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Objective: This study evaluates the level of radiation safety awareness and adherence to protective practices among pregnant female radiographers in the United Arab Emirates, aiming to identify gaps and develop targeted interventions for enhancing occupational safety., Methods: Employing a cross-sectional design, the study surveyed 133 female radiographers using a self-developed questionnaire covering demographics, awareness and knowledge, workplace practices, communication, and satisfaction., Results: The survey showed high awareness among radiographers, with 97% acknowledging radiation risks during pregnancy, although 42.9% had not received formal training. Concerns over long-term health effects were significant, with 66.2% of participants worried about potential impacts. Despite these concerns, 83.5% had been informed about radiation risks and protective measures, indicating active information provision in many workplaces. However, inconsistencies in information dissemination across different work settings were noted., Conclusions: The findings highlight the need for standardized radiation safety protocols for pregnant radiographers. The variability in safety training and information dissemination suggests the importance of establishing uniform safety practices. Recommendations include developing comprehensive education and training programs for pregnant radiographers, ensuring open communication for radiation safety and pregnancy-related concerns, and enforcing clear guidelines for workplace accommodations., (© 2024. The Author(s).)

Objectives: This study evaluated the efficacy of a novel comprehensive shield designed to minimize radiation exposure (RE) to Physicians performing coronary and structural heart procedures., Background: The Protego™ radiation shielding system (Image Diagnostics Inc., Fitchburg, Ma) is designed to provide comprehensive protection from RE and has been State certified sufficient to allow operators to perform procedures without orthopedically burdensome lead aprons., Methods: This single center two-group cohort study assessed the efficacy of this shield in a large number of cardiac procedures (coronary and structural), comparing operator RE compared to standard protection methods (personal lead apparel and "drop down" shield)., Results: The Protego™ system reduced operator RE by 99 % compared to Standard Protection. RE was significantly lower at both "Head" level by thyroid median dose 0.0 (0.0, 0,0) vs 5.7 (2.9, 8.2) μSv (p < 0.001), as well as waist dose 0.0 (0.0, 0.0) vs 10.0 (5.0, 16.6) μSv (p < 0.001). "Zero" Total RE was documented by Raysafe™ in 64 % (n = 32) of TAVR cases and 73.2 % (n = 183) of the coronary cases utilizing Protego™. In contrast, standard protection did not achieve "Zero" exposure in a single case. These dramatic differences in RE were achieved despite higher fluoroscopy times in the Protego™ arm (11.9 ± 8.6 vs 14.3 ± 12.5 min, p = 0.015). Per case procedural exposure measured by Dose Area Product was higher in the Protego™ group compared to standard protection (115.4 ± 139.2 vs 74.9 ± 69.3, p < 0.001)., Conclusion: The Protego™ shield provides total body RE protection for operators performing both coronary and structural heart procedures. This shield allows procedural performance without the need for personal lead aprons and has potential to reduce catheterization laboratory occupational health hazards., Competing Interests: Declaration of competing interest *JG is an owner of equity and Board Member of ECLS, Inc., which licenses technology to Image Diagnostics Inc., which manufactures and sells the Protego™ shield. No funding for this study was provided., (Copyright © 2024. Published by Elsevier Inc.)

Given the new recommendations for occupational eye lens doses, various lead glasses have been used to reduce irradiation of interventional radiologists. However, the protection afforded by lead glasses over prescription glasses (thus over-glasses-type eyewear) has not been considered in detail. We used a phantom to compare the protective effects of such eyewear and regular eyewear of 0.07 mm lead-equivalent thickness. The shielding rates behind the eyewear and on the surface of the left eye of an anthropomorphic phantom were calculated. The left eye of the phantom was irradiated at various angles and the shielding effects were evaluated. We measured the radiation dose to the left side of the phantom using RPLDs attached to the left eye and to the surface/back of the left eyewear. Over-glasses-type eyewear afforded good protection against x-rays from the left and below; the average shielding rates on the surface of the left eye ranged from 0.70-0.72. In clinical settings, scattered radiation is incident on physicians' eyes from the left and below, and through any gap in lead glasses. Over-glasses-type eyewear afforded better protection than regular eyewear of the same lead-equivalent thickness at the irradiation angles of concern in clinical settings. Although clinical evaluation is needed, we suggest over-glasses-type Pb eyewear even for physicians who do not wear prescription glasses., (© 2024 Society for Radiological Protection. Published on behalf of SRP by IOP Publishing Limited. All rights reserved.)

