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A novel radiation protection drape reduces radiation exposure during fluoroscopy guided electrophysiology procedures.

OBJECTIVE: The purpose of this study was to evaluate a novel disposable lead-free radiation protection drape for decreasing radiation scatter during electrophysiology procedures. BACKGROUND: In recent years, there has been an exponential increase in the number of electrophysiology (EP) procedures exposing patients, operators and laboratory staff to higher radiation doses. METHODS: The RADPAD was positioned slightly lateral to the incision site for pectoral device implants and superior to the femoral vein during electrophysiology studies. Each patient served as their own control and dosimetric measurements were obtained at the examiner's elbow and hand. Radiation badge readings for the operator were obtained three months prior to RADPAD use and three months after introduction. RESULTS: Radiation dosimetry was obtained in twenty patients: 7 electrophysiology studies, 6 pacemakers, 5 catheter ablations, and 2 implantable cardioverter-defibrillators. Eleven women and nine men with a mean age of 63 +/- 4 years had an average fluoroscopy time of 2.5 +/- 0.42 minutes per case. Mean dosimetric measurements at the hand were reduced from 141.38 +/- 24.67 to 48.63 +/- 9.02 milliroentgen (mR) per hour using the protective drape (63% reduction; p < 0.0001). Measurements at the elbow were reduced from 78.78 +/- 7.95 mR per hour to 34.50 +/- 4.18 mR per hour using the drape (55% reduction; p < 0.0001). Badge readings for three months prior to drape introduction averaged 2.45 mR per procedure versus 1.54 mR per procedure for 3 months post-initiation (37% reduction). CONCLUSION: The use of a novel radiation protection surgical drape can significantly reduce scatter radiation exposure to staff and operators during a variety of EP procedures.

Electrophysiologic Techniques, Cardiac↗

[Gonad protective effect of radiation protective apron in chest radiography].

Depending on the facility, a radiation protective apron (protector) is used to protect the gonad from radiation exposure in chest radiography. To determine the necessity of using a protector during chest radiography, we measured the effect of the protector on the gonad in this study. First, using a human body phantom, we measured the absorbed dose of the female gonad with and without the protector, using a thermoluminescence dosimeter (TLD), and confirmed its protective effect. Using the protector, the absorbed dose was reduced to 28+/-2% and 39+/-4% for field sizes of 14 x 17 inch and 14 x 14 inch, respectively. Next, we used Monte Carlo simulation and confirmed, not only the validity of the actual measurement values, but also the fact that the influence of radiation on the absorbed dose of the gonad was mostly from scattered radiation from inside the body for the 14 x 17 inch field size, and also from the X-ray tube for the 14 x 14 inch field size. Although a certain protective effect is achieved by using the protector, the radiation dose to the gonad is only a few microGy even without a protector. Thus, the risk of a genetic effect would be as small as 10(-8). Given that acceptable risk is below 10(-6), we conclude the use of a radiation protective apron is not necessary for diagnostic chest radiography.

Female↗

RADIATION PROTECTION IN CANADA. III. THE ROLE OF THE RADIATION PROTECTION DIVISION IN SAFEGUARDING THE HEALTH OF THE PUBLIC.

The current status of radiation protection in Canada is discussed in the last of a three-part series. Particular emphasis has been placed on the role of the Radiation Protection Division of the Department of National Health and Welfare. A radioactive fallout study program has been established involving the systematic collection of air and precipitation samples from 24 locations, soil samples from 23 locations, fresh-milk samples from 16 locations, wheat samples from nine areas and human-bone specimens from various hospitals throughout Canada. A whole-body-counting facility and a special study of fallout in Northern areas have also been initiated. For any age group, the highest average strontium-90 concentration in human bone so far reported has been less than four picocuries per gram of calcium compared with the maximum permissible level of 67 derived from the International Committee on Radiation Protection (ICRP) recommendations. By the end of 1963 a general downward trend of levels of radioactivity detected in other parts of the program has been observed. Programs to assess the contribution to the radiation exposure of members of the population from medical x-rays, nuclear reactor operations and natural background-radiation sources have also been described. The annual genetically significant dose from diagnostic x-ray examinations in Canadian public hospitals has been estimated to be 25.8 mrem. Results from the reactor-environment monitoring programs have not suggested the presence of radioactivity beyond that contributed from fallout.

