Dosemeter readings and effective dose to the cardiologist with protective clothing in a simulated interventional procedure

A personal dosemeter issued for individual monitoring is calibrated in terms of personal dose equivalent, usually H(P)(10). In general it yields a reasonable estimate of effective dose (E) when the exposed person does not wear protective clothing. In interventional cardiology, however, a lead equivalent apron is worn and often a thyroid collar. A correction factor will then be necessary to convert a dosemeter reading to E. To explore this factor an interventional cardiology procedure is simulated based on exposure conditions typical for a modern hospital in the BENELUX area. The dose to the cardiologist is investigated using Monte Carlo simulation of radiation transport. It is concluded that a personal dosemeter may best be worn outside the apron at a central position high on the chest for least dependence on the beam direction. It will overestimate E by roughly a factor of 20 (apron and thyroid collar of 0.25 mm Pb).     

Measurements of finger doses in x-ray guided surgery, nuclear medicine and research

The Norwegian Radiation Protection Authority has performed measurements of finger doses to nuclear medicine staff exposed to 99Tc(m), researchers handling 32P, surgeons performing X-ray guided orthopaedic surgery and surgeons and radiologists performing X-ray guided endovascular treatment of abdominal aortic aneurysms (AAA). Calibrations were done with X-ray qualities N-40, N-60 and N-300 and with the beta source 90Sr + 90Y. Annual doses were estimated for the nuclear medicine staff and the orthopaedic surgeons. The mean annual finger dose to nuclear medicine staff exposed to 99Tc(m) was estimated to be 18.8 mSv, and the mean annual finger dose to surgeons performing X-ray guided orthopaedic surgery was 13.7 mSv. The surgeons and radiologists performing X-ray guided endovascular treatment of AAA received a mean finger dose of 0.35 mSv per treatment. The majority of researchers handling 32P received no finger dose at all, and the maximum reading was 1.65 mSv. All occupational groups received finger doses well below the annual finger dose limit of 500 mSv.     

Occupational exposure doses in interventional procedures in Bosnia and Herzegovina

Monitoring of occupationally exposed workers in Bosnia and Herzegovina started in 1960s and it was interrupted in 1992. Dosimetry service resumed in 1999 when the International Atomic Energy Agency provided Radiation Protection Centre with Harshaw 4500 Thermoluminescence dosemeter (TLD)-reader and the first set of TLDs. The highest doses are received by professionals working in interventional procedures (radiology, cardiology, gastroenterohepatology etc.). Number of these procedures is increasing each year (just in cardiology this increase is 24 % per year). Results from two TLDs are used to estimate effective dose. One is worn under the apron (chest level), and the other above (neck level). Calculation is performed using Niklason's methodology. Total number of occupationally exposed persons in interventional radiology is 90. The collective dose they receive is 67 person mSv, while the mean dose is 0.77 mSv (based on 12-month period). Highest doses are received by physicians (3.7 mSv), while radiographers and nurses receive 2.1 and 1.9 mSv respectively. This occurs due to the fact that physicians stand closer to the source (patient). The lead apron is proven to be the most efficient radiation protection equipment, but, also, lead thyroid shield and glasses can significantly lower doses received by professionals. The use of this equipment is highly recommended.     

Occupational radiation doses in interventional radiology: simulations

In interventional radiology, occupational radiation doses can be high. Therefore, many authors have established conversion coefficients from the dose-area product data or from the personal dosemeter reading to the effective dose of the radiologist. These conversion coefficients are studied also in this work, with an emphasis on sensitivity of the results to changes in exposure conditions. Comparison to earlier works indicates that, for the exposure conditions examined in this work, all previous models discussed in this work overestimate the effective dose of the radiologist when a lead apron and a thyroid shield are used. Without the thyroid shield, underestimation may occur with some models.     

Patient and endoscopist radiation doses during ERCP procedures

The aim of the study was to calculate radiation doses for patients and staff during interventional Endoscopic retrograde cholangiopancreatography (ERCP) procedures. Patient age (A), kerma-area product (KAP), fluoroscopy time (T) and total number of films (F) were collected for 157 interventional ERCP procedures. One endoscopist (>10 y of experience) monitored using a thermoluminescent dosemeter worn over the lead apron performed the ERCPs. Median (range) KAP was 3.1 Gy cm(-2) (0.1-106.7 Gy cm(-2)). Median (range) A, T and F were 72 y, 2.6 (0.2-26.0) min and 2 (1-4) images, respectively. No correlation was observed between KAP and A, T or F. Monthly endoscopist dose was negligible due to the use of lead apron, collar and two lead-articulated ceiling mounted shields. The endoscopist dose is minimal when using appropriate protective measures. Patient doses showed large variation that has to be further investigated.     

