Radiation safety education and compliance with safety procedures-The Korea Nurses' Health Study.

AIMS AND OBJECTIVES: To examine the current state of radiation safety education and its influence on nurses' compliance with safety procedures. BACKGROUND: Use of radiation in therapy and diagnosis has prolonged and improved millions of lives, but it presents potential hazards for healthcare professionals. DESIGN: A cross-sectional design. METHODS: Participants included 1,672 female nurses of childbearing age who had recently been exposed to radiation-emitting generators or radiation. Quantitative data were taken from the Korea Nurses' Health Study, the Korean version of the Nurses' Health Study conducted in the USA. Confounding variables included sociodemographic factors, duration of employment in a department where work involved radiation, hospital's geographical location, bed size and hospital safety climate. Statistical analyses included descriptive statistics, Spearman's correlation coefficients and multivariable ordinal logistic regression. RESULTS: Half (50.3%) of nurses received no safety training, whereas the other half received some safety training as follows: only once (14.4%), irregularly (10.2%) and regularly (25.1%). Of the six radioactive safety compliance questionnaires, 29.4%, 20.2%, 30.7% and 19.7% complied to none, one, two and more than three, respectively. After controlling for confounding variables, relative to that observed with no safety education, irregular education that occurred more than twice (OR = 1.597, CI = 1.177-2.164) and regular education (OR = 2.223, CI = 1.770-2.792) increased the likelihood that nurses would comply with safety procedures. CONCLUSIONS: Low levels of safety education and adherence raise critical concerns regarding nurses' well-being. As routine safety education increases safety adherence, healthcare managers and policymakers should emphasise regular safety education. RELEVANCE TO CLINICAL PRACTICE: Radiation safety education for nurses and their compliance with safety procedures have seldom been discussed in South Korea. However, as nurses' safety is directly related to the quality of patient care, additional safety education should be provided for hospital nurses to minimise their occupational exposure to harmful radioactive substances in clinical settings.

Need for radiation safety education for interventional cardiology staff, especially nurses.

OBJECTIVE: Cardiac interventional radiology (IR) can cause radiation injury to the staff who administer it as well as to patients. Although education in the basic principles of radiation is required for nurses, their level of radiation safety knowledge is not known. The present study used a questionnaire protocol to assess the level of radiation safety knowledge among hospital nurses. METHODS AND RESULTS: A questionnaire to assess the level of training and current understanding of radiation safety was administered to 305 nurses in 2008 and again to 359 nurses in 2010. Our study indicates that nurses had insufficient knowledge about radiation safety, and that a high percentage of nurses were concerned about the health hazards of radiation. Moreover, more than 80% of the nurses expressed an interest in attending periodic radiation safety seminars. Annual radiation protection training for hospital staff (including nurses) is important. CONCLUSIONS: Our results suggest that nurses do not have sufficient knowledge of radiation safety and should receive appropriate radiation safety training. Many had a minimal understanding of radiation and thus had significant concerns about the safety of working with radiation. Periodic radiation safety education/training for nurses is essential.

Radiation dose of nurses during IR procedures: a controlled trial evaluating operator alerts before nursing tasks.

PURPOSE: To compare radiation exposure of nurses when performing nursing tasks associated with interventional procedures depending on whether or not the nurses called out to the operator before approaching the patient. MATERIALS AND METHODS: In a prospective study, 93 interventional radiology procedures were randomly divided into a call group and a no-call group; there were 50 procedures in the call group and 43 procedures in the no-call group. Two monitoring badges were used to calculate effective dose of nurses. In the call group, the nurse first told the operator she was going to approach the patient each time she was about to do so. In the no-call group, the nurse did not say anything to the operator when she was about to approach the patient. RESULTS: In all the nursing tasks, the equivalent dose at the umbilical level inside the lead apron was below the detectable limit. The equivalent dose at the sternal level outside the lead apron was 0.16 µSv ± 0.41 per procedure in the call group and 0.51 µSv ± 1.17 per procedure in the no-call group. The effective dose was 0.018 µSv ± 0.04 per procedure in the call group and 0.056 µSv ± 0.129 per procedure in the no-call group. The call group had a significantly lower radiation dose (P = .034). CONCLUSIONS: Radiation doses of nurses were lower in the group in which the nurse called to the operator before she approached the patient.

Radiation exposure to operating room personnel and patients during endovascular procedures.

OBJECTIVE: To characterize radiation exposure to patients and operating room personnel during fluoroscopic procedures. METHODS: Patient dose information was collected from the imaging equipment. Real-time dosimetry was used to measure doses to the operators, scrub nurse, radiologic technologist (RT), and anesthesiologist in 39 cases of endovascular thoracoabdominal aortic aneurysm repair using fenestrated endografts. Overall equivalent doses and dose rates at time points of interest were noted and compared with the corresponding patient doses. RESULTS: The dosimeter on the anesthesia equipment received 143 µSv (38-247) more radiation per case than the average operator, and the scrub nurse and RT received 106 µSv (66-146) and 100 µSv (55-145) less, respectively. Adjusting for protective lead aprons by the Webster methodology, the average operator received an effective dose of 38 µSv. Except for the RT, personnel doses were well correlated with patient dose as measured by kerma area product (KAP) (r = .82 for average operator, r = .85 for scrub nurse, and r = .86 for anesthesia; all P < .001) but less well correlated with fluoroscopy time or cumulative air kerma (CAK). When preoperative cone beam computed tomography was performed, the equivalent dose to the RT was 1.1 µSv (0.6-1.5) when using shielding and 37 µSv (22-53) when unshielded. Digital subtraction acquisitions accounted for a large fraction of all individuals' doses. Decreasing field size (and thus, increasing magnification) was associated with decreased KAP (r = .47; P < .001) and increased CAK (r = -.56; P < .001). The square of the field size correlated strongly with the KAP/CAK ratio (r = .99; P < .001). Increased lateral angulation of the C-arm increased both CAK and KAP (at field size, 22 cm; r = .54 and r = .44; both P < .001) and the average dose rate to an operator was 1.78 (1.37-2.31) times as high in a lateral projection as in a posterior-anterior projection. CONCLUSIONS: Personnel doses were best correlated with KAP and less well correlated with fluoroscopy time or CAK. The dosimeter on the anesthesia equipment recorded the highest doses attributable to ineffective shielding. Operators can reduce the effective dose to themselves, the patient, and other personnel by minimizing the use of digital subtraction acquisitions, avoiding lateral angulation, using higher magnification levels when possible, and being diligent about the use of shielding during fluoroscopy cases.

Risk for radiation-induced cataract for staff in interventional cardiology: is there reason for concern?

OBJECTIVES: To examine the prevalence of radiation-associated lens opacities among interventional cardiologists and nurses and correlate with occupational radiation exposure. BACKGROUND: Interventional cardiology personnel are exposed to relatively high levels of X-rays and based on recent findings of radiation-associated lens opacities in other cohorts, they may be at risk for cataract without use of ocular radiation protection. METHODS: Eyes of interventional cardiologists, nurses, and age- and sex-matched unexposed controls were screened by dilated slit lamp examination and posterior lens changes graded using a modified Merriam-Focht technique. Individual cumulative lens X-ray exposure was calculated from responses to a questionnaire and personal interview. RESULTS: The prevalence of radiation-associated posterior lens opacities was 52% (29/56, 95% CI: 35-73) for interventional cardiologists, 45% (5/11, 95% CI: 15-100) for nurses, and 9% (2/22, 95% CI: 1-33) for controls. Relative risks of lens opacity was 5.7 (95% CI: 1.5-22) for interventional cardiologists and 5.0 (95% CI: 1.2-21) for nurses. Estimated cumulative ocular doses ranged from 0.01 to 43 Gy with mean and median values of 3.4 and 1.0 Gy, respectively. A strong dose-response relationship was found between occupational exposure and the prevalence of radiation-associated posterior lens changes. CONCLUSIONS: These findings demonstrate a dose dependent increased risk of posterior lens opacities for interventional cardiologists and nurses when radiation protection tools are not used. While study of a larger cohort is needed to confirm these findings, the results suggest ocular radio-protection should be utilized.

Radiation safety in fluoroscopy for neuraxial injections.

Certified Registered Nurse Anesthetists (CRNAs) perform epidural steroid injections for chronic back and extremity pain. Placing epidural needles using fluoroscopy and confirming the needle placement by epidurogram has been suggested as a means to increase the efficacy of epidural injections while decreasing complications. Because of the risk of radiation injury to patients and staff when using fluoroscopy, the purpose of this article is to review the concepts of fluoroscopy and radiation safety for CRNAs. Following a literature search using keywords such as fluoroscopy, radiation injury, and radiation safety, relevant articles were identified. In addition, the reference lists of these articles were reviewed to identify other pertinent sources regarding this topic. The risks of stochastic and deterministic effects from radiation exposure necessitate the need for practitioners who are knowledgeable in equipment, patient, and procedure related factors that influence radiation exposure. Practitioner conduct, using the as-low-as-reasonably achievable (ALARA) principle, results in choices regarding these factors that minimize the time and intensity of radiation exposure to patients, anesthesia providers, and staff.

[Nursing care in patients undergoing interventional neuroendovascular procedures]. / Cuidados de enfermería al paciente sometido a técnicas de neurointervencionismo endovascular.

Vascular interventional radiology (VIR) procedures have increased markedly, partly due to the current healthcare context, which encourages the use of less invasive procedures that reduce pressure on surgery departments and decrease hospital stays. In most patients, these techniques can be carried out in a single intervention. VIR procedures are based on the possibility of gaining access to vascular structures through a catheter inserted percutaneously without the need for open surgery. Due to the complexity of these procedures, hospitalization is required before and after the technique is performed but length of stay is short compared with that associated with surgery. As the health workers closest to patients, nurses must respond to their information needs. The provision of comprehensive nursing care should include all the care required before, during and after the procedure and all aspects related to the quality of the healthcare process. Knowledge of how diagnostic and therapeutic VIR techniques are performed in the neurovascular section is essential. Based on the authors' experience, the present article aims to provide nurses with knowledge of some neurointerventional procedures (cerebral angiography and embolization of intracranial aneurysms) and of the care provided in RVI rooms.

The consent process in interventional radiology: the role of specialist nurses.

AIMS: To evaluate the impact of patient education by specialist nurses on patients' understanding of interventional procedures, their anxiety levels and satisfaction with the given information. MATERIALS AND METHODS: Sixty patients attending the radiology department for gastrointestinal interventional procedures were interviewed. Patients were assessed using a combination of categorical and visual analogue scales. Parameters were assessed on admission and after additional information had been given by specialist nurses. After the procedure patients were asked to rate the quality of information given and their overall satisfaction. RESULTS: Four of the 60 patients were excluded due to a Mini Mental Test score of <7. Only 35 (62.5%) claimed to have been given information by the referring consultant. Fifty-three patients received additional information before formally giving consent, 50 (96.2%) from the specialist nurses. Patient anxiety before and after information did not significantly change (p=0.52) but there was significant improvement in levels of satisfaction (p=0.001) and perceived understanding (p<0.001). Patients rated overall quality of information at an average of 9.2/10 and overall satisfaction was high (median=9.1/10). CONCLUSION: The use of specialist nurses to educate patients greatly increases patient understanding. The process of informed consent is improved and patient satisfaction is increased.

Development of evidence-based protocols for evaluation and management of dysfunctional vascular access devices in interventional radiology.

Assessment and treatment of dysfunctional vascular access devices (VADs) is a mutual responsibility of nurses who use these devices and the interventional radiology (IR) team. Understanding causes of dysfunction, implementing assessment and treatment protocols, and communication between referral areas and the IR team are beneficial to both areas and to the patient. This study describes development of evidence-based protocols, combining research utilization and a quality improvement educational process.

Uterine artery embolization.

The use of uterine artery embolization is a new approach in the treatment of uterine fibroids. Embolization is a technique in which blood vessels that supply nutrients and oxygen to fibroids are blocked. This blockage causes the fibroid muscle cells to degenerate and form scar tissue, thus shrinking the fibroid. Usually the fibroid no longer causes symptoms. This minimally invasive procedure involves an overnight hospital stay and results in a reduction of fibroid symptoms. Most women notice the greatest improvement in the first eight weeks. This procedure has been performed only since 1990 and, therefore, long-term results are unknown.

Relieving the pressure in the radiology department.

Interventional radiological procedures can be complex, requiring patients, many of whom already have compromised arterial circulation, to lie immobile for significant periods. X-ray table mattresses are designed to avoid radiation attenuation, which could degrade image quality or increase patient dose. Consequently, most mattresses do not have pressure redistribution properties. Skin changes, noted after lengthy radiological procedures, would appear to indicate that this unrelieved pressure places vulnerable patients at risk of sustaining pressure damage that could potentially initiate pressure ulcer development. This article examines the biomedical basis of pressure ulcer development, and discusses the suitability of alternative support devices for radiological examinations in an apparently under-researched environment.

Transjugular liver biopsy: method of choice for taking a biopsy.

A transjugular liver biopsy is a route of obtaining a biopsy of the liver for the diagnosis and management of patients with hepatic disease. In this article the author will demonstrate how a liver biopsy via the transjugular route is taken using X-ray guidance and will describe the method step-by-step as it is performed at the Royal Free Hospital. Finally, the indications and advantages of using this method will be considered. This article should increase awareness of what a transjugular liver biopsy is and inform the reader of how a tissue sample is taken, thus enabling further understanding of the procedure. It is concluded that the transjugular route of obtaining a liver biopsy enables a good size and quality of sample to be taken in a safe and effective manner with only one pass (one attempt) being required. This method involves minimal complications and has many advantages.

Patterns of anesthesia and nursing care for interventional radiology procedures: a national survey of physician practices and preferences.

PURPOSE: Through a survey of interventional radiologists, to document patterns of conscious sedation, nursing assistance, and care before and after the intervention and to compare demographics and different interventional radiology practices. MATERIALS AND METHODS: The survey was sent to the 1,713 members of the Society of Cardiovascular and Interventional Radiology. The levels of sedation were categorized according to the following grading scale commonly employed by anesthesiologists: awake/alert, drowsy/arousable, asleep/arousable, deep sedation, and general anesthesia. The drugs used for sedation were recorded. The procedures were categorized as diagnostic vascular or visceral or therapeutic vascular or visceral. Data were available for most standard vascular and visceral procedures. RESULTS: Six hundred thirty-four (37%) interventional radiologists responded, and 500,000 procedures were analyzed. Most (90%) therapeutic procedures employed the drowsy/arousable level of sedation. Eighty-seven percent of respondents had the assistance of a full-time radiology nurse, 90% reported routine use of blood pressure or pulse oximetry monitoring, and 75% reported daily rounds were performed by physicians. CONCLUSION: The data supply useful background information regarding the use of anesthesia, periprocedural monitoring, clinical assessment, and nursing care.