Radiation exposure during angiographic interventions in interventional radiology – risk and fate of advanced procedures

References

• Adamus R, Loose R, Wucherer M. 2012. Strahlenschutzmaßnahmen bei speziellen radiologischen Interventionen. RöFo-Fortschritte auf dem Gebiet der R. 184(1):201–205.
   Google Scholar
• Adamus R, Loose R, Wucherer M, Uder M, Galster M. 2016. Radiation protection in interventional radiology. Radiologe. 56(3):275–281.
   PubMed Web of Science ®Google Scholar
• Albayati MA, Kelly S, Gallagher D, Dourado R, Patel AS, Saha P, Bajwa A, El-Sayed T, Salter R, Gkoutzios P, et al. 2015. Editor's choice – angulation of the C-arm during complex endovascular aortic procedures increases radiation exposure to the head. Eur J Vasc Endovasc Surg. 49(4):396–402.
   PubMed Web of Science ®Google Scholar
• Balter S, Hopewell JW, Miller DL, Wagner LK, Zelefsky MJ. 2010. Fluoroscopically guided interventional procedures: a review of radiation effects on patients' skin and hair. Radiology. 254(2):326–341.
   PubMed Web of Science ®Google Scholar
• Balter S, Miller DL. 2014. Patient skin reactions from interventional fluoroscopy procedures. AJR Am J Roentgenol. 202(4):W335–W342.
   PubMed Web of Science ®Google Scholar
• Bartal G, Roguin A, Paulo G. 2016. Call for implementing a radiation protection culture in fluoroscopically guided interventional procedures. AJR Am J Roentgenol. 206(5):1110–1111.
   PubMed Web of Science ®Google Scholar
• Bartal G, Vano E, Paulo G, Miller DL. 2014. Management of patient and staff radiation dose in interventional radiology: current concepts. Cardiovasc Intervent Radiol. 37(2):289–298.
   PubMed Web of Science ®Google Scholar
• Basheerudeen SAS, Kanagaraj K, Jose M, Ozhimuthu A, Paneerselvam S, Pattan S, Joseph S, Raavi V, Perumal V. 2017. Entrance surface dose and induced DNA damage in blood lymphocytes of patients exposed to low-dose and low-dose-rate X-irradiation during diagnostic and therapeutic interventional radiology procedures. Mutat Res Genet Toxicol Environ Mutag. 818:1–6.
   PubMed Web of Science ®Google Scholar
• Becker BV, Lissek F, Waldeck S. 2017. Radiation protection in the interventional radiology. StrahlenschutzPraxis. 23(4):22–24.
   Google Scholar
• Boal T, Pinak M. 2015. Dose limits to the lens of the eye: International Basic Safety Standards and Related Guidance. Ann ICRP. 44(1 Suppl.):112–117.
   PubMedGoogle Scholar
• Böckler D. 2020. Praktische Tipps für den persönlichen Strahlenschutz bei endovaskulären Eingriffen im Hybrid-Operationssaal. Gefässchirurgie. 25(1):19–30.
   Web of Science ®Google Scholar
• Busse T, Reifart J, Reifart N. 2018. Influence of novel X‐ray imaging technology on radiation exposure during chronic total occlusion procedures. Catheter Cardiovasc Interv. 92(7):1268–1273.
   PubMed Web of Science ®Google Scholar
• Chida K, Kaga Y, Haga Y, Kataoka N, Kumasaka E, Meguro T, Zuguchi M. 2013. Occupational dose in interventional radiology procedures. Am J Roentgenol. 200(1):138–141.
   PubMed Web of Science ®Google Scholar
• Ciraj-Bjelac O, Rehani M. 2014. Eye dosimetry in interventional radiology and cardiology: current challenges and practical considerations. Radiat Prot Dosimetry. 162(3):329–337.
   PubMed Web of Science ®Google Scholar
• Clerinx P, Buls N, Bosmans H, De Mey J. 2008. Double-dosimetry algorithm for workers in interventional radiology. Radiat Prot Dosimetry. 129(1–3):321–327.
