A Practical Method for Slice Spacing Measurement Using the American Association of Physicists in Medicine Computed Tomography Performance Phantom.

Background: The slice spacing has a crucial role in the accuracy of computed tomography (CT) images in sagittal and coronal planes. However, there is no practical method for measuring the accuracy of the slice spacing. Purpose: This study proposes a novel method to automatically measure the slice spacing using the American Association of Physicists in Medicine (AAPM) CT performance phantom. Methods: The AAPM CT performance phantom module 610-04 was used to measure slice spacing. The process of slice spacing measurement involves a pair of axial images of the module containing ramp aluminum objects located at adjacent slice positions. The middle aluminum plate of each image was automatically segmented. Next, the two segmented images were combined to produce one image with two stair objects. The centroid coordinates of two stair objects were automatically determined. Subsequently, the distance between these two centroids was measured to directly indicate the slice spacing. For comparison, the slice spacing was calculated by accessing the slice position attributes from the DICOM header of both images. The proposed method was tested on phantom images with variations in slice spacing and field of view (FOV). Results: The results showed that the automatic measurement of slice spacing was quite accurate for all variations of slice spacing and FOV, with average differences of 9.0% and 9.3%, respectively. Conclusion: A new automated method for measuring the slice spacing using the AAPM CT phantom was successfully demonstrated and tested for variations of slice spacing and FOV. Slice spacing measurement may be considered an additional parameter to be checked in addition to other established parameters.

Simulating the head of a TrueBeam linear particle accelerator and calculating the photoneutron spectrum on the central axis of a 10-MV photon using particle and heavy-ion transport system code.

Photon energy is higher than the (γ,n) threshold, allowing it to interact with the nuclei of materials with high z properties and liberate fast neutrons. This represents a potentially harmful source of radiation for humans and the environment. This study validated the Monte Carlo simulation, using the particle and heavy-ion transport code system (PHITS) on a TrueBeam 10-MV linear particle accelerator's head shielding model and then used this PHITS code to simulate a photo-neutron spectrum for the transport of the beam. The results showed that, when comparing the simulated to measured PDD and crosslines, 100% of the γ-indexes were <1 (γ3%/3mm) for both simulations, for both phase-space data source and a mono energy source. Neutron spectra were recorded in all parts of the TrueBeam's head, as well as photon neutron spectra at three points on the beamline.

A novel method for developing contrast-detail curves from clinical patient images based on statistical low-contrast detectability.

Purpose. To develop a method to extract statistical low-contrast detectability (LCD) and contrast-detail (C-D) curves from clinical patient images.Method. We used the region of air surrounding the patient as an alternative for a homogeneous region within a patient. A simple graphical user interface (GUI) was created to set the initial configuration for region of interest (ROI), ROI size, and minimum detectable contrast (MDC). The process was started by segmenting the air surrounding the patient with a threshold between -980 HU (Hounsfield units) and -1024 HU to get an air mask. The mask was trimmed using the patient center coordinates to avoid distortion from the patient table. It was used to automatically place square ROIs of a predetermined size. The mean pixel values in HU within each ROI were calculated, and the standard deviation (SD) from all the means was obtained. The MDC for a particular target size was generated by multiplying the SD by 3.29. A C-D curve was obtained by iterating this process for the other ROI sizes. This method was applied to the homogeneous area from the uniformity module of an ACR CT phantom to find the correlation between the parameters inside and outside the phantom, for 30 thoracic, 26 abdominal, and 23 head images.Results. The phantom images showed a significant linear correlation between the LCDs obtained from outside and inside the phantom, with R2values of 0.67 and 0.99 for variations in tube currents and tube voltages. This indicated that the air region outside the phantom can act as a surrogate for the homogenous region inside the phantom to obtain the LCD and C-D curves.Conclusion. The C-D curves obtained from outside the ACR CT phantom show a strong linear correlation with those from inside the phantom. The proposed method can also be used to extract the LCD from patient images by using the region of air outside as a surrogate for a region inside the patient.

Developing simulation-based learning application for radiation therapy students at pre-clinical stage.

