Radiation protection

X-ray imaging and interventional procedures in modern medicine

Radiation personal protection equipment (PPE) have evolved little since its introduction. Due to environmental and safety concerns lead-free radiation aprons replaced lead-plastics. During the same time period, image guided surgical interventional techniques, requiring x-ray during the procedure, were introduced. For patients it meant less invasive procedures. For healthcare professionals, it meant increased exposure to radiation.

The benefits of imaging techniques are immense and new products are continuously being introduced to the market. Interventional Cardiologists, Interventional Radiologists, Vascular and Cardiac Surgeons perform a majority of the image guided procedures. According to literature, radiation doses can range from equivalent of 1-60 milliSievert (mSv) for cardiac related procedures. These type of procedures has recent decade doubled in frequency. However, the increasing use and complexity of radiological imaging techniques and interventional procedures imaging and interventional techniques have not been matched by increasing awareness and knowledge in radiation protection by the medical community practitioners.

With conventional radiology and CT, occupational radiation exposure is minimal since the staff leaves the room during the procedure. In interventional cardiology, professional exposure can be as high as 2-5 mSv per year, although more frequently it remains <1mSv. Most experienced (and therefore most exposed) interventional cardiologists and electrophysiologists have an exposure per annum of about 5 mSv, two or three times higher than diagnostic radiologists. In a typical situation in an operating room, personnel can be exposed to energy doses ranging between 30-100 keV, which can be a harmful exposure on a routine basis. To mitigate the risk of radiation exposure, the use of leaded aprons, thyroid gland and glasses are often mandatory.

However, Radiation PPE aprons has not been designed to be worn for long periods of time. PPE aprons expose the wearer to ergonomic risks. Consequently, healthcare professionals wearing radiation protection aprons often experience pain in the deltoid, trapezius, lumbago and cervical region. There is a correlation between PPE users, orthopedic problems and sick leave. Thus the radiation protective equipment need to be further developed. 

New radiation PPE is needed to protect healthcare professionals from additional risks due to the extensive use of radiological imaging techniques and interventional procedures. This is where 10MD comes into the picture.

 

References:

  1. Climbing Head and Neck Tumor Count in Interventional Cardiologists Prompts Calls for More Study. Heartwire, 2014-04-23.
  2. Picano et.al. The appropriate and justified use of medical radiation in cardiovascular imaging. A position document by ESC. Eur Heart Journal 2014.
  3. Venneri L. Rossi F, Botto N, Andreassi MG, Salcone N, Emad A, Lazzeri M, Gori C, Vano E, Picano E. Cancer risk from professional exposure in staff working in cardiac catherization laboratory: insights from the national Research Council´s Biological Effects of Ionizing Radioation VII Report. Am Heart J. 2009:157:118-124.
  4. Bjersgård. A., 10MD pre-study Halmstad Center of Health Technology, Q4, 2012.
  5. Venneri L, Rossi F, Botto N, Andreassi MG, Salcone N, Emad A, Lazzeri M, Gori C, Vano E, Picano E. Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights 
from the National Research Council’s Biological Effects of Ionizing Radiation VII Report. Am Heart J 2009;157:118e124.
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  6. Klein LW, Miller DL, Balter S, Laskey W, Haines D, Norbash A, Mauro MA, Goldstein JA, Joint Inter-Society Task Force on Occupational Hazards in the Interventional Laboratory. Occupational health hazards in the interventional laboratory: time for a safer environment. Radiology 2009;250:538e544.
  7. Roguin A, Goldstein J, Bar O. Brain tumours among interventional cardiologists: a cause for alarm? Report of four new cases from two cities and a review of the literature. EuroIntervention 2012;7:1081–6.
  8. Roguin A, Goldstein J, Bar O. Brain malignancies and ionising radiation: more cases reported. EuroIntervention 2012;8:169–70.
  9. Roguin A, Goldstein J, Bar O, Goldstein JA. Brain and neck tumors among physicians performing interventional procedures. Am J Cardiol 2013.