   PubMed Web of Science ®Google Scholar
• Cousins C, Miller D, Bernardi G, Rehani M, Schofield P, Vañó E, Einstein A, Geiger B, Heintz P, Padovani R. 2011. International commission on radiological protection. J ICRP Publ. 120:1–125.
   Google Scholar
• Dauer LT, Hamada N, Blakely EA. 2017. National Council on Radiation Protection and Measurements Commentary Number 26: impact of revised guidance on radiation protection for the lens of the eye. J Am Coll Radiol. 14(7):980–982.
   PubMed Web of Science ®Google Scholar
• de Ruiter QM, Jansen MM, Moll FL, Hazenberg CE, Kahya NN, van Herwaarden JA. 2018. Procedure and step-based analysis of the occupational radiation dose during endovascular aneurysm repair in the hybrid operating room. J Vasc Surg. 67(6):1881–1890.
   PubMed Web of Science ®Google Scholar
• de Ruiter QM, Moll FL, Hazenberg CE, van Herwaarden JA. 2021. Radiation awareness for endovascular abdominal aortic aneurysm repair in the hybrid operating room: an instant operator risk chart for daily practice. J Endovasc Ther. 28(4):530–541.
   PubMed Web of Science ®Google Scholar
• Ellis JA, Nossek E, Kronenburg A, Langer DJ, Ortiz RA. 2018. Intracranial aneurysm: diagnostic monitoring, current interventional practices, and advances. Curr Treat Options Cardiovasc Med. 20(12):1–9.
   PubMedGoogle Scholar
• European Commission. 2014. Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom. Off J. 13:1–73.
   Google Scholar
• European Society of Radiology. 2011. White paper on radiation protection by the European Society of Radiology. Insights Imaging. 2:357–362.
   PubMedGoogle Scholar
• Falco MD, Masala S, Stefanini M, Bagalà P, Morosetti D, Calabria E, Tonnetti A, Verona-Rinati G. 2018. Effective-dose estimation in interventional radiological procedures. Radiol Phys Technol. 11(2):149–155.
   PubMed Web of Science ®Google Scholar
• Faulkner K, Ortiz-Lopez P, Vano E. 2005. Patient dosimetry in diagnostic and interventional radiology: a practical approach using trigger levels. Radiat Prot Dosimetry. 117(1–3):166–168.
   PubMed Web of Science ®Google Scholar
• Fransen PSS, Beumer D, Berkhemer OA, van den Berg LA, Lingsma H, van der Lugt A, van Zwam WH, van Oostenbrugge RJ, Roos YBWEM, Majoie CB, et al. 2014. MR CLEAN, a multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands: study protocol for a randomized controlled trial. Trials. 15(1):343–311.
   PubMed Web of Science ®Google Scholar
• Frieben H. 1902. Demonstration eines Cancroid des rechten Handruckens, das sich nach langdauernder Einwirkung von Rontgenstrahlen entwickelt hatte. Fortschr Rontgenstr. 6:106–111.
   Google Scholar
• Galster M, Guhl C, Uder M, Adamus R. 2013. Exposition der Augenlinse des Untersuchers und Effizienz der Strahlenschutzmittel bei fluoroskopischen Interventionen. Fortschr Rontgenstr. 185(5):474–481.
   Google Scholar
• Gould JE, Vedantham S. 2006. The role of interventional radiology in trauma. Semin Intervent Radiol. 23(3):270–278.
   PubMedGoogle Scholar
• Grunert J-H. 2019. Rechtsvorschriften, Richtlinien und Empfehlungen bezüglich der Anwendung von Röntgenstrahlung. Strahlenschutz für Röntgendiagnostik und Computertomografie. Berlin (Germany): Springer; p. 219–231.
   Google Scholar
• Hall E, Brenner D. 2008. Cancer risks from diagnostic radiology. Br J Radiol. 81(965):362–378.
   PubMed Web of Science ®Google Scholar
• Haninger T, Hödlmoser H, Figel M, König-Meier D, Henniger J, Sommer M, Jahn A, Ledtermann G, Eßer R. 2016. Properties of the BeOSL dosimetry system in the framework of a large-scale personal monitoring service. Radiat Prot Dosimetry. 170(1–4):269–273.