INTRODUCTION: Simulation-based education has been particularly valuable as a preclinical training method that adequately prepares students for clinical practice, including simulation in educational programs enhances the quality of learning outcomes. However, relevant previous research has exhibited several crucial limitations, with most of them having focused solely on the setup procedures. This study aimed to outline the development of an educational application in radiationtherapy and emphasizes the essential factors that radiation therapist technologists(RTTs) must consider in the treatment room from the perspective of experienced RTTs. METHOD: We connected the virtual pendants to the linear accelerator components using C# programming and Unity. Customized scripts were assigned to specific linear accelerator (LINAC) functions, and the patient and RTT avatars were developed. We also included audio feedback for the realistic gantry movement sounds. RESULT: This study outlines various aspects of radiotherapy procedures duringtreatment, such as the simulation of patient positioning, treatment fields, and pendantfunctions, aimed toward enabling the effective use of virtual reality technology inradiation therapy. DISCUSSION: This study explores the potential of an avatar-based app for radiotherapy education, providing foundational data for future trials. CONCLUSION: Simulation learning is the most advantageous pre-clinical instrument for equipping students with the skills necessary for clinical practice. This study's resultsare expected to facilitate radiotherapy students' adoption of clinical replacement applications and improve collaborative partnerships and knowledge sharing. Notably, this application complements traditional learning methods, further enhancing the overall educational experience.

Directional vector visualization of scattered rays in mobile c-arm fluoroscopy.

Previous radiation protection-measure studies for medical staff who perform X-ray fluoroscopy have employed simulations to investigate the use of protective plates and their shielding effectiveness. Incorporating directional information enables users to gain a clearer understanding of how to position protective plates effectively. Therefore, in this study, we propose the visualization of the directional vectors of scattered rays. X-ray fluoroscopy was performed; the particle and heavy-ion transport code system was used in Monte Carlo simulations to reproduce the behavior of scattered rays in an X-ray room by reproducing a C-arm X-ray fluoroscopy system. Using the calculated results of the scattered-ray behavior, the vectors of photons scattered from the phantom were visualized in three dimensions. A model of the physician was placed on the directional vectors and dose distribution maps to confirm the direction of the scattered rays toward the physician when the protective plate was in place. Simulation accuracy was confirmed by measuring the ambient dose equivalent and comparing the measured and calculated values (agreed within 10%). The directional vectors of the scattered rays radiated outward from the phantom, confirming a large amount of backscatter radiation. The use of a protective plate between the patient and the physician's head part increased the shielding effect, thereby enhancing radiation protection for the physicians compared to cases without the protective plate. The use of directional vectors and the surrounding dose-equivalent distribution of this method can elucidate the appropriate use of radiation protection plates.

A novel approach to predict acute radiation dermatitis in patients with head and neck cancer using a model based on Bayesian probability.

PURPOSE: In this study, we aimed to establish a method for predicting the probability of each acute radiation dermatitis (ARD) grade during the head and neck Volumetric Modulated Arc Therapy (VMAT) radiotherapy planning phase based on Bayesian probability. METHODS: The skin dose volume >50 Gy (V50), calculated using the treatment planning system, was used as a factor related to skin toxicity. The empirical distribution of each ARD grade relative to V50 was obtained from the ARD grades of 119 patients (55, 50, and 14 patients with G1, G2, and G3, respectively) determined by head and neck cancer specialists. Using Bayes' theorem, the Bayesian probabilities of G1, G2, and G3 for each value of V50 were calculated with an empirical distribution. Conversely, V50 was obtained based on the Bayesian probabilities of G1, G2, and G3. RESULTS: The empirical distribution for each graded patient group demonstrated a normal distribution. The method predicted ARD grades with 92.4 % accuracy and provided a V50 value for each grade. For example, using the graph, we could predict that V50 should be ≤24.5 cm3 to achieve G1 with 70 % probability. CONCLUSIONS: The Bayesian probability-based ARD prediction method could predict the ARD grade at the treatment planning stage using limited patient diagnostic data that demonstrated a normal distribution. If the probability of an ARD grade is high, skin care can be initiated in advance. Furthermore, the V50 value during treatment planning can provide radiation oncologists with data for strategies to reduce ARD.

Impact of Noise Level on the Accuracy of Automated Measurement of CT Number Linearity on ACR CT and Computational Phantoms.

