Feature
The medical physics consult
Radiation Protection Tools in Interventional Radiology

https://doi.org/10.1016/j.jacr.2012.08.003Get rights and content

Introduction

The nature of fluoroscopically guided interventional procedures results in unavoidable radiation exposure to personnel. The operator and assistants generally must stand close to the patient. Procedure complexity can result in extended fluoroscopy times. Studies reporting measurements of staff radiation dose show that high levels are possible [1].

Several developments have resulted in renewed interest in reducing occupational radiation levels. First, the International Commission on Radiological Protection recommends that effective dose be limited to 20 mSv/year averaged over 5 consecutive years, with no single year exceeding 50 mSv. In the United States, a reduction from the current effective dose limit of 50 mSv/year is under consideration [2]. Second, recent data indicate that the threshold for radiation-induced cataracts is lower than previously assumed. These findings prompted a recommendation from the International Commission on Radiological Protection that the dose limit to the lens be lowered from 150 mSv/year to 20 mSv/year averaged over 5 years [3].

It is possible for personnel to reduce occupational radiation exposure with careful attention to their actions during fluoroscopic procedures. Various types of protective devices are available, including apparel and shields. In general, shielding devices should be used whenever possible to keep personnel exposure as low as reasonably achievable without lengthening the procedure or compromising patient safety. In this column, we review how occupational radiation dose can be reduced during fluoroscopically guided interventional procedures by using protective shielding devices.

Section snippets

Protective Apparel

Staff members present in a procedure room during fluoroscopy should wear appropriate protective apparel. Radiation protective aprons and thyroid shields are available in thicknesses ranging from 0.25-mm to 1-mm lead-equivalent thickness. In many states, regulations require the use of aprons of at least 0.5-mm lead-equivalent thickness.

Studies have documented an increase in orthopedic problems in interventionalists, believed to be related to long-term use of heavy radiation protective garments [4

Protective Shields

Large mobile shields mounted on wheels are available in 0.5-mm to 2.0-mm lead-equivalent thickness and provide nearly complete protection from scatter in the shield's shadow. When the screens are made fully or partially from transparent lead glass or plastic, personnel can remain behind the barriers and observe the patient and the procedure. This shielding is particularly useful for nurses and for personnel who remain in the procedure room during high-dose digital image acquisition.

Conclusions

Maintaining operator exposure at a level that is as low as reasonably achievable requires the use of shielding devices. Interventional radiologists should be aware of available radiation protection tools and strive to incorporate them into their routine practice whenever possible.

References (13)

There are more references available in the full text version of this article.

Cited by (9)

  • Radiobiology in Cardiovascular Imaging

    2016, JACC: Cardiovascular Imaging
    Citation Excerpt :

    Although this recommended lens-of-eye dose limit has not yet been implemented in the United States, the Electric Power Research Institute recently reviewed the available epidemiologic research (47), and the National Council on Radiation Protection and Measurement (NCRP) is preparing an updated commentary addressing the issues of risk and dose limitation in radiation protection and including guidance on the lens of the eye (48). At the same time, various shielding strategies have been investigated to evaluate their impact in reducing eye dose in fluoroscopy (48–53). For example, using an anthropomorphic phantom and a miniature solid-state dosimeter positioned at the phantom’s eye, Thornton et al. (51) evaluated the impact of common shielding strategies used alone and in combination on the scattered dose to the fluoroscopy operator’s eye.

  • Quality improvement guidelines for adult diagnostic cervicocerebral angiography: Update cooperative study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS)

    2015, Journal of Vascular and Interventional Radiology
    Citation Excerpt :

    Selective angiography allows optimal assessment of the extracranial and intracranial vasculature and better defines pathologic conditions such as arterial occlusions or stenoses (atherosclerotic or caused by other vasculopathy), aneurysms, vasospasm, low- or high-flow arteriovenous shunts, and coincident and/or contributory conditions. Evaluation of the intracranial circulation is an essential component of the angiographic study of all pathologic conditions involving the cervicocerebral vessels (39–63). When performing CCA for any diagnosis, the field of view should include all vessels potentially affected by or contributing to the suspected pathologic condition.

  • Minimizing radiation exposure in minimally invasive spine surgery: Lessons learned from neuroendovascular surgery

    2014, Neurosurgery Clinics of North America
    Citation Excerpt :

    Operators should keep track of radiation exposure with the use of thermoluminescent dosimetry badges, typically worn at the waist level under the apron and at the thyroid level over the lead shield. The International Commission on Radiological Protection recommends that the effective dose be limited to 20 mSv/y averaged over 5 consecutive years, with no single year exceeding 50 mSv.4 X-ray tube voltage and current, automatic brightness control (ABC), collimation, beam filtration, use of pulsed fluoroscopy mode, and magnification are various parameters of the fluoroscopy unit that affect radiation dose to the patient.

  • Assessment of needle guidance devices for their potential to reduce fluoroscopy time and operator hand dose during C-arm cone-beam computed tomography-guided needle interventions

    2013, Journal of Vascular and Interventional Radiology
    Citation Excerpt :

    Sterile radiation-attenuating surgical gloves are commercially available. These gloves can provide significant protection from scatter radiation but provide only minimal protection when hands are placed in the primary x-ray beam (21–23). The reduction in operator hand dose by employing laser guidance is attributable to the more efficient placement of the needle and the reduced number of corrective needle manipulations in the entry point view, effectively preventing direct exposure of the hands to the primary beam leaving scatter radiation as the predominant contribution to the operator’s hand dose.

View all citing articles on Scopus
View full text