   PubMed Web of Science ®Google Scholar
• Hasegawa K, Umemoto N, Inoue S, Iio Y, Shibata N, Mizutani T, Sawamura A, Sugiura T, Taniguchi T, Asai T. 2020. Digital zoom is a useful, simple, and cost-effective method of reducing radiation exposure in percutaneous coronary intervention. Cardiovasc Interv Ther. 35:1–8.
   PubMed Web of Science ®Google Scholar
• Hertault A, Rhee R, Antoniou GA, Adam D, Tonda H, Rousseau H, Bianchini A, Haulon S. 2018. Radiation dose reduction during EVAR: results from a prospective multicentre study (the REVAR study). Eur J Vasc Endovasc Surg. 56(3):426–433.
   PubMed Web of Science ®Google Scholar
• International Commission on Radiological Protection. 2007. ICRP publication 103. Ann ICRP. 37(2.4):2.
   Google Scholar
• Jacob S, Boveda S, Bar O, Brézin A, Maccia C, Laurier D, Bernier M-O. 2013. Interventional cardiologists and risk of radiation-induced cataract: results of a French multicenter observational study. Int J Cardiol. 167(5):1843–1847.
   PubMed Web of Science ®Google Scholar
• Jacob S, Michel M, Spaulding C, Boveda S, Bar O, Brézin AP, Streho M, Maccia C, Scanff P, Laurier D, et al. 2010. Occupational cataracts and lens opacities in interventional cardiology (O'CLOC study): are X-rays involved? BMC Public Health. 10(1):537–538.
   PubMed Web of Science ®Google Scholar
• Jaschke W, Bartal G, Martin CJ, Vano E. 2020. Unintended and accidental exposures, significant dose events and trigger levels in interventional radiology. Cardiovasc Intervent Radiol. 43(8):1114–1121.
   PubMed Web of Science ®Google Scholar
• Kamusella P, Scheer F, Lüdtke CW, Wiggermann P, Wissgott C, Andresen R. 2017. Interventional angiography: radiation protection for the examiner by using lead-free gloves. J Clin Diagn Res. 11(7):TC26.
   PubMed Web of Science ®Google Scholar
• Karadag B, Ikitimur B, Durmaz E, Avci BK, Cakmak HA, Cosansu K, Ongen Z. 2013. Effectiveness of a lead cap in radiation protection of the head in the cardiac catheterisation laboratory. EuroIntervention. 9(6):754–756.
   PubMed Web of Science ®Google Scholar
• Kato M, Chida K, Ishida T, Toyoshima H, Yoshida Y, Yoshioka S, Moroi J, Kinoshita T. 2019. Occupational radiation exposure of the eye in neurovascular interventional physician. Radiat Prot Dosimetry. 185(2):151–156.
   PubMed Web of Science ®Google Scholar
• Kazempour M, Saeedimoghadam M, Shooli FS, Shokrpour N. 2015. Assessment of the radiation attenuation properties of several lead free composites by Monte Carlo simulation. J Biomed Phys Eng. 5(2):67–76.
   PubMedGoogle Scholar
• Kim JH. 2018. Three principles for radiation safety: time, distance, and shielding. Korean J Pain. 31(3):145–146.
   PubMed Web of Science ®Google Scholar
• Kirkwood ML, Arbique GM, Guild JB, Timaran C, Anderson JA, Valentine RJ. 2015. Deterministic effects after fenestrated endovascular aortic aneurysm repair. J Vasc Surg. 61(4):902–907.
   PubMed Web of Science ®Google Scholar
• Klein LW, Miller DL, Balter S, Laskey W, Haines D, Norbash A, Mauro MA, Goldstein JA. 2009. Occupational health hazards in the interventional laboratory: time for a safer environment. Radiology. 250(2):538–544.
   PubMed Web of Science ®Google Scholar
• Koenig A, Etzel R, Keil B, Fiebich M, Mahnken A. 2017. Effektivität der Kombination verschiedener Strahlenschutzmittel in der Interventionellen Radiologie. RöFo-Fortschritte auf dem Gebiet der R. 189(S 01):S1–S124.
   Google Scholar
• Koenig AM, Etzel R, Thomas RP, Mahnken AH. 2019. Personal radiation protection and corresponding dosimetry in interventional radiology: an overview and future developments. Fortschr Rontgenstr. 191(6):512–521.