Air Pollution↗

Trends in radiation protection--a view from the National Council on Radiation Protection and Measurements (NCRP).

The present status of ionizing radiation protection in our society, with the exception of extraordinary events such as the Chernobyl accident, can be considered reasonably satisfactory. Occupationally, average exposures have risks no greater than accident rates in "safe" industries and show a downward trend in concert with results of safety practices in other occupations; higher exposures are being addressed specifically, and a new NCRP guideline may prove useful. An important concern relating to the quality factor for neutrons is at least partially accounted for by recent International Commission on Radiological Protection (ICRP) and NCRP recommendations. Among public exposures, the most important by far is exposure to indoor Rn. However, this problem is being addressed on all fronts, and its magnitude and the means to deal with it will soon be better known. For the near future, we should see a stabilizing of risk estimates, albeit at levels very probably higher than formerly. There may also be an increasing tendency to use incidence rather than mortality for calculating these estimates. These changes may require some adjustment in our perspective on limits. As the difference in risk between the sexes becomes more definite, we may wish to adopt a policy of equal risk rather than one of equal dose. Age data also emphasize, more and more, the decline of risk with age; consequently, using older workers when feasible in radiation-exposure circumstances becomes more desirable. For the longer-term future, various developments can be expected, including, possibly, a more suitable climate for a risk system, a more appropriate way to express differences in radiation quality, further knowledge of the role probabilities of causation may play in radiation control, the effect of mitigating and enhancing factors, and progress in fundamental oncology. All of these are exciting possibilities which may provide a variety of options for the most effective radiation protection in the future.

Accidents↗

Excerpts from Maintaining Radiation Protection Records. National Council on Radiation Protection and Measurements.

This is the first of a three-part series of articles from a report by the NCRP, to be reprinted in successive issues of Radiology Management. The report offers practical recommendations for establishing a radiation safety program. Different aspects of record-keeping, an essential part of all radiation safety programs, will be highlighted in each article. The introduction and a chapter on the systematic generation of records are included in this issue.

Facility Regulation and Control↗

Medical perspective on ways to improve radiation protection standards.

Radiation has been used in medical practice for over a century. While hazards were recognized very early, radiation protection in medicine evolved over many subsequent decades. Current issues and problems of radiation protection in medicine are mainly the result of rapidly changing technology and lack of education. With the widespread application of computed tomography and digital radiography, use of high dose radiological equipment by nonradiologists, and continuing accidental exposures in radiation therapy there are problems not envisioned before. Radiation protection in medicine is not likely to be improved significantly simply with the addition of more standards, but it will require a combined approach with the medical and educational communities.

Diagnostic Imaging↗

RADIATION PROTECTION IN CANADA: VII. THE ROLE OF INDUSTRIAL HYGIENE IN THE FIELD OF RADIATION PROTECTION.

The main emphasis of a provincial radiation protection program is on ionizing radiation produced by machines, although assistance is given to the Federal Radiation Protection Division in its program relating to radioactive substances. The basis for the Saskatchewan program of radiation protection is the Radiological Health Act 1961. An important provision of the Act is annual registration of radiation equipment. The design of the registration form encourages a "do-it-yourself" radiation and electrical safety inspection.Installations are inspected every two years by a radiation health officer. Two hundred and twenty-one deficiencies were found during inspection of 224 items of radiation equipment, the commonest being failure to use personal film badges. Insufficient filtration of the beam, inadequate limitation of the beam, and unnecessary exposure of operators were other common faults.Physicians have a responsibility to weigh the potential advantages against the hazards when requesting radiographic or fluoroscopic procedures.

Canada↗