Double-dosimetry algorithm for workers in interventional radiology

Based on double-dosemeter readings, a conservative effective dose (E) estimation algorithm for lead apron workers in interventional radiology is proposed. Typical radiation conditions for various exposure geometries were simulated using the MCNPX 2.4.0 code. The simulation model consisted of an X-ray source and image intensifier, a patient phantom and a voxelised staff member phantom with lead apron. The effective staff dose and dosemeter readings for several positions of the worker were calculated. The effective dose to a physician, positioned in close proximity to the primary beam, can be estimated within a 10% underestimation margin by E = 1.64 H(p)(10)(thorax,under) + 0.075 H(p)(10)(neck,over). The dose to the eye lens can be estimated by a dosemeter reading at collar level (R(2) = 0.98).     

Estimating effective dose for a cardiac catheterisation procedure with single or double personal dosemeters

In most countries of the European Union legislation requires individual determination and registration of the dose to radiological workers exposed to ionising radiation to check whether dose limits are exceeded. To assess stochastic risk, ideally effective dose (E) should be known. In practice, personal dose equivalent [H(P)(10)] is used as it can be measured with a personal dosemeter. The dosemeter reading may provide a reasonable assessment of H(P)(10), but it may deviate strongly from E, in particular in radiology procedures for medical diagnosis or intervention when protective clothing like lead-equivalent apron and thyroid collar is worn. In the literature various correction factors and algorithms to convert readings of single or dual dosemeters to an estimate of E can be found. An illustrative example of a cardiac catheterisation procedure, in which dose calculations are made by Monte Carlo simulation of radiation transport, shows that such corrections may still yield considerable overestimation.     

Doses to operators during interventional radiology procedures: focus on eye lens and extremity dosimetry

The present study is focused on the personnel doses during several types of interventional radiology procedures. Apart from the use of the official whole body dosemeters (thermoluminescence dosemeter type), measurements were performed to the extremities and the eyes using thermoluminescent loose pellets. The mean doses per kerma area product were calculated for the monitored anatomic regions and for the most frequent types of procedures. Higher dose values were measured during therapeutic procedures, especially embolisations. The maximum recorded doses during a single procedure were 1.8 mSv to the finger (nephrostomy), 2.1 mSv to the wrist (liver chemoembolisation), 0.6 mSv to the leg (brain embolisation) and 2.4 mSv to the eye (brain embolisation). The annual doses estimated for the operator with the highest workload according to the measurements and the system's log book were 90.4 mSv to the finger, 107.9 mSv to the wrist, 21.6 mSv to the leg and 49.3 mSv to the eye. Finally, the effect of the beam angulation (i.e. projection) and shielding equipment on the personnel doses was evaluated. The measurements were performed within the framework of the ORAMED (Optimization of RAdiation Protection for MEDical staff) project.     

Preliminary assessment of the dose to the interventional radiologist in fluoro-CT-guided procedures

A preliminary assessment of the occupational dose to the intervention radiologist received in fluoroscopy computerised tomography (CT) used to guide the collection of lung and bone biopsies is presented. The main aim of this work was to evaluate the capability of the reading system as well as of the available whole-body (WB) and extremity dosemeters used in routine monthly monitoring periods to measure per procedure dose values. The intervention radiologist was allocated 10 WB detectors (LiF: Mg, Ti, TLD-100) placed at chest and abdomen levels above and below the lead apron, and at both right and left arms, knees and feet. A special glove was developed with casings for the insertion of 11 extremity detectors (LiF:Mg, Cu, P, TLD-100H) for the identification of the most highly exposed fingers. The H(p)(10) dose values received above the lead apron (ranged 0.20-0.02 mSv) depend mainly on the duration of the examination and on the placement of physician relative to the beam, while values below the apron are relatively low. The left arm seems to receive a higher dose value. H(p)(0.07) values to the hand (ranged 36.30-0.06 mSv) show that the index, middle and ring fingers are the most highly exposed. In this study, the wrist dose was negligible compared with the finger dose. These results are preliminary and further studies are needed to better characterise the dose assessment in CT fluoroscopy.     

Overview of double dosimetry procedures for the determination of the effective dose to the interventional radiology staff

In interventional radiology, for an accurate determination of effective dose to the staff, measurements with two dosemeters have been recommended, one located above and one under the protective apron. Such 'double dosimetry' practices and the algorithms used for the determination of effective dose were reviewed in this study by circulating a questionnaire and by an extensive literature search. The results indicated that regulations for double dosimetry almost do not exist and there is no firm consensus on the most suitable calculation algorithms. The calculation of effective dose is mainly based on the single dosemeter measurements, in which either personal dose equivalent, directly, (dosemeter below the apron) or a fraction of personal dose equivalent (dosemeter above the apron) is taken as an assessment of effective dose. The most recent studies suggest that there might not be just one double dosimetry algorithm that would be optimum for all interventional radiology procedures. Further investigations in several critical configurations of interventional radiology procedures are needed to assess the suitability of the proposed algorithms.     