   Google Scholar
• Komemushi A, Suzuki S, Sano A, Kanno S, Kariya S, Nakatani M, Yoshida R, Kono Y, Ikeda K, Utsunomiya K, et al. 2014. Radiation dose of nurses during IR procedures: a controlled trial evaluating operator alerts before nursing tasks. J Vasc Interv Radiol. 25(8):1195–1199.
   PubMed Web of Science ®Google Scholar
• Koukorava C, Carinou E, Simantirakis G, Vrachliotis T, Archontakis E, Tierris C, Dimitriou P. 2011. Doses to operators during interventional radiology procedures: focus on eye lens and extremity dosimetry. Radiat Prot Dosimetry. 144(1–4):482–486.
   PubMed Web of Science ®Google Scholar
• Kuhelj D, Zdesar U, Jevtic V, Skrk D, Omahen G, Zontar D, Surlan M, Glusic M, Popovic P, Kocijancic IJ, et al. 2010. Risk of deterministic effects during endovascular aortic stent graft implantation. Br J Radiol. 83(995):958–963.
   PubMed Web of Science ®Google Scholar
• Lee MY, Kwon J, Ryu GW, Kim KH, Nam HW, Kim KP. 2019. Review of national diagnostic reference levels for interventional procedures. Prog Med Phys. 30(4):75–88.
   Google Scholar
• Loose R, Wucherer M, Walz M, Adamus R. 2020. The new radiation protection framework since 2019 – implementation in Germany and comparison of some aspects in seven European countries. Fortschr Rontgenstr. 192(11):1036–1045.
   Google Scholar
• Meisinger QC, Stahl CM, Andre MP, Kinney TB, Newton IG. 2016. Radiation protection for the fluoroscopy operator and staff. AJR Am J Roentgenol. 207(4):745–754.
   PubMed Web of Science ®Google Scholar
• Mettler FA Jr, Huda W, Yoshizumi TT, Mahesh M. 2008. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 248(1):254–263.
   PubMed Web of Science ®Google Scholar
• Mettler FA, Mahesh M, Bhargavan-Chatfield M, Chambers CE, Elee JG, Frush DP, Miller DL, Royal HD, Milano MT, Spelic DC, et al. 2020. Patient exposure from radiologic and nuclear medicine procedures in the United States: procedure volume and effective dose for the period 2006–2016. Radiology. 295(2):418–427.
   PubMed Web of Science ®Google Scholar
• Miller DL, Balter S, Cole PE, Lu HT, Schueler BA, Geisinger M, Berenstein A, Albert R, Georgia JD, Noonan PT, et al. 2003. Radiation doses in interventional radiology procedures: the RAD-IR study. Part I: overall measures of dose. J Vasc Interv Radiol. 14(6):711–727.
   PubMed Web of Science ®Google Scholar
• Miller DL, Vanó E, Bartal G, Balter S, Dixon R, Padovani R, Schueler B, Cardella JF, De Baère T, Society of Interventional Radiology. 2010. Occupational radiation protection in interventional radiology: a joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. Cardiovasc Intervent Radiol. 33(2):230–239.
   PubMed Web of Science ®Google Scholar
• Mogensen D, Mujic A, Bolam K, Mourant N. 2020. How collimation affects patient radiation dose. In: Undergraduate research showcase. 124. Boise (ID): Boise State University. [accessed 2021 Jul 8]. https://scholarworks.boisestate.edu/under_showcase_2020/124.
   Google Scholar
• Monastiriotis S, Comito M, Labropoulos N. 2015. Radiation exposure in endovascular repair of abdominal and thoracic aortic aneurysms. J Vasc Surg. 62(3):753–761.
   PubMed Web of Science ®Google Scholar
• Mooney R, McKinstry C, Kamel H. 2000. Absorbed dose and deterministic effects to patients from interventional neuroradiology. Br J Radiol. 73(871):745–751.
   PubMed Web of Science ®Google Scholar
• Nakashima E, Neriishi K, Minamoto A. 2006. A reanalysis of atomic-bomb cataract data, 2000–2002: a threshold analysis. Health Phys. 90(2):154–160.
   PubMed Web of Science ®Google Scholar
• Neriishi K, Nakashima E, Minamoto A, Fujiwara S, Akahoshi M, Mishima HK, Kitaoka T, Shore RE. 2007. Postoperative cataract cases among atomic bomb survivors: radiation dose response and threshold. Radiat Res. 168(4):404–408.
   PubMed Web of Science ®Google Scholar
• Neto FAB, Alves AFF, Mascarenhas YM, Giacomini G, Maués NHPB, Nicolucci P, de Freitas CCM, Alvarez M, de Pina DR. 2017. Efficiency of personal dosimetry methods in vascular interventional radiology. Phys Med. 37:58–67.
   PubMed Web of Science ®Google Scholar
• Parikh JR, Geise RA, Bluth EI, Bender CE, Sze G, Jones AK, Human Resources Commission of the American College of Radiology. 2017. Potential radiation-related effects on radiologists. AJR Am J Roentgenol. 208(3):595–602.
   PubMed Web of Science ®Google Scholar
• Pasciak AS, Jones AK. 2014. Time to take the gloves off: the use of radiation reduction gloves can greatly increase patient dose. J Appl Clin Med Phys. 15(6):5002–5359.
   PubMed Web of Science ®Google Scholar
• Rajaraman P, Doody MM, Yu CL, Preston DL, Miller JS, Sigurdson AJ, Freedman DM, Alexander BH, Little MP, Miller DL, et al. 2016. Journal club: cancer risks in US radiologic technologists working with fluoroscopically guided interventional procedures, 1994–2008. Am J Roentgenol. 206(5):1101–1109.
   PubMed Web of Science ®Google Scholar
• Rehani MM, Srimahachota S. 2011. Skin injuries in interventional procedures. Radiat Prot Dosimetry. 147(1–2):8–12.
   PubMed Web of Science ®Google Scholar
• Rigatelli G, Panin S, Fiorrevanti R, Oliva L, Dario A, Tiberio L, Bedendo E, Pertoldi D, Chambers C. 2016. Impact of operators’ height on individual radiation exposure measurements during catheter‐based cardiovascular interventions. J Interv Cardiol. 29(1):83–88.
   PubMed Web of Science ®Google Scholar
• Roguin A, Goldstein J, Bar O. 2012. Brain tumours among interventional cardiologists: a cause for alarm? Report of four new cases from two cities and a review of the literature. EuroIntervention. 7(9):1081–1086.
   PubMed Web of Science ®Google Scholar
• Sanchez R, Vano E, Fernández J, Moreu M, Lopez-Ibor L. 2014. Brain radiation doses to patients in an interventional neuroradiology laboratory. AJNR Am J Neuroradiol. 35(7):1276–1280.
   PubMed Web of Science ®Google Scholar
• Sánchez R, Vañó E, Fernández J, Rosati S, Lopez-Ibor L. 2016. Radiation doses in patient eye lenses during interventional neuroradiology procedures. AJNR Am J Neuroradiol. 37(3):402–407.
   PubMed Web of Science ®Google Scholar
• Schegerer A, Loose R, Heuser LJ, Brix G. 2019. Diagnostic reference levels for diagnostic and interventional X-ray procedures in Germany: update and handling. Fortschr Rontgenstr. 191(8):739–751.
   Google Scholar
• Schulz B, Heidenreich R, Heidenreich M, Eichler K, Thalhammer A, Naeem NNN, Vogl TJ, Zangos S. 2012. Radiation exposure to operating staff during rotational flat-panel angiography and C-arm cone beam computed tomography (CT) applications. Eur J Radiol. 81(12):4138–4142.
   PubMed Web of Science ®Google Scholar
• Sohrabi M. 1997. ''Low dose'' and/or ''high dose'' in radiation protection: a need to setting criteria for dose classification [Abstract]. IAEA International Conference on Low Doses of Ionizing Radiation: Biological Effects and Regulatory Control; Seville (Spain). p. 487–490.
