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Purpose: This work was designed to study the effectiveness of radiation protection caps in lowering the dose to the brain and the eye lens during fluoroscopically guided interventions., Materials and Methods: Two types of radiation protection caps were examined with regards to their capacity to lower the radiation dose. One cap is equipped with lateral flaps, the other one is not. These caps were fitted to the head of an anthropomorphic Alderson-Rando (A.-R.) phantom. The phantom was positioned aside an angiographic table simulating the position of the first operator during a peripheral arterial intervention. One of the brain slices and both eyes of the A.-R. phantom were equipped with thermoluminescence dosimeters (TLDs)., Results: The analysis of the data showed that the cap without lateral flaps reduced the dose to the brain by 11,5-27,5 percent depending on the position within the brain. The cap with lateral protection flaps achieved a shielding effect between 44,7 and 78,9 percent. When evaluating the dose to the eye, we did see an increase of dose reduction from 63,3 to 66,5 percent in the left eye and from 45,8 to 46,8 percent in the right eye for the cap without lateral protection. When wearing the cap with lateral protection we observed an increase of dose reduction from 63,4 to 67,2 percent in the left eye and from 45,8 to 50,0 percent in the right eye., Conclusion: Radiation protection caps can be an effective tool to reduce the dose to the brain and the eyes.

Patients in fluoroscopically guided interventions (FGI) may be exposed to substantial radiation dose levels (SRDL). The most commonly reported adverse reactions are skin injuries with erythema or necrosis. It is therefore important for the interventional radiologist to know deterministic effects with their threshold doses. If possible all relevant modality parameters should be displayed on the interventionalists screen. Dosimetric parameters should be displayed in digital imaging and communications in medicine (DICOM) units and stored as DICOM Radiation Dose Structured Report (RDSR). The peak skin dose (PSD) is the most relevant risk parameter for skin injuries. Dose management systems (DMS) help optimising radiation exposure of patients. However, their calculation of skin dose maps is only available after a FGI. Therefore, dose maps and PSD should preferably be calculated and displayed in real time by the modality.

The new regulatory basis in Germany for medical radiation protection ("Strahlenschutzverordnung" and "Strahlenschutzgesetz") went into effect on 31 December 2018 and has brought many changes. A system for record keeping and analysis of unintended exposures must be established and the occurrence of significant events must be reported to the competent authority. In the future, medical physics experts have to be consulted for equipment with high doses. Further programs for the early detection of diseases may be considered and approved by the federal office for radiation protection. Changes have been defined for teleradiology, procedure descriptions, tasks of the medical institutions for quality assurance and dose limits. Because of extended requirements for documentation and evaluations, the functionality of a dose management system will practically be necessary in bigger radiology departments or offices. Uncertainties in interpretation still exist for several parts of the regulations. The existing complementing guidelines shall be used for the time being.

German regulations require a license for using ionizing radiation in medicine. This license-called "Fachkunde"-varies for different medical procedures such as CT, fluoroscopy, radiography, or mammography. The required frequencies and training times also vary for different medical disciplines such as radiology, cardiology, vascular surgery, traumatology, nuclear medicine, and radiotherapy, among others. The quality criteria for a specific license require a minimum training time under supervision and a minimum frequency of a wide range of procedures. Depending on the radiation doses used and the complexity of procedures performed, this may go up to 5000 examinations and 36 months for a radiology resident. A refresher course is mandatory every 5 years.

The application of ionizing radiation in medicine seems to be a safe procedure for patients as well as for occupational exposition to personnel. The developments in interventional radiology with fluoroscopy and dose-intensive interventions require intensified radiation protection. It is recommended that all available tools should be used for this purpose. Besides the options for instruments, x‑ray protection at the intervention table must be intensively practiced with lead aprons and mounted lead glass. A special focus on eye protection to prevent cataracts is also recommended. The development of cataracts might no longer be deterministic, as confirmed by new data; therefore, the International Commission on Radiological Protection (ICRP) has lowered the threshold dose value for eyes from 150 mSv/year to 20 mSv/year. Measurements show that the new values can be achieved by applying all X‑ray protection measures plus lead-containing eyeglasses.

Since the discovery of X-rays, over exposures and radiation in juries have been reported in both patients and persons exposed in the course of their professional duties. Each year, more than 2,500 million diagnostic radiological examinations, 32 million nuclear medicine examinations or treatment procedures and 5.5 million radiotherapy sessions are performed world wide. Despite all precautions, avoidable incidents and accidents occur through out the world every year, albeit with low frequency. Where as diagnostic radiology is generally safe for patients and staff, intervention al procedures (e.g. coronary artery dilatations) involve the risks of occupational over exposure and of skin injuries to patients. In nuclear medicine, radiation protection is focused on the introduction of new procedures with beta-emitters, for example. The increasing frequency of positron emission tomography (PET) requires a special focus on shielding measures. In radiotherapy, occupational over exposure caused by mal functions and accidents is relatively rare.

For 110 years, x-rays and special x-ray films have been used in medical diagnostics. New developments in the field of x-ray techniques, and especially new computer applications, have led to new imaging techniques which have substantially expanded the spectrum of radiological examinations. In spite of significant technological and medical advances in the field of MRI and multidetector-CT, radiographic images of the lungs, skeleton and organs still comprise up to 80% of the routine radiological workload. The increasing availability of digital detectors has led to the continual replacement of conventional film/screen systems. The inclusion of digital mammography was delayed due to the higher requirements for spatial resolution. For about 2 years, dynamic flat panel detectors have started to replace the image intensifier which has been used in fluoroscopy for 40 years.

Since the discovery of X-rays , overexposures and radiation injuries have been reported in both patients and persons exposed in the course of their professional duties. Each year, more than 2,500 million diagnostic radiological examinations, 32 million nuclear medicine examinations or treatment procedures and 5.5 million radiotherapy sessions are performed worldwide. Despite all precautions, avoidable incidents and accidents occur throughout the world every year , albeit with low frequency. Whereas diagnostic radiology is generally safe for patients and staff, interventional procedures (e.g. coronary artery dilatations) involve the risks of occupational overexposure and of skin injuries to patients. In nuclear medicine, radiation protection is focused on the introduction of new procedures with beta-emitters, for example. The increasing frequency of positron emission tomography (PET) requires a special focus on shielding measures. In radiotherapy, occupational overexposure caused by malfunctions and accidents is relatively rare.