Transition in occupational radiation exposure monitoring methods in diagnostic and interventional radiology

Radiation exposure monitoring is a traditional keystone of occupational radiation safety measures in medical imaging. The aim of this study was to review the data on occupational exposures in a large central university hospital radiology organisation and propose changes in the radiation worker categories and methods of exposure monitoring. An additional objective was to evaluate the development of electronic personal dosimeters and their potential in the digitised radiology environment. The personal equivalent dose of 267 radiation workers (116 radiologists and 151 radiographers) was monitored using personal dosimeters during the years 2006-2010. Accumulated exposure monitoring results exceeding the registration threshold were observed in the personal dosimeters of 73 workers (59 radiologists' doses ranged from 0.1 to 45.1 mSv; 14 radiographers' doses ranged from 0.1 to 1.3 mSv). The accumulated personal equivalent doses are generally very small, only a few angiography radiologists have doses >10 mSv per 5 y. The typical effective doses are <10 μSv y(-1) and the highest value was 0.3 mSv (single interventional radiologist). A revised categorisation of radiation workers based on the working profile of the radiologist and observed accumulated doses is justified. Occupational monitoring can be implemented mostly with group dosimeters. An active real-time dosimetry system is warranted to support radiation protection strategy where optimisation aspects, including improving working methods, are essential.     

Occupational radiation exposure during removal of radioactive reactor components from GRR-1 pool

The aim of the study was to control occupational exposure during the removal of radioactive reactor components from a Greek research reactor pool. The method comprised the prediction of the radiation levels, the design of special shielding structures and the occupational dose assessment. Activation calculations were performed using the FISPACT code to predict the source term. Monte Carlo simulations using MCNP code were utilized to estimate the ambient dose equivalent rates. The results of the calculations were verified by measurements and were found to be in good agreement. Thermoluminescence dosemeter (TLD) and electronic personal dosemeter (EPD) were implemented to measure the radiation exposure of the workers. The total collective dose of 14 participating workers was 0.15 man mSv. The maximum individual effective dose was 0.02 mSv, and the maximum extremity equivalent dose was 0.09 mSv. The discussed method provides a useful tool enabling work planning during reactor decommissioning and renovation activities ensuring that exposures will be maintained ALARA.     

Improvements in extremity dose assessment for ionising radiation medical applications

This study aims at testing the INTE ring dosemeter based on MCP-Ns and TLD-100 detectors on users from the field of medical applications, namely radiopharmacists, personnel at a cyclotron facility with corresponding FDG synthesis cells, interventional radiology technologists and radiologists. These users were chosen due to the fact that they have a significantly high risk of exposure to their hands. Following previous results, MCP-Ns TL thin material was used for radiology measurements, whereas TLD-100 was preferred for other applications. The dosemeters were tested to make sure that they were waterproof and that they could be sterilised properly prior to use. Results confirm the need to implement finger dosimetry, mainly for interventional radiologists as finger dose can be >50 times higher than whole-body dose and 3 times higher than wrist dose.     

Hand exposure to ionising radiation of nuclear medicine workers

The specific nature of work in nuclear medicine departments involves the use of isotopes and handling procedures, which contribute to the considerable value of an equivalent dose received, in particular, by the fingertips. Standard nuclear medicine department uses ring dosemeters placed usually at the base of the middle finger. The main aim of the study was to find out whether a relationship exists between the doses recorded by thermoluminescent detectors placed at various locations on the radiopharmacists' hands and the doses recorded by the ring detectors, and to determine the character of that relationship. The correction factor represents a correction value to be used to calculate the doses which might be received by locations on the hand from the dose recorded by the ring dosemeter. The dose recorded by the ring dosemeter is on the average five times lower than that received by the fingertips of thumb, index and middle fingers.     