Background: Methods for segmentation, i.e., Full-segmentation (FS) and Segmentation-rotation (SR), are proposed for maintaining Computed Tomography (CT) number linearity. However, their effectiveness has not yet been tested against noise. Objective: This study aimed to evaluate the influence of noise on the accuracy of CT number linearity of the FS and SR methods on American College of Radiology (ACR) CT and computational phantoms. Material and Methods: This experimental study utilized two phantoms, ACR CT and computational phantoms. An ACR CT phantom was scanned by a 128-slice CT scanner with various tube currents from 80 to 200 mA to acquire various noises, with other constant parameters. The computational phantom was added by different Gaussian noises between 20 and 120 Hounsfield Units (HU). The CT number linearity was measured by the FS and SR methods, and the accuracy of CT number linearity was computed on two phantoms. Results: The two methods successfully segmented both phantoms at low noise, i.e., less than 60 HU. However, segmentation and measurement of CT number linearity are not accurate on a computational phantom using the FS method for more than 60-HU noise. The SR method is still accurate up to 120 HU of noise. Conclusion: The SR method outperformed the FS method to measure the CT number linearity due to its endurance in extreme noise.

Dose estimation for cone-beam computed tomography in image-guided radiation therapy for pelvic cancer using adult mesh-type reference computational phantoms.

The use of cone-beam computed tomography (CBCT) is expanding owing to its installation in linear accelerators for radiation therapy, and the imaging dose induced by this system has become the center of attention. Here, the dose to patients caused by the CBCT imager was investigated. Organ doses and effective doses for male and female mesh-type reference computational phantoms (MRCPs) and pelvis CBCT mode, routinely used for pelvic irradiation, were estimated using the Particle and Heavy Ion Transport Code System. The simulation results were confirmed based on the point-dose measurements. The estimated organ doses for male MRCPs with/without raised arms and for female MRCPs with/without raised arms were 0.00286-35.6 mGy, 0.00286-35.1 mGy, 0.00933-39.5 mGy, and 0.00931-39.0 mGy, respectively. The anticipated effective doses for male MRCPs with/without raised arms and female MRCPs with/without raised arms irradiated by pelvis CBCT mode were 4.25 mSv, 4.16 mSv, 7.66 mSv, and 7.48 mSv, respectively. The results of this study will be useful for patients who undergo image-guided radiotherapy with CBCT. However, because this study only covered one type of cancer with one type of imager, and image quality was not considered, more studies should be conducted to estimate the radiation dose from imaging devices in radiation therapy.

Prevention and Repair of Ultraviolet B-Induced Skin Damage in Hairless Mice via Transdermal Delivery of Growth Factors Immobilized in a Gel-in-Oil Nanoemulsion.

Ultraviolet (UV) radiation from the sun or artificial sources is one of the primary causes of skin damage, including sunburns, tanning, erythema, and skin cancer. Among the three different types of UV rays, UVB rays have a medium wavelength that can penetrate the epidermal layer of the skin, resulting in sunburn, suntan, blistering, and melanoma in case of chronic exposure. This study aimed to evaluate the preventive and therapeutic effects of a gel-in-oil nanogel dispersion (G/O-NGD) as a transdermal delivery biomolecular carrier for skin damage caused by UVB light. The efficacy of this carrier against UVB-induced skin damage was investigated in vivo by delivering different growth factors (GFs) encapsulated in a G/O-NGD. Artificial UVB light was used to induce skin damage in nude mice, followed by the transdermal application of five GF [vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), transforming growth factor (TGF)-1, and insulin-like growth factor (IGF)-α]-immobilized G/O-NGD. Among these GFs, VEGF and bFGF promoted angiogenesis, while EGF, TGF-1, and IGF-α promoted the repair and regeneration of damaged cells. The results showed that G/O-NGD was superior to heparin-immobilized G/O-NGD in reducing UVB-induced skin damage, such as erythema, epidermal water reduction, inflammation, and dermis thickening. In addition, G/O-NGD could prevent and treat abnormal follicle proliferation caused by UVB rays and exhibited potential to repair lipid glands. Overall, our results demonstrate the potential of G/O-NGDs for the treatment of UVB-induced skin damage.

Application of liquid scintillation light guide (LSLG) to scattered X-ray measurement from dental panoramic radiography system.