   Google Scholar
• Stewart FA, Akleyev AV, Hauer-Jensen M, Hendry JH, Kleiman NJ, Macvittie TJ, Aleman BM, Edgar AB, Mabuchi K, Muirhead CR, et al. 2012. ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs-threshold doses for tissue reactions in a radiation protection context. Ann ICRP. 41(1–2):1–322.
   PubMedGoogle Scholar
• Teichgräber U. 2018. Strahlenschutz in der Angiographie. Springer: Teichgräber. Periphere arterielle Interventionen: Praxisbuch für Radiologie und Angiologie.
   Google Scholar
• Tharmalingam S, Sreetharan S, Brooks AL, Boreham DR. 2019. Re-evaluation of the linear no-threshold (LNT) model using new paradigms and modern molecular studies. Chem Biol Interact. 301:54–67.
   PubMed Web of Science ®Google Scholar
• Toivonen M. 2001. Patient dosimetry protocols in digital and interventional radiology. Radiat Prot Dosimetry. 94(1–2):105–108.
   PubMed Web of Science ®Google Scholar
• Tsapaki V, Ahmed NA, AlSuwaidi JS, Beganovic A, Benider A, BenOmrane L, Borisova R, Economides S, El-Nachef L, Faj D, et al. 2009. Radiation exposure to patients during interventional procedures in 20 countries: initial IAEA project results. AJR Am J Roentgenol. 193(2):559–569.
   PubMed Web of Science ®Google Scholar
• Tsapaki V. 2020. Radiation dose optimization in diagnostic and interventional radiology: current issues and future perspectives. Phys Med. 79:16–21.
   PubMed Web of Science ®Google Scholar
• Uthoff H, Benenati MJ, Katzen BT, Peña C, Gandhi R, Staub D, Schernthaner M. 2014. Lightweight bilayer barium sulfate–bismuth oxide composite thyroid collars for superior radiation protection in fluoroscopy-guided interventions: a prospective randomized controlled trial. Radiology. 270(2):601–606.
   PubMed Web of Science ®Google Scholar
• Vano E, Fernandez J, Sanchez R. 2011. Occupational dosimetry in real time. Benefits for interventional radiology. Radiat Meas. 46(11):1262–1265.
   Web of Science ®Google Scholar
• Vano E, Järvinen H, Kosunen A, Bly R, Malone J, Dowling A, Larkin A, Padovani R, Bosmans H, Dragusin O, et al. 2008. Patient dose in interventional radiology: a European survey. Radiat Prot Dosimetry. 129(1–3):39–45.
   PubMed Web of Science ®Google Scholar
• Vano E, Kleiman NJ, Duran A, Rehani MM, Echeverri D, Cabrera M. 2010. Radiation cataract risk in interventional cardiology personnel. Radiat Res. 174(4):490–495.
   PubMed Web of Science ®Google Scholar
• Vano E, Kleiman NJ, Duran A, Romano-Miller M, Rehani MM. 2013. Radiation-associated lens opacities in catheterization personnel: results of a survey and direct assessments. J Vasc Interv Radiol. 24(2):197–204.
   PubMed Web of Science ®Google Scholar
• Vano E, Sanchez R, Fernandez J. 2015. Estimation of staff lens doses during interventional procedures. Radiat Prot Dosimetry. 165(1–4):279–283.
   PubMed Web of Science ®Google Scholar
• Visweswaran S, Joseph S, Hegde V, Annalakshmi O, Jose M, Perumal V. 2019. DNA damage and gene expression changes in patients exposed to low-dose X-radiation during neuro-interventional radiology procedures. Mutat Res Genet Toxicol Environ Mutag. 844:54–61.
   PubMed Web of Science ®Google Scholar
• Walz M, Wucherer M, Loose R. 2019. What are the implications of the new radiation protection ordinance? Radiologe. 59(5):457–466.
   PubMed Web of Science ®Google Scholar
• Yonehara S, Brenner AV, Kishikawa M, Inskip PD, Preston DL, Ron E, Mabuchi K, Tokuoka S. 2004. Clinical and epidemiologic characteristics of first primary tumors of the central nervous system and related organs among atomic bomb survivors in Hiroshima and Nagasaki, 1958–1995. Cancer. 101(7):1644–1654.
   PubMed Web of Science ®Google Scholar