Trends in Occupational Radiation Doses for U.S. Radiologic Technologists Performing General Radiologic and Nuclear Medicine Procedures, 1980-2015.

Background Occupational doses to most medical radiation workers have declined substantially since the 1950s because of improvements in radiation protection practices. However, different patterns may have emerged for radiologic technologists working with nuclear medicine because of the higher per-procedure doses and increasing workloads. Purpose To summarize annual occupational doses during a 36-year period for a large cohort of U.S. radiologic technologists and to compare dose between general radiologic technologists and those specializing in nuclear medicine procedures. Materials and Methods Annual personal dose equivalents (referred to as doses) from 1980 to 2015 were summarized for 58 434 (62%) participants in the U.S. Radiologic Technologists (USRT) cohort who responded to the most recent mailed work history survey (years 2012-2014) and reported never regularly performing interventional procedures. Doses were partitioned according to the performance of nuclear medicine (yes or no, frequency, procedure type) by calendar year. Annual dose records were described by using summary statistics (eg, median and 25th and 75th percentiles). Results Median annual doses related to performance of general radiologic procedures decreased from 0.60 mSv (interquartile range [IQR], 0.10-1.9 mSv) in 1980 to levels below the limits of detection by 2015, whereas annual doses related to performance of nuclear medicine procedures remained relatively high during this period (median, 1.2 mSv; IQR, 0.12-3.0 mSv). Higher median annual doses were associated with more frequent (above vs below the median) performance of diagnostic nuclear medicine procedures (≥35 vs <35 times per week; 1.6 mSv [IQR, 0.30-3.3 mSv] and 0.9 mSv [IQR, 0.10-2.6 mSv]). Higher and more variable annual doses were associated with more frequent performance of cardiac nuclear medicine (≥10 times per week) and PET (nine or more times per week) examinations (median, 1.6 mSv [IQR, 0.30-2.2 mSv] and 2.2 mSv [IQR, 0.10-4.6 mSv], respectively). Conclusion Annual doses to U.S. radiologic technologists performing general radiologic procedures declined during a 36-year period. However, consistently higher and more variable doses were associated with the performance of nuclear medicine procedures, particularly cardiac nuclear medicine and PET procedures. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Mettler and Guiberteau in this issue.

Personal dosimeter utilisation among South African interventionalists.

Ionising radiation (IR) is increasingly being used in diagnostic and therapeutic procedures and offers increased benefits to patients but poses an increased occupational health risk to operators. The consistent use and monitoring of radiation health care workers' dosimeters is an important part of the process for ensuring adequate monitoring and control of IR in the workplace. There is however often inconsistent dosimeter utilisation among these workers. The aim of this study was to report on the dosimeter utilisation and dosimetry practices in South African interventionalists. We conducted a survey and did in-depth and group interviews to evaluate dosimetry practices and the factors influencing these practices. We used STATA 15 to do a descriptive analysis of the quantitative data. A thematic analysis of the qualitative data was done using a deductive and inductive approach. There were 108 respondents (35 radiologists, 41 adult cardiologists, 32 paediatric cardiologists). The majority overall (65.8%), and in each category were males. The median age was 44 (interquartile range (IQR) 31-66)) and the median years worked with fluoroscopy was 10 years (IQR 1-32). Overall interventionalists (55%) ranked their perceived occupation risk as 2/10. Thirteen per cent of all interventionalists reported never using a personal dosimeter (PD), 58% reported wearing it >70% of the time. Inconsistent and inappropriate use of PDs emerged strongly from the qualitative data. There was poor dosimeter utilisation in this study. Participants were not aware of the role of medical physics departments. Evaluation of dosimetry practices as a means of monitoring and improving radiation safety in the catheterisation laboratory must be improved to create an improved culture of radiation safety and protection.

Radiation induced cataracts in interventionalists occupationally exposed to ionising radiation.

Background: Occupational exposure to ionising radiation may have detrimental health effects. Longer and more complex fluoroscopic procedures have placed interventionalists at increased occupational health risks especially for developing cataracts in the radiosensitive lenses of the eyes. Objectives: This study aimed to determine the prevalence of occupational related cataracts and describe the risk factors for cataracts in occupationally exposed interventionalists compared with unexposed doctors. Method: A cross-sectional study using multiple methods. A survey was conducted. The radiation workload was determined based on a self-administered questionnaire and dose area product values determined in previous studies. Both groups had slit lamp examinations. The data were analysed analytically using R software version 9.3. Results: The study included 98 interventionalists. The combined prevalence of posterior sub-capsular (PSC) and cortical cataracts was 18.8% in the exposed and 13.9% in the unexposed group. The prevalence of PSC cataracts in the exposed group was 5.9% and 2.8% in the unexposed group, with an odds ratio (OR) of 2.2 (95% confidence interval [CI]: 0.58; 8.61). Posterior sub-capsular cataracts were more common in the left eye. The increase in cataracts was not statistically significant in the exposed group but is of clinical significance. Conclusion: The findings are important as they highlight the need for greater vigilance for protecting the radiation healthcare workforce in a developing country setting. Contribution: The research is the first of its kind in South Africa and Africa and contributes to determining the prevalence in this highly skilled and occupationally vulnerable group.