A 1.2 m flexible liquid scintillation light guide (LSLG) detector connected to a portable electric device was developed and applied to monitor X-rays scattered from a panoramic dental X-ray imaging apparatus. The X-ray absorption of the LSLG tube was simulated for 20 and 40 keV X-rays. The LSLG detector was calibrated by comparing doses measured by a 3-inch NaI(Tl) detector using Am-241 and Cs-137 sources. A linear relationship was obtained between dose rates (µSv/h) and count rates (cps). The elapsed time profile of scattered radiation from a panoramic dental X-ray imaging apparatus was determined. Local absorbed doses were measured with small OSL dosimeters on the LSLG tube suspended over the shoulder and the eyeglass. Behind the ears and neck (in the center of the LSLG tube) showed high doses. The LSLG detector was useful for real-time monitoring of scattered X-rays.

Automated development of the contrast-detail curve based on statistical low-contrast detectability in CT images.

PURPOSE: We have developed a software to automatically find the contrast-detail (C-D) curve based on the statistical low-contrast detectability (LCD) in images of computed tomography (CT) phantoms at multiple cell sizes and to generate minimum detectable contrast (MDC) characteristics. METHODS: A simple graphical user interface was developed to set the initial parameters needed to create multiple grid region of interest of various cell sizes with a 2-pixel increment. For each cell in the grid, the average CT number was calculated to obtain the standard deviation (SD). Detectability was then calculated by multiplying the SD of the mean CT numbers by 3.29. This process was automatically repeated as many times as the cell size was set at initialization. Based on the obtained LCD, the C-D curve was obtained and the target size at an MDC of 0.6% (i.e., 6-HU difference) was determined. We subsequently investigated the consistency of the target sizes for a 0.6% MDC at four locations within the homogeneous image. We applied the software to images with six noise levels, images of two modules of the American College of Radiology CT phantom, images of four different phantoms, and images of four different CT scanners. We compared the target sizes at a 0.6% MDC based on the statistical LCD and the results from a human observer. RESULTS: The developed system was able to measure C-D curves from different phantoms and scanners. We found that the C-D curves follow a power-law fit. We found that higher noise levels resulted in a higher MDC for a target of the same size. The low-contrast module image had a slightly higher MDC than the distance module image. The minimum size of an object detected by visual observation was slightly larger than the size using statistical LCD. CONCLUSIONS: The statistical LCD measurement method can generate a C-D curve automatically, quickly, and objectively.

Dose estimation for cone-beam computed tomography in image-guided radiation therapy using mesh-type reference computational phantoms and assuming head and neck cancer.

This study aimed to estimate the additional dose the cone-beam computed tomography (CBCT) system integrated into the Varian TrueBeam linear accelerator delivers to a patient with head and neck cancer using mesh-type International Commission on Radiological Protection reference computational phantoms. In the first part, for use as a benchmark for the accuracy of the Monte Carlo geometry of CBCT, Particle and Heavy Ion Transport code System (PHITS) calculations were confirmed against measured lateral and depth dose profiles using a computed tomography dose profiler. After obtaining good agreement, organ dose calculations were performed by PHITS using mesh-type reference computational phantom (MRCP) and irradiating the neck region; the effective dose was calculated utilising absorbed organ doses and tissue weighting factors for male and female MRCP. Substantially, it has been found that the effective doses for male and female MRCP are 0.81 and 1.06 mSv, respectively. As this study aimed to assess the imaging dose from the CBCT system used in image-guided radiation therapy, it is required to take into account this dose in terms of both the target organ and surrounding tissues. Although the absorbed organ dose values and effective dose values obtained for both MRCP males and females were small, attention should be paid to the additional dose resulting from CBCT. This study can create awareness on the importance of doses arising from imaging techniques, especially CBCT.

Visualization of dose distribution and basic study of dose estimation using plastic scintillator and digital camera.

Radiation can be visualized using a scintillator and a digital camera. If the amount of light emitted by the scintillator increases with dose, the dose estimation can be obtained from the amount of light emitted. In this study, the basic performance of the scintillator and digital camera system was evaluated by measuring computed tomography dose index (CTDI). A circular plastic scintillator plate was sandwiched between polymethyl methacrylate (PMMA) phantoms, and x-rays were irradiated to them while rotating the x-ray tube to confirm changes in light emission. In addition, CTDI was estimated from the amount of light emitted by the scintillator during the helical scan and compared with the value measured from dosimeter. The scintillator emitted light while changing its distribution according to the movement of the x-ray tube. The measured CTDIvolwas 33.20 mGy, the CTDIvolestimated from the scintillation light was approximately 46 mGy, which was 40% larger. In particular, when the scintillator was directly irradiated, the dose was overestimated compared with the value measured from the dosimeter. This overestimation can be because of the reproducibility of the position and the difference between the sensitivity of the scintillator to detect light emission and the sensitivity of the dosimeter, and the non-uniformity of position sensitivity due to the wide-angle lens.