Objective: To compare the protective effect of Zero Gravity (ZG) with conventional radiation protection during endovascular aneurysm repair (EVAR). Secondly, user experience was surveyed with a questionnaire on ergonomics., Methods: This was a single centre, prospective, randomised, two arm trial where 71 consecutive elective infrarenal EVAR procedures were randomised into two groups: (1) operator using ZG and assistant using conventional protection (n = 36), and (2) operator and assistant using conventional radiation protection (n = 35). A movable floor unit ZG system consists of a lead shield (1.0 mm Pb equivalent) for the front of the body and 0.5 mm Pb equivalent acrylic shielding for the head and neck. The ZG also includes arm flaps of 0.5 mm Pb equivalent covering the arm up to the elbow. Deep dose equivalent values, H p (10) were measured with direct ion storage dosimeters (DIS) placed on various anatomical regions of the operator (axilla, chest, abdomen, and lower leg). Personal dose equivalent values, H p (3) to eye lenses were measured in the operating and assisting surgeon using thermoluminescence dosimeters. The study was registered at the US National Institute of Health #NCT04078165., Results: Protection with the standard protection was superior in chest (0.0 vs. 0.1 μSv), abdomen (0.0 vs. 0.6 μSv), and lower leg (0.4 vs. 2.2 μSv) (p < .001). On the other hand, the ZG system yielded better shielding for the axilla (1.5 vs. 0.0 μSv) and eyes (6.3 vs. 1.1 μSv) of the operator. The use of ZG hampered the deployment of ancillary shields, which is particularly relevant for protection of the assisting surgeon. Users found ZG more cumbersome than conventional garments, it also impaired communication and reduced field of view., Conclusion: Both ZG and conventional radiation protection reduced radiation exposure. Conventional protection allows better manoeuvrability at the price of wider exposure of the upper arm and axilla. ZG indirectly impaired protection of the assistant., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

A manufacturer has released a novel shielding solution (NSS): Rampart M1128 and claimed that the personal protective equipment (PPE) can be removed. This study investigates the scatter intensities with the NSS or the traditional shielding solutions (TSS) including the ceiling-suspended screen and the tableside lead drape. Isodose maps were generated by two series of measurements with an anthropomorphic phantom using NSS and TSS. Three survey meters were positioned at different heights to measure the scatter intensities at the eye, chest, and pelvic levels. Additional measurements were made at the primary and secondary operators? locations to evaluate the scatter intensities with different clinical projections. For the main operator positions, the isodose maps showed that NSS could result in a scatter dose that reduced by 80% to 95% compared to the same positions with TSS at the eye and chest levels. The corresponding result at the pelvic level was a reduction of 50%. These reductions should be compared to the additional protection by PPE: up to 80% reduction from lead eyeglasses and up to 95% from protective garments. Considering both operators at clinically relevant LAO projections, NSS resulted in scatter dose that was 80% to 96%, 76% to 96% and 25% to 60% lower than those of the TSS at eye, chest and pelvis levels. The protection of NSS is comparable with that of TSS alongside PPE at the eye but not at the chest and the pelvic levels under the setup of coronary angiography., (© 2023. Crown.)

Our objective was to demonstrate, through computer simulations, radiation exposure levels from a 90 Y contamination event during radioembolization procedures to calculate the radiation doses from various contamination scenarios. We also provide reasonable safety protocols to prevent contamination and minimize radiation exposure during decontamination. Methods: Simulations were performed using the computer code VARSKIN+, version 1.0, to determine the amount of radiation exposure resulting from different contamination scenarios. Results: The annual radiation dose limit to the skin and the lens of the eye was exceeded within 23 s of exposure to a 44-MBq droplet. Double layers of surgical gloves and level 3 gowns provided some attenuation of radiation from 90 Y contamination by reducing the dose rate by 39% and 44%, respectively. Two layers of surgical gloves offered the best ratio of radiation protection without compromising dexterity. Conclusion: This study demonstrated that radiation exposures during 90 Y spills or contamination events can be considerable. Interventional radiology and nuclear medicine personnel must be mindful of the risks, follow strategies to prevent spills, and be familiar with recommended decontamination procedures for spills in the interventional radiology suite., (© 2023 by the Society of Nuclear Medicine and Molecular Imaging.)

Prerequisite. In the conditions of a full-scale invasion, the issue of radiation safety and anti-radiation protection in the Armed Forces of Ukraine (AFU) occupies a special place, since the aggressor country violated global geopolitical international decisions, occupied civilian nuclear facilities, in the process of their liberation servicemen mayhave to act in conditions of increased radiation risk, the possibility of using tactical nuclear weapons also is not excluded., Objective: to investigate the state of the current national regulatory framework for ensuring radiation safety and anti-radiation protection of military personnel during the period of martial law., Methods: bibliographic, analytical, historical, systematic approach., Results: The main normative document on the organization of radiation safety and anti-radiation protection of both personnel and the population in Ukraine, as well as military personnel, currently in everyday conditions and in case of radiation accidents since 1998 and until now, are the State Hygienic Standards «Radiation Safety Standards of Ukraine (NRBU-97)». But neither in this document, nor in the transition to NRBU-2021-P, the issue of exposure to such a category as military personnel during the performance of combat (special) tasks is considered. The system of monitoring the radiation situation in Ukraine, documents on the organization of medical support for military personnel, including the Guidelines on the Medical Support of the Armed Forces of Ukraine for a Special Period (2019)and the Guidelines on the Organization of Radiation Safety in the Armed Forces of Ukraine (2020), were analyzed.modules of radiation safety principles in the Armed Forces of Ukraine were proposed., Conclusion: The unsolved problem of normalization of the radiation factor in the case of man-made and socio-political emergencies can create significant problems in the organization of anti-radiation protection of troops and the population in the case of the use of nuclear weapons or radiation accidents in a special period and requires anurgent solution. It is obvious that there is a need to develop regulatory documents regarding the response and planning of continuous activities to respond to potential nuclear and radiation threats during martial law, including relationships at all levels of the management vertical and methods of communication in the event of a threat., (L. V. Ruschak, O. M. Ivanko, V. A. Potapchuk, D. O. Ruschak, D. A. Bazyka, V. O. Sushko, A. A. Chumak.)

Introduction: Studies indicate there may be inadequate care given to transgender and non-binary (TGNB) patients in healthcare environments, with radiology departments not being equipped to cater for this group. There is currently a deficit in research concerning the use of radiation safety measures for TGNB patients. The purpose of this research was to examine opinions of Irish Radiation Safety Experts (RSE) on current status of radiation safety protocols and techniques in place for TGNB patients and consider any changes necessary., Methodology: Ten semi-structured interviews were conducted with RSEs from eight Irish hospitals, including five radiation protection officers (RPO) and five medical physicists. Question included: current radiation safety protocols for TGNB patients, potential issues and challenges with current practice, and recommendations of new measures. Coding was used to facilitate content analysis for interpretation of findings., Results: No reference to TGNB patients in local policies or guidelines was evident. Interviews established key radiation safety risks including inadvertent exposure of the foetus and insensitive patient care. Prominent categories identified included additional education, gender identification at patient registration and consideration of current policies and guidelines. The extent to which RSEs promoted the implementation of further measures to radiology departments varied., Conclusions: A clear lack of guidance and instruction for radiation safety for TGNB patients is evident. Whilst there are few TGNB patients in Irish hospitals, participants believed that inclusive changes should be made concurrent with Ireland's evolving culture and in the interest of equality of patient safety., Implications for Practice: Inclusive changes should be made to radiology departments concurrent with Ireland's evolving culture. However, barriers to implementing such measures include a lack of available resources, investment, and instruction from authoritative bodies., Competing Interests: Conflict of interest None to declare., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction Radiation safety training remains variable among gastroenterologists performing endoscopic retrograde cholangiopancreatography (ERCP). This study sought to ascribe dosimeter readings to various real-world ERCP scenarios to provide data supporting the 3 pillars of radiation safety: distance, time, and shielding. Methods An ERCP fluoroscopy unit was used to generate radiation scatter from 2 differently sized anthropomorphic phantoms. Radiation scatter was measured at various distances from the emitter, with and without a lead apron, and at various frame rates (measured in frames per second, fps) and degrees of fluoroscopy pedal actuation. An image quality phantom was used to assess resolution at various frame rates and air gaps. Results Increasing the distance resulted in a decrease in measured scatter (from 0.75 mR/h at 1.5 ft to 0.15 mR/h at 9 ft with the average phantom and from 50 mR/h at 1.5 ft to 3.06 mR/h at 9 ft with the large phantom). Depressing the fluoroscopy pedal less frequently, or decreasing the frame rate (ie, increasing the time per frame), resulted in a linear decrease in scatter (from 55 mR/h at 8 fps to 24.5 mR/h at 4 fps and 13.60 mR/h at 2 fps). Providing shielding through the presence of a 0.5-mm lead apron reduced scatter (from 4.10 to 0.11 mR/h with the average phantom; from 15.30 mR/h to 0.43 mR/h with the large phantom). However, decreasing the frame rate from 8 fps to 2 fps did not change the number of line pairs identified on the image phantom. A greater air gap increased the number of line pairs resolved. Conclusions Implementing the 3 pillars of radiation safety led to a quantifiable, clinically significant decrease in radiation scatter. The authors hope that these findings spark greater implementation of radiation safety measures among practitioners utilizing fluoroscopy.

Purpose: The use of gonad contact shielding (GCS) in radiology departments has varied across countries, possibly because, until recently, there was no agreed consensus with mixed evidence supporting its use. This study aims to explore radiographers' use and opinion on GCS in digital radiography (DR) and to evaluate whether radiographers' use of GCS is associated with their gender, highest educational qualification, and/or years of experience., Method: An online survey was sent via email to potential participants through the Society of Medical Radiographers Malta (SRM) