of the creation of a scale of indicators ranging from 0 to 5. The radiation levels were categorized according to gender, kind of procedure, value of kerma air product (Pka), and accumulated radiation dose (mGy). The MARP model was applied in 121 institutions over 8 y. A total of 201 656 patient radiation doses (Dose-area product and accumulated kerma) data were launched into the system over time, with an average of 22 406 doses per year. In the context of the workers (cardiologists, radiographers, and nurses) monitored during the MARP application, 8007 cases (with an average of 890 per year) of occupational radiation doses were recorded. This study showed a strategy for quality evaluation in fluoroscopy using a model with a compulsory information system for monitoring safety.
Asunto(s)
Exposición Profesional , Dosis de Radiación , Humanos , Fluoroscopía/métodos , Medición de Riesgo/métodos , Exposición Profesional/análisis , Exposición Profesional/prevención & control , Femenino , Masculino , Radiografía Intervencional/efectos adversos , Monitoreo de Radiación/métodos , Protección Radiológica/normas , Protección Radiológica/métodos , Radiología Intervencionista/métodos , Radiología Intervencionista/normas , Exposición a la Radiación/análisisRESUMEN
Since the introduction of uterine artery embolization as a treatment option for symptomatic leiomyomas, there has been a growing interest in expanding the role of interventional radiology (IR) in the evaluation and treatment of obstetrics and gynecology (OBGYN) patients. This review provides an overview of opportunities for collaboration between IR and OBGYN. This can include medically and/or surgically complex patients, efforts to reduce quantitative blood loss, obstetrical emergencies, and consideration of fertility or uterine preservation. Increased collaborative efforts between IR and OBGYN would allow for patients to be fully informed regarding the complete spectrum of surgical and nonsurgical treatment options available to them. The purpose of this review is to foster opportunities to improve outcomes and respect patient values.
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Leiomioma/terapia , Grupo de Atención al Paciente , Hemorragia Posparto/terapia , Radiografía Intervencional , Embolización de la Arteria Uterina , Neoplasias Uterinas/terapia , Adulto , Conducta Cooperativa , Femenino , Preservación de la Fertilidad , Humanos , Comunicación Interdisciplinaria , Leiomioma/diagnóstico por imagen , Leiomioma/patología , Hemorragia Posparto/diagnóstico por imagen , Radiografía Intervencional/efectos adversos , Resultado del Tratamiento , Embolización de la Arteria Uterina/efectos adversos , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/patologíaRESUMEN
OBJECTIVE: Fenestrated-branched endovascular aneurysm repair (F/B-EVAR) is a complex procedure that generates high radiation doses. Magnification aids in vessel cannulation but increases radiation. The aim of the study was to compare radiation doses to patients and operating room staff from two fluoroscopy techniques, standard magnification vs dual fluoroscopy with live-image digital zooming during F/B-EVAR. METHODS: An observational, prospective, single-center study of F/B-EVAR procedures using Philips Allura XperFD20 equipment (Philips Healthcare, Amsterdam, The Netherlands) was performed during a 42-month period. Intravascular ultrasound, three-dimensional fusion, and extreme collimation were used in all procedures. Intraoperative live-image processing was performed with two imaging systems: standard magnification in 123 patients (81%) and dual fluoroscopy with live-image digital zooming in 28 patients (18%). In the latter, the live "processed" zoomed images are displayed on examination displays and live images are displayed on reference displays. The reference air kerma was collected for each case and represents patient dose. Operating staff personal dosimetry was collected using the DoseAware system (Philips Healthcare). Patient and staff radiation doses were compared using nonparametric tests. RESULTS: Mean age was 71.6 ± 11.4 years. The median body mass index was 27 kg/m2 (interquartile range [IQR], 24.4-30.6 kg/m2) and was the same for both groups. Procedures performed with dual fluoroscopy with digital zooming demonstrated significantly lower median patient (1382 mGy [IQR, 999-2045 mGy] vs 2458 mGy [IQR, 1706-3767 mGy]; P < .01) and primary operator radiation doses (101 µSv [IQR, 34-235 µSv] vs 266 µSv [IQR, 104-583 µSv]; P < .01) compared with standard magnification. Similar significantly reduced radiation doses were recorded for first assistant, scrub nurse, and anesthesia staff in procedures performed with dual fluoroscopy. According to device design, procedures performed with four-fenestration/branch devices generated higher operator radiation doses (262 µSv [IQR, 116.5-572 µSv] vs 171 µSv [IQR, 44-325 µSv]; P < .01) compared with procedures with three or fewer fenestration/branches. Among the most complex design (four-vessel), operator radiation dose was significantly lower with digital zooming compared with standard magnification (128.5 µSv [IQR, 70.5-296 µSv] vs 309 µSv [IQR, 150-611 µSv]; P = .01). CONCLUSIONS: Current radiation doses to patients and operating personnel are within acceptable limits; however, dual fluoroscopy with live-image digital zooming results in dramatically lower radiation doses compared with the standard image processing with dose-dependent magnification. Operator radiation doses were reduced in half during procedures performed with more complex device designs when digital zooming was used.
Asunto(s)
Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Exposición Profesional/prevención & control , Exposición a la Radiación/prevención & control , Magnificación Radiográfica , Radiografía Intervencional , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta/diagnóstico por imagen , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Femenino , Fluoroscopía , Humanos , Masculino , Persona de Mediana Edad , Exposición Profesional/efectos adversos , Salud Laboral , Seguridad del Paciente , Estudios Prospectivos , Exposición a la Radiación/efectos adversos , Magnificación Radiográfica/efectos adversos , Radiografía Intervencional/efectos adversos , Medición de Riesgo , Factores de RiesgoRESUMEN
ANTECEDENTES: Las unidades de Cardiología intervencional han evidenciado un número creciente de procedimientos, cada vez más variados y complejos, lo cual podría eventualmente generar daños a los profesionales ocupacionalmente expuestos a radiaciones ionizantes (POEs) de no contar con los adecuados elementos de radioprotección y un uso correcto de ellos. OBJETIVO: Caracterizar la disponibilidad y utilización de los elementos de radioprotección y dosimetría de unidades de cardiología intervencionista de centros Sudamericanos. MATERIAL Y MÉTODOS: Se realizó una encuesta autoaplicada a 139 POEs, de ambos sexos de 7 países, a través de una plataforma on-line, se les consultó sobre características demográficas, dosimétricas y de radioprotección. RESULTADOS: Los elementos de radioprotección más tradicionales; delantales y cuellos plomados se utilizaron un 99,5 % y 98,4 % respectivamente, aquellos elementos más recientes como gafas, gorros y paños plomados solo alcanzaron un 36,8 %, 6,8 % y 34,2%, de utilización respectivamente, en cuanto a la utilización de los dosímetros, solo un 7,9 % lo hace apegado a las normas de la Organización Internacional de Energía Atómica (OIEA). CONCLUSIÓN: Se constató en la muestra analizada una falta de elementos de radioprotección y un uso inadecuado de ellos, urge realizar intervenciones educativas y técnicas para mejorar estos datos.
BACKGROUND: Due to the increasing number of interventional cardiology procedures currently performed, health professionals (POE) are exposed to ionizing radiation unless adequate protective elements are used. AIM: to describe the use of radioprotection elements and dosimetry in interventional cardiology laboratories in South America. METHODS: A self-administered survey was performed on 139 POE of both sexes and 7 countries using an online platform. Demographic data, dosimetry and characteristics of radioprotection analyzed. RESULTS: Commonly used radioprotective elements (lead aprons and collars) were used in 99.5% and 98% respectively. Recently introduced protection elements like lead goggles, caps and drapery were used in 36.8, 6.8 and 34.2% , respectively. Dosimetry according to the International Atomic Energy Commission (OIAE) was performed in only 7.9% of the procedures. CONCLUSION: there is a severe lack of adequate radioprotection during interventional cardiology procedures. Urgent measures, including technical implementation and educational interventions are needed to improve radioprotection in interventional cardiology.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Protección Radiológica/métodos , Radiografía Intervencional/efectos adversos , Exposición Profesional/prevención & control , Servicio de Cardiología en Hospital , Dosis de Radiación , Radiación Ionizante , Protección Radiológica/instrumentación , Protección Radiológica/estadística & datos numéricos , América del Sur , Proyectos Piloto , Encuestas y Cuestionarios , Autoinforme , Equipo de Protección PersonalRESUMEN
Prostatic artery embolisation (PAE) is used to treat patients with benign prostatic hyperplasia and with lower urinary obstructive tract symptoms. It is an interventional procedure which uses fluoroscopy equipment and can result in exposure to high doses of radiation in patients and staff. We aimed to demonstrate the reduction of radiation doses received by staff during PAE by implementing an optimised protocol called Radiation Exposure Curtailment for Embolisation (RECiFE). This protocol was implemented in cooperation with the medical team and technical team using Siemens Combined Applications to Reduce Exposure (CARE) protocol. The results showed approximately 83% reduction in the radiation doses received by the main physician during PAE. Thus, by adjusting the acquisition parameters of the angiographic equipment and implementing the RECiFE protocol, it is possible to optimise the PAE procedure and reduce the staff radiation dose.
Asunto(s)
Embolización Terapéutica/efectos adversos , Exposición Profesional/efectos adversos , Fantasmas de Imagen , Hiperplasia Prostática/terapia , Exposición a la Radiación/efectos adversos , Protección Radiológica/métodos , Radiografía Intervencional/efectos adversos , Brasil , Humanos , MasculinoRESUMEN
BACKGROUND: Iodine contrast medium (ICM) is considered to be gold standard in endovascular procedures, but its nephrotoxicity and hypersensitivity limit the widespread use. Carbon dioxide (CO2) is considered as an alternative for endovascular procedures in patients with contraindication to ICM. However, no studies have compared the outcomes of endovascular aneurysm repair (EVAR) performed with ICM or CO2 among patients with no contraindication to ICM. METHODS: From May 2012 to April 2014, 36 patients with abdominal aortic aneurysms underwent EVAR in a prospective, randomized, and controlled study. Patients were randomized into 2 groups, CO2 or ICM group. RESULTS: We were able to perform the proposed procedures in all patients in this study. There were no conversions to open surgery and no CO2-related complications. Endovascular material costs, duration of surgery, and time of fluoroscopy were similar between groups, and the cost of the contrast media was smaller in the CO2 group than in the ICM group. Among CO2 group procedures, 62.5% of the patients needed ICM complementary use. CONCLUSIONS: The use of CO2 as a contrast medium for EVAR is an alternative in patients with no restriction for ICM, with similar outcomes when compared to ICM, regarding duration of surgery, duration of fluoroscopy, and endovascular material costs. Using CO2, there were no changes in creatinine clearance and no risk of hypersensitivity reactions; moreover, there was a reduction in contrast-related costs for EVAR procedures. However, in our study, additional use of ICM to visualize the internal iliac artery was needed in most procedures.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Aortografía/métodos , Implantación de Prótesis Vascular , Dióxido de Carbono/administración & dosificación , Angiografía por Tomografía Computarizada , Medios de Contraste/administración & dosificación , Procedimientos Endovasculares , Yohexol/administración & dosificación , Radiografía Intervencional/métodos , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Implantación de Prótesis Vascular/efectos adversos , Brasil , Dióxido de Carbono/efectos adversos , Medios de Contraste/efectos adversos , Procedimientos Endovasculares/efectos adversos , Femenino , Humanos , Yohexol/efectos adversos , Masculino , Persona de Mediana Edad , Tempo Operativo , Valor Predictivo de las Pruebas , Estudios Prospectivos , Radiografía Intervencional/efectos adversos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Malignancy resulting in impaired biliary drainage includes a number of diagnoses familiar to the interventional radiologist. Adequate drainage of such a system can significantly improve patient quality of life, and can facilitate the further treatment options and care of such patients. In the setting of prior instrumentation, cholangitis can present as an urgent indication for drainage. Current initial interventional management of malignant biliary duct obstruction frequently includes endoscopic or percutaneous intervention, with local practices and preprocedural imaging guiding interventional approaches and subsequent management. This article addresses the indications for percutaneous drainage, technical considerations in performing such drainage, and specific techniques useful in attempting to achieve clinical end points in patients with malignant biliary duct obstruction.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica , Colestasis/terapia , Neoplasias del Sistema Digestivo/complicaciones , Radiografía Intervencional/métodos , Catéteres , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/instrumentación , Colestasis/diagnóstico , Colestasis/etiología , Constricción Patológica , Diagnóstico por Imagen/métodos , Dilatación , Drenaje , Humanos , Cuidados Paliativos , Valor Predictivo de las Pruebas , Diseño de Prótesis , Radiografía Intervencional/efectos adversos , Radiografía Intervencional/instrumentación , Factores de Riesgo , Stents , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
AIM: To evaluate the techniques, results, and complications related to computed tomography (CT)-guided percutaneous core needle biopsies of solid pancreatic lesions. METHODS: CT-guided percutaneous biopsies of solid pancreatic lesions performed at a cancer reference center between January 2012 and September 2013 were retrospectively analyzed. Biopsy material was collected with a 16-20 G Tru-Core needle (10-15 cm; Angiotech, Vancouver, CA) using a coaxial system and automatic biopsy gun. When direct access to the lesion was not possible, indirect (transgastric or transhepatic) access or hydrodissection and/or pneumodissection maneuvers were used. Characteristics of the patients, lesions, procedures, and histologic results were recorded using a standardized form. RESULTS: A total of 103 procedures included in the study were performed on patients with a mean age of 64.8 year (range: 39-94 year). The mean size of the pancreatic lesions was 45.5 mm (range: 15-195 mm). Most (75/103, 72.8%) procedures were performed via direct access, though hydrodissection and/or pneumodissection were used in 22.2% (23/103) of cases and indirect transhepatic or transgastric access was used in 4.8% (5/103) of cases. Histologic analysis was performed on all biopsies, and diagnoses were conclusive in 98.1% (101/103) of cases, confirming 3.9% (4/103) of tumors were benign and 94.2% (97/103) were malignant; results were atypical in 1.9% (2/103) of cases, requiring a repeat biopsy to diagnose a neuroendocrine tumor, and surgical resection to confirm a primary adenocarcinoma. Only mild/moderate complications were observed in 9/103 patients (8.7%), and they were more commonly associated with biopsies of lesions located in the head/uncinate process (n = 8), than of those located in the body/tail (n = 1) of the pancreas, but this difference was not significant. CONCLUSION: CT-guided biopsy of a pancreatic lesion is a safe procedure with a high success rate, and is an excellent option for minimally invasive diagnosis.
Asunto(s)
Adenocarcinoma/patología , Biopsia con Aguja Gruesa , Biopsia Guiada por Imagen/métodos , Tumores Neuroendocrinos/patología , Neoplasias Pancreáticas/patología , Radiografía Intervencional , Tomografía Computarizada por Rayos X , Adenocarcinoma/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Gruesa/efectos adversos , Femenino , Humanos , Biopsia Guiada por Imagen/efectos adversos , Masculino , Persona de Mediana Edad , Tumores Neuroendocrinos/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Valor Predictivo de las Pruebas , Pronóstico , Radiografía Intervencional/efectos adversos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/efectos adversosRESUMEN
BACKGROUND: Iodine contrast medium (ICM) is considered gold standard in endovascular revascularization procedures. However, nephrotoxicity and hypersensitivity to ICM are causes that limit its indiscriminate use. Carbon dioxide (CO2) contrast angiography has been used as an alternative in patients with formal contraindication to ICM. However, no studies to the present date have compared in a randomized and prospective way, outcomes of revascularization procedures performed with either ICM or CO2 in patients eligible for use of both contrasts. METHODS: Between April 2012 and April 2013, 35 patients with peripheral arterial disease with arterial lesions classified as Trans-Atlantic Inter-Society Consensus A or B (identified on preoperative angio computed tomography scan) and adequate runoff underwent femoropopliteal revascularization by endovascular technique in a prospective, randomized, and controlled study. Patients were randomized into 2 groups: CO2 group and ICM group, according to the contrast media selected of the procedure. We evaluated the following outcomes in both groups: feasibility of the procedures, complications, surgical outcomes (ankle-brachial index [ABI]), glomerular filtration rate using the Cockcroft-Gault formula, relationship between the volume of injected iodine and postoperative creatinine clearance, quality of the angiographic images obtained with CO2, costs of the endovascular materials, and finally, cost of contrast agents. RESULTS: We were able to perform the proposed procedures in all patients treated in this series (ICM group and CO2). There were no CO2-related complications. No procedures required conversion to open surgery. Clinical results were satisfactory, with regression of ischemia and increased levels of ABI in both groups. Variations in creatinine clearance levels showed a numerical increase in the CO2 group and a decrease in ICM group, however, with no statistically significant difference between the delta clearance in each group. All CO2 arteriograms of the supragenicular arteries were graded as good or fair by both observers with high interobserver image quality concordance. There was no statistical difference between endovascular material costs between the groups, but the contrast cost was significantly lower in CO2 group (P < 0.001). CONCLUSIONS: The use of CO2 in patients with no restriction for ICM is an alternative that does not limit the feasibility of the procedures. Similar outcomes were observed with CO2 when compared with the gold standard contrast (ICM) regarding quality of images produced, with no associated changes in creatinine clearance or hypersensitivity reactions and also allows a reduction in contrast-related costs in angioplasty procedures.
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Dióxido de Carbono/economía , Medios de Contraste/economía , Análisis Costo-Beneficio , Procedimientos Endovasculares/economía , Arteria Femoral/diagnóstico por imagen , Costos de la Atención en Salud , Enfermedad Arterial Periférica/economía , Enfermedad Arterial Periférica/terapia , Arteria Poplítea/diagnóstico por imagen , Radiografía Intervencional/economía , Adulto , Anciano , Anciano de 80 o más Años , Índice Tobillo Braquial , Brasil , Dióxido de Carbono/efectos adversos , Constricción Patológica , Medios de Contraste/efectos adversos , Procedimientos Endovasculares/efectos adversos , Estudios de Factibilidad , Femenino , Arteria Femoral/fisiopatología , Tasa de Filtración Glomerular/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Arteria Poplítea/fisiopatología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Radiografía Intervencional/efectos adversos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
El objetivo de este articulo fue entregar una guia con recomendaciones para mejorar la Seguridad Radiológica durante los procedimientos de intervencionismo cardiológico. Se describe la clasificación de los efectos causados por las radiaciones ionizantes a los pacientes y personal médico. Se recomienda la aplicación de un programa de Garatia de Calidad, el cual implicará tantos gastos, como mayores beneficios. Como parte de este programa, se sugiere la implementación de un programa de Protección Radiológica, que incluya al personal, monitoreo de la radiación, blindajes y entrenamiento del personal. Se deben establecer acciones permanentes en cada laboratorio de hemodinamia para gestionar de la mejor forma posible las dosis de radiación antes, durante y después de la intervención. Finalmente, para avanzar en la implementación de estas recomendaciones, creemos que un paso fundamental es la revisión de nuestro marco juridico en el ámbito de la Seguridad Radiológica, donde resultan imprescindibles aspectos como la implementación de programas de Garantia de Calidad y Protección Radiológica, junto al establecimiento de Niveles Referenciales de dosis para pacientes.
In this paper we present guidelines aimed to improve radiation safety during invasive cardiovascular procedures. Unwanted effects upon patients and medical personnel are conventionally classified. A program of Quality Assurance is proposed, an aspect of which is a program for radiologic protection, including operator protection, radiation monitoring, shielding and personnel training. Permanent and specific actions should be taken at every cardiovascular lab, before, during and after interventions. In order to implement these guidelines and actions, a fundamental step is a review of current legislation. Specific programs for quality control and radiologic protection along with a definition of acceptable radiation exposure doses are required.
Asunto(s)
Humanos , Cardiología/métodos , Protección Radiológica/normas , Radiografía Intervencional/efectos adversos , Traumatismos por Radiación/prevención & control , Control de Calidad , Exposición a la Radiación , Traumatismos por Radiación/etiologíaRESUMEN
BACKGROUND: It is not known whether leaded glass goggles with 0.25 mm Pb equivalency, used in interventional cardiology procedures, attenuate radiation below the levels established by the latest recommendation of the International Commission on Radiological Protection (ICRP). AIM: To assess if the degree of attenuation of the secondary ionizing radiation achieved by the use of 0.25 mm Pb leaded glass goggles, in occupationally exposed workers in interventional cardiology procedures, meets the latest ICRP recommendations. MATERIAL AND METHODS: A prospective investigation was carried out to compare the eye exposure to secondary ionizing radiation received by occupationally exposed personnel in a 9 months period. A set of two thermo luminescent dosimeters was arranged in the front and back of leaded glass goggles in a cohort of seven members of an interventional cardiology service, exposed to 1057 consecutive procedures. RESULTS: The monthly dose equivalent measurement performed in front of the goggles ranged between 1.1 and 6.5 mSv, for paramedics and interventional cardiologists. The radiation measured in the back of the glass varied between 0.66 and 2.75 mSv, respectively. The degree of attenuation of the dose at eye level ranged from 40% to 57.7%, respectively. The projected annual exposure would reach 33 mSv for the interventional cardiologist. CONCLUSIONS: With a similar load of work and wearing 0.25 mm Pb equivalent glass goggles, interventional cardiologists will exceed the crystalline equivalent dose limit recommended by the ICRP (20 mSv/year averaged over the past 5 years).
Asunto(s)
Cardiología , Lesiones Oculares/prevención & control , Dispositivos de Protección de los Ojos , Exposición Profesional/prevención & control , Traumatismos por Radiación/prevención & control , Protección Radiológica/instrumentación , Radiografía Intervencional/efectos adversos , Adulto , Femenino , Humanos , Agencias Internacionales , Masculino , Estudios Prospectivos , Dosis de Radiación , Radiografía Intervencional/métodos , Estándares de Referencia , Estadísticas no ParamétricasRESUMEN
The radiation dose received by cardiologists during percutaneous coronary interventions, electrophysiology procedures and other interventional cardiology procedures can vary by more than an order of magnitude for the same type of procedure and for similar patient doses. There is particular concern regarding occupational dose to the lens of the eye. This document provides recommendations for occupational radiation protection for physicians and other staff in the interventional suite. Simple methods for reducing or minimizing occupational radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in radiation protection for all interventional cardiology personnel, and the availability of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of radiation protection in the interventional suite. These recommendations for occupational radiation protection in interventional cardiology and electrophysiology have been endorsed by the Asian Pacific Society of Interventional Cardiology, the European Association of Percutaneous Cardiovascular Interventions, the Latin American Society of Interventional Cardiology, and the Society for Cardiovascular Angiography and Interventions.
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Cateterismo Cardíaco/efectos adversos , Enfermedades Profesionales/prevención & control , Exposición Profesional/prevención & control , Dosis de Radiación , Traumatismos por Radiación/prevención & control , Protección Radiológica , Radiografía Intervencional/efectos adversos , Cateterismo Cardíaco/normas , Relación Dosis-Respuesta en la Radiación , Diseño de Equipo , Fluoroscopía/efectos adversos , Humanos , Enfermedades Profesionales/etiología , Exposición Profesional/normas , Salud Laboral/normas , Guías de Práctica Clínica como Asunto , Ropa de Protección , Traumatismos por Radiación/etiología , Protección Radiológica/instrumentación , Protección Radiológica/normas , Radiografía Intervencional/normas , Medición de Riesgo , Factores de RiesgoRESUMEN
Background: It is not known whether leaded glass goggles with 0.25 mm Pb equivalency, used in interventional cardiology procedures, attenuate radiation below the levels established by the latest recommendation of the International Commission on Radiological Protection (ICRP). Aim: To assess ifthe degree of attenuation of the secondary ionizing radiation achieved by the use of 0.25 mm Pb leaded glass goggles, in occupationally exposed workers in interventional cardiology procedures, meets the latest ICRP recommendations. Material and Methods: A prospective investigation was carried out to compare the eye exposure to secondary ionizing radiation received by occupationally exposed personnel in a 9 months period. A set of two thermo luminescent dosimeters was arranged in the front and back of leaded glass goggles in a cohort ofseven members of an interventional cardiology service, exposed to 1057 consecutive procedures. Results: The monthly dose equivalent measurement performed in front ofthe goggles ranged between 1.1 and 6.5 mSv, for paramedics and interventional cardiologists. The radiation measured in the back of the glass varied between 0.66 and 2.75 mSv, respectively. The degree of attenuation of the dose at eye level ranged from 40% to 57.7%, respectively. The projected annual exposure would reach 33 mSvfor the interventional cardiologist. Conclusions: With a similar load ofwork and wearing 0.25 mm Pb equivalent glass goggles, interventional cardiologists will exceed the crystalline equivalent dose limit recommended by the ICRP (20 mSv/year averaged over the past 5 years).
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Cardiología , Lesiones Oculares/prevención & control , Dispositivos de Protección de los Ojos , Exposición Profesional/prevención & control , Traumatismos por Radiación/prevención & control , Protección Radiológica/instrumentación , Radiografía Intervencional/efectos adversos , Agencias Internacionales , Estudios Prospectivos , Dosis de Radiación , Radiografía Intervencional/métodos , Estándares de Referencia , Estadísticas no ParamétricasRESUMEN
This study aims to contribute to the construction of a scenario regarding patient radiation exposure in Brazilian interventional radiology, aiming to provide data for the future drafting of specific legislation on interventional radiology because there is currently a lack of safety regulations for haemodynamics services in this country. Fourteen haemodynamics services in the states of Santa Catarina and Bahia were evaluated. The radiological devices were characterised through measurements of air kerma-area product, entrance surface air kerma (Ke), exposure time, spatial resolution (SR), low-contrast resolution and half-value layer. During the evaluation of instrument parameters, several non-conformities were found according to current Brazilian regulations, with SR presenting the most critical situation. The results of the present study indicate the need for the optimisation of clinical practices in complex radiological procedures, although the overall results for the dose scenario in the present study revealed values similar to those reported in international publications.