Development and evaluation of the effectiveness of educational material for radiological protection that uses augmented reality and virtual reality to visualise the behaviour of scattered radiation.

Understanding the behaviour of scattered radiation is important for learning appropriate radiation protection methods, but many existing visualisation systems for radiation require special devices, making it difficult to use them in education. The purpose of this study was to develop teaching material for radiation protection that can help visualise the scattered radiation with augmented reality (AR) and virtual reality (VR) on a web browser, develop a method for using it in education and examine its effectiveness. The distribution of radiation during radiography was calculated using Monte Carlo simulation, and teaching material was created. The material was used in a class for department of radiological technology students and its influence on motivation was evaluated using a questionnaire based on the evaluation model for teaching materials. In addition, text mining was used to evaluate impressions objectively. Educational material was developed that can be used in AR and VR for studying the behaviour of scattered radiation. The results of the questionnaire showed that the average value of each item was more than four on a five-point scale, indicating that the teaching material attracted the interest of users. Through text mining, it could be concluded that there was improved understanding of, and confidence in, radiation protection.

Investigation of Eye Lens Dose Estimate based on AAPM Report 293 in Head Computed Tomography.

BACKGROUND: Estimation of eye lens dose is important in head computed tomography (CT) examination since the eye lens is a sensitive organ to ionizing radiation. OBJECTIVE: The purpose of this study is to compare estimations of eye lens dose in head CT examinations using local size-specific dose estimate (SSDE) based on size-conversion factors of the American Association of Physicists in Medicine (AAPM) Report No. 293 with those based on size-conversion factors of the AAPM Report No. 220. MATERIAL AND METHODS: This experimental study is conducted on a group of patients who had undergone nasopharyngeal CT examination. Due to the longitudinal (z-axis) dose fluctuation, the average global SSDE and average local SSDE (i.e. particular slices where the eyes are located) were investigated. All estimates were compared to the measurement results using thermo-luminescent dosimeters (TLDs). The estimated and measured doses were implemented for 14 patients undergoing nasopharyngeal CT examination. RESULTS: It was found that the percentage differences of the volume CT dose index (CTDIvol), average global SSDE based on AAPM No. 220 (SSDEo,g), average local SSDE based on AAPM No. 220 (SSDEo,l), average global SSDE based on AAPM No. 293 (SSDEn,g) and average local SSDE based on AAPM No. 293 (SSDEn,l) against the measured TLD doses were 22.5, 21.7, 15.0, 9.3, and 2.1%, respectively. All comparisons between dose estimates and TLD measurements gave p-values less than 0.001, except for SSDEn,l (p-value = 0.566). CONCLUSION: SSDE based on AAPM Report No. 293 can be used to accurately estimate eye lens radiation doses by performing the calculations on a number of specific slices containing the eyes.

Radiation protection education using virtual reality for the visualisation of scattered distributions during radiological examinations.

When working in radiology and patient assistance in medical facilities, radiation workers need to understand how to properly protect themselves and others from scattered radiation. In this study, a visualisation method is examined to facilitate the understanding of the spread of scattered radiation in radiography, computerised tomography (CT), and angiography rooms, and the application of this system for radiation protection education is proposed. X-ray radiography, x-ray CT, and angiography rooms were constructed using the particle and heavy ion transport code system, and the scattered radiation distributions that occurred when a patient was irradiated with x-rays were simulated. The three-dimensional (3D) distribution of each moment was continuously displayed to create a four-dimensional (4D) distribution. Using the obtained data, a radiation protection education seminar was conducted that included exercises to allow the students to confirm the presence of scattered radiation from any direction. The effectiveness of the scattered radiation visualisation data was evaluated using an interview. The position of the assistant for conducting standing chest radiographs that experienced the least scattered radiation was determined to be at the side and foot side of the patient. As a result of an interview that was provided to the participants following the seminar, the effectiveness of this system for providing education about radiation protection was confirmed. The visualisation method allowed the students to better understand the behaviour of radiation and the sources of scattered radiation. The visualisation of 3D and 4D scattered radiation distributions in radiological examination rooms can intuitively enhance the understanding of the spread of invisible radiation and the appropriate methods of mitigating radiation exposure.

An Improved Method of Automated Noise Measurement System in CT Images.

BACKGROUND: It is necessary to have an automated noise measurement system working accurately to optimize dose in computerized tomography (CT) examinations. OBJECTIVE: This study aims to develop an algorithm to automate noise measurement that can be implemented in CT images of all body regions. MATERIALS AND METHODS: In this retrospective study, our automated noise measurement method consists of three steps as follows: the first is segmenting the image of the patient. The second is developing a standard deviation (SD) map by calculating the SD value for each pixel with a sliding window operation. The third step is estimating the noise as the smallest SD from the SD map. The proposed method was applied to the images of a homogenous phantom and a full body adult anthropomorphic phantom, and retrospectively applied to 27 abdominal images of patients. RESULTS: For a homogeneous phantom, the noises calculated using our proposed and previous algorithms have a linear correlation with R2 = 0.997. It is found that the noise magnitude closely follows the magnitude of the water equivalent diameter (Dw) in all body regions. The proposed algorithm is able to distinguish the noise magnitude due to variations in tube currents and different noise suppression techniques such as strong, standard, mild, and weak ones in a reconstructed image using the AIDR 3D algorithm. CONCLUSION: An automated noise calculation has been proposed and successfully implemented in all body regions. It is not only accurate and easy to implement but also not influenced by the subjectivity of user.

Basic study of mobile gamma ray imaging using a digital camera and scintillator.

Gamma cameras are used in nuclear medicine examinations involving radioisotopes; however, they do not provide real-time feedback. We propose a real-time imaging method based on a commercially available digital camera and a scintillator array to provide simple and accurate measurements of radioisotope accumulation and contamination. We evaluate the sensitivity and resolution of the proposed device using x-rays as a proxy for gamma-rays. The performance of the device is demonstrated using PENTAX KP and ORCA-spark C11440-36U digital cameras. A caesium iodide scintillator array is irradiated with x-rays, with the state of light emission confirmed using live view images. The pixel value is evaluated as a function of dose rate. Furthermore, we investigate the state of light emission in response to amplifying the light signal using an image intensifier. For the PENTAX KP, luminescence is observable for a dose rate of approximately 10 mSv h-1, which changes to 2.1 mSv h-1when an image intensifier is used. Notably, the ORCA-spark detected emission at a low dose rate of 0.06 mSv h-1. However, using an image intensifier resulted in noisier images. Therefore, although the ORCA-spark can observe luminescence at a suitable predicted dose rate for application in nuclear medicine examinations, a collimator is required to control the spread of gamma rays. However, as this causes the sensitivity to decrease, increasing the amount of light emitted by the scintillator and improving the sensitivity of the camera is vital.

[Proposal for Reduction Measures of Eye Lens Exposure Based on Actual Exposure Management in Radiation-exposed Medical Staff].

PURPOSE: To investigate the actual condition of the crystalline lens equivalent dose and effective dose according to the type of job and the type of duties in a medical institution. We also sought to clarify effective exposure reduction strategies. METHODS: Equivalent crystalline lens doses, effective doses, job type, and duties for 8656 persons · year were obtained from 17 medical facilities. We analyzed the relationship between the effective dose and the crystalline lens equivalent dose in uniform exposure control and non-uniform exposure control conditions. Exposure data were obtained for 13 unique job types and duties. RESULTS: The ratio of the lens equivalent dose to the effective dose of non-uniform exposure managers was 2 to 6 times and varied depending on the occupation. The percentage of persons whose annual lens equivalent dose exceeded 20 mSv was 4.75% for medical doctors, 1.17% for nurses, and 0.24% for radiological technologists. Highly exposed tasks included doctors in cardiology and gastroenterology performing angiography and endoscopy, nurses in endoscopy, and radiological technologists in radiography and CT examinations. CONCLUSION: Thorough unequal exposure control for operations with high crystalline lens exposure, radiation protection education, and effective use of proper personal protective equipment such as the use of radiation protection glasses may reduce lens exposure levels.