Personal Protective Equipment Availability and Utilization Among Interventionalists.

OBJECTIVE: This study explored personal protective equipment (PPE) availability and PPE utilization among interventionalists in the catheterization laboratory, which is a highly contextualized workplace. METHODS: This is a cross-sectional study using mixed methods. Participants (108) completed a survey. A hyperlink was sent to the participants, or they were asked to complete a paper-based survey. Purposively selected participants (54) were selected for individual (30) or group (six) interviews. The interviews were conducted at conferences, or appointments were made to see the participants. Logistic regression analysis was performed. The qualitative data were analyzed thematically. RESULTS: Lead glasses were consistently used 10.2% and never used 61.1% of the time. All forms of PPE were inconsistently used by 92.6% of participants. Women were 4.3 times more likely to report that PPE was not available. PPE compliance was related to fit and availability. CONCLUSIONS: PPE use was inconsistent and not always available. Improving the culture of radiation protection in catheterization laboratories is essential to improve PPE compliance with the aim of protecting patients and operators. This culture of radiation protection must include all those involved including the users of PPE and the administrators and managers who are responsible for supplying sufficient, appropriate, fitting PPE for all workers requiring such protection.

Interventionalists' perceptions on a culture of radiation protection.

BACKGROUND: Occupational exposure to ionising radiation poses potential health risks to radiation workers unless adequate protection is in place. The catheterisation laboratory is a highly contextualised workplace with a distinctive organisational and workplace culture. OBJECTIVE: This study was conducted to understand the culture of radiation protection (CRP). METHODS: This study was a qualitative study and data were collected through 30 in-depth and 6 group interviews with 54 purposively selected South African interventionalists (interventional radiologists and cardiologists). The participants included a diversity of interventionalists who varied in sex, geographic location and years of experience with fluoroscopy. The transcribed data were analysed thematically using a deductive and inductive approach. RESULTS: 'Culture of radiation protection' emerged as a complex theme that intersected with other themes: 'knowledge and awareness of radiation', 'radiation safety practice', 'personal protective equipment (PPE) utilisation' and 'education and training'. CONCLUSION: Establishing and sustaining a CRP provides an opportunity to mitigate the potentially detrimental health effects of occupational radiation exposure. Education and training are pivotal to establishing a CRP. The time to establish a culture of radiation in the catheterisation laboratory is now.

Perceptions of radiation safety training among interventionalists in South Africa.

Exposure to ionising radiation may have deterministic and stochastic health effects, which include skin changes, chromosomal aberrations, cataracts and carcinomas. Formalised training in radiation safety and protection improves knowledge on the subject and facilitates greater compliance in safety practices. This qualitative study included 54 interventionalists (adult and paediatric cardiologists, and interventional radiologists). The participants were purposively selected and interviewed to explore their perceptions about radiation safety. A thematic analysis of the transcripts was done using a deductive and inductive approach. Findings showed participating cardiologists had less knowledge about radiation safety than participating radiologists. Cardiologists reported little or no formal training on radiation safety and did not display a culture of radiation safety. There was no consensus on how the training gap should be addressed. There is a perceived need to change and enhance the radiation safety culture among interventionists, and the participants proffered some ideas. These included the need for re-curricularisation of cardiologists' training to create awareness of radiation safety practices.

Climate change impacts on working people (the HOTHAPS initiative): findings of the South African pilot study.

BACKGROUND: It is now widely accepted that climate change is occurring as a result of the accumulation of greenhouse gases (GHG) in the atmosphere. With the prospect of a warmer world, increased attention is being devoted to the implications for worker well-being and work performance. OBJECTIVES: The 'high occupational temperature health and productivity suppression' (HOTHAPS) programme is a multi-centre health research and prevention programme aimed at characterising and quantifying the extent to which working people are affected by, or adapt to, heat exposure while working. The main aim of the current South African pilot study was to look at the perceptions of outdoor workers regarding their work environment in hot weather and how this affected their health and productivity levels. DESIGN: A qualitative study utilising focus group discussions was employed in two sites, Johannesburg (which has a temperate climate) and Upington (located in the hottest part of South Africa). RESULTS: In summary, the pilot study demonstrated that especially in Upington, where daily maximum temperatures may reach +40°C, workers reported a wide range of heat-related effects, including sunburn, sleeplessness, irritability, and exhaustion leading to difficulty in maintaining work levels and output during very hot weather. Few, if any, measures were being undertaken by employers to protect health or improve worker comfort. CONCLUSION: This pilot study has demonstrated that people working in sun-exposed conditions in hot parts of South Africa currently experience heat-related health effects, with implications for their well-being and ability to work and that further research is warranted. In this regard, the pilot study has proved valuable in informing the design, site, sample selection, and logistical planning for a proposed main study on the health and performance aspects of work in hot weather in South Africa.