Task-specific monitoring of nuclear medicine technologists' radiation exposure

Many studies have demonstrated that the exposure of nuclear medicine technologists arises primarily from radioactive patients rather than from preparation of radiopharmaceuticals. However, in order to devise strategies to reduce staff exposure, it is necessary to identify the specific tasks within each procedure that result in the highest radiation doses. An ESM Eberline FH41B-10 radiation dosemeter, which records the ambient dose equivalent rate, was used to monitor the radiation exposure of a technologist and to record the dose rate in microSv per hour every 32 s throughout a working day. The technologist recorded the procedures that were being performed so that the procedures that resulted in higher doses could be identified clearly. The measured doses clearly showed that the major contributions to the technologist's dose were the following: (1) transferring incapacitated patients from the imaging table to a hospital trolley; (2) difficult injections without syringe shields; and (3) setting up patients for gated myocardial scans. The average dose to the technologist from transferring patients after a bone scan was 0.54 microSv, 40% of the total dose of 1.3 microSv for the complete bone scan procedure. The average dose received injecting 900 MBq of 99Tcm-HDP using a tungsten syringe shield was 0.57microSv, but the highest dose was 1.6 microSv, in a patient in whom the injection was difficult. A 0.5 mm lead apron was found to reduce the dose when setting up a patient for a gated stress 99Tcm-sestamibi myocardial scan by approximately a factor of 2. The average dose per patient for this task was reduced from 1.1 to 0.6 microSv. It is recommended that staff waiting for assistance with patient transfers stand away from the patient, that tungsten syringe shields be used for all radiopharmaceutical injections and that a 0.5 mm lead apron be worn when attending patients containing high activities of 99Tcm radiopharmaceuticals, such as those having myocardial imaging.     

Comparison of double dosimetry algorithms for estimating the effective dose in occupational dosimetry of interventional radiology staff

'Double dosimetry' i.e. measurement with two dosemeters, one located above the protective apron and one under has been recommended in interventional radiology (IR) to determine the effective dose to staff. Several algorithms have been developed to calculate the effective dose from the readings of the two dosemeters, but there is no international consensus on what is the best algorithm. In this work, a few of the most recently developed algorithms have been tested in typical IR conditions. The effective dose and personnel dosemeter readings were obtained experimentally by using thermoluminescent dosemeters in and on a Rando-Alderson phantom provided with a lead apron. In addition, the effective dose and personnel dosemeter readings were calculated by the Monte Carlo method for the same irradiation geometry. The results suggest that most of the algorithms overestimate effective dose in the selected IR conditions, but there is also a risk of underestimation by using the least conservative algorithms. Two of the algorithms seem to comply best with the chosen criteria of performance, i.e. no underestimation, minimum overestimation and close estimation of effective dose in typical IR conditions. However, it might not be justified to generalise the results. It is recommended that whenever personnel doses approach or exceed the dose limit, IR conditions should be further investigated and the possibility of over- or under-estimation of effective dose by the algorithm used should be considered.     

Measuring cosmic-ray exposure in aircraft using real-time personal dosemeters

Aircrew exposure to radiation was measured on several long-haul flights using two small commercial electronic personal dosemeters: one was a photon dosemeter, the NRF20; the other was a neutron dosemeter, the NRY21-both manufactured by Fuji Electric Systems Co. Ltd. for radiation protection at nuclear facilities. Non-neutron doses were measured using the photon dosemeter, and neutron doses were measured using the neutron dosemeter. The measured non-neutron doses at commercial aviation altitudes agree with the EPCARD (European Program Package for the Calculation of Aviation Route Doses) dose calculation within a difference of 8 %. However, the recorded neutron doses were 5-15 times larger than the EPCARD calculation. These over-measurements are dependent on cut-off rigidities.     

Hp(0.07) photon irradiations at Seibersdorf for the EURADOS extremity dosemeter intercomparison 2009

In August 2009, almost 1000 passive extremity dosemeters were irradiated at the Dosimetry Laboratory Seibersdorf as part of the EURADOS intercomparison IC2009. Forty-four European individual monitoring services participated, with a total of 59 dosimetry systems (46 finger ring, 4 finger tip and 9 wrist/ankle dosemeter systems). Additionally, finger-ring dosemeters from the Dosimetry Service Seibersdorf were irradiated in a non-competitive manner. Dosemeter irradiations on rod and pillar phantoms in four photon-radiation fields complying with the ISO standard 4037 were performed with personal dose equivalent values (H(p)(0.07)) ranging from 4 to 480 mSv. Traceability was established by using an air-kerma-calibrated monitor ionisation chamber together with the X-ray facility as well as a calibrated (137)Cs gamma radiation field with a collimated beam geometry. The ISO-tabulated conversion coefficients from air kerma free-in-air to H(p)(0.07) were applied, resulting in the main contribution to the expanded measurement uncertainties.     

Comparison between direct ion storage and thermoluminescence dosimetry individual monitoring systems, and Internet reporting

A new electronic direct ion storage (DIS) dosemeter allows accumulated personal dose equivalent Hp(d) at depths of 10 mm and 0.07 mm to be monitored in a few seconds by inserting the dosemeter into a local reader without deleting the accumulated dose. The DIS system meets general requirements on individual monitoring of hospital personnel using ionising radiation. It differs greatly from off-line thermoluminescence dosimetry systems and offers many additional benefits. The non-volatile reading takes only 5 s, is taken as often as needed, and the data are collected into a dose database, where background radiation is subtracted. Individual personnel doses are reported in Intranet as well as on the Internet at regular intervals to the National Regulatory Authorities.