Efficiency evaluation of leaded glasses and visors for eye lens dose reduction during fluoroscopy guided interventional procedures.

PURPOSE: Fluoroscopy guided interventional procedures guarantee high benefits for patients, but are associated with high levels of radiation exposure for the medical staff. Their increasing use and complexity results in even higher radiation exposures, with a risk to exceed the annual dose limit of 20 mSv for the eye lens. The aim of the study was to evaluate the potential dose reduction of eye lens exposure for lead glasses and for two types of visors (half and full), used by physicians performing interventional procedures. METHODS: Eye lens dose measurements were carried out on an anthropomorphic phantom simulating a physician performing a fluoroscopy guided interventional procedure. Dose reduction factors were calculated using high sensitivity thermoluminescent dosimeters. Moreover, a spatial dose distribution was generated for the two visors. RESULTS: The dose reduction coefficient was found to be 1.6 for the glasses, 1.2 for the half visor and 4.5 for the full visor. CONCLUSIONS: Optimal radiation protection requires a combination of different radiation protection equipment. Full visors that cover all the face of the operator are recommended, as they absorb scattered radiation reaching the eyes from all directions. Full visors should be prioritized over radiation protection glasses for cases where other protective equipment such as ceiling shielding cannot be used.

Quality assurance of dose management systems.

BACKGROUND AND AIM: Dose management systems (DMS's) have been widely used for radiation dose data collection and analysis, and have been proven useful for optimization. Although DMS's are used for patient dosimetry, a quality assurance (QA) program has not yet been developed. The aim of this work was to propose vendor neutral quality tests and discuss how QA can be established for DMS's to ensure robustness and quality of patient dose data. MATERIALS & METHODS: Different DMS's functions were organized in three groups according to their complexity. As basic functions, we defined those that depend on simple data collection and require data verification. Intermediate functions provide calculations such as effective dose or higher dose alerts, while the advanced group aims to address complicated analyses, such as peak skin dose calculations. RESULTS: An Excel file was developed that includes quality tests on basic and intermediate functions for different modalities (radiography, interventional radiology, CT and mammography) and is provided as Annex. For advanced functionalities, tests are discussed to guide medical physics experts to design their QA program as appropriate. CONCLUSIONS: The QA program is intended to ensure the trustworthy functioning for applications in normal circumstances and patient outliers. As DMS's are systems with regular upgrades, the associated QA program should be a dynamic process that takes into account the functionalities of the DMS and its application in the clinics. Medical physics experts should ensure the safety and accuracy of DMS's, as an essential component in patient dosimetry - part of their mission.

Systematic literature review on the benefit of patient protection shielding during medical X-ray imaging: Towards a discontinuation of the current practice.

PURPOSE: Patient shielding during medical X-ray imaging has been increasingly criticized in the last years due to growing evidence that it often provides minimal benefit and may even compromise image quality. In Europe, and as also shown in a short assessment in Switzerland, the use of patient shielding is inhomogeneous. The aim of this study was to systematically review recent literature in order to assess benefits and appraise disadvantages related to the routine use of patient shielding. METHODS: To evaluate benefits and disadvantages related to the application of patient shielding in radiological procedures, a systematic literature review was performed for CT, radiography, mammography and fluoroscopy-guided medical X-ray imaging. In addition, reports from medical physics societies and authorities of different countries were considered in the evaluation. RESULTS: The literature review revealed 479 papers and reports on the topic, from which 87 qualified for closer analysis. The review considered in- and out-of-plane patient shielding as well as shielding for pregnant and pediatric patients. Dose savings and other dose and non-dose related effects of patient shielding were considered in the evaluation. CONCLUSIONS: Although patient shielding has been used in radiological practice for many years, its use is no longer undisputed. The evaluation of the systematic literature review of recent studies and reports shows that dose savings are rather minimal while significant dose- and non-dose-related detrimental effects are present. Consequently, the routine usage of patient protection shielding in medical X-ray imaging can be safely discontinued for all modalities and patient groups.

Swiss population exposure to radiation by interventional radiology in 2008.

The aim of this study was to investigate the radiation exposure of the Swiss population to interventional procedures. A nationwide survey was conducted in Switzerland. The annual effective dose per capita due to interventional procedures was found to be 0.14 mSv, corresponding to 12% of the total dose. Coronary angiography and percutaneous coronary interventions were found to be the most frequent and the most irradiating interventional procedures, accounting for 52% of the total examination frequency and 64% of the dose delivered to the population. Switzerland stands at the same level as other countries in terms of effective dose per capita due to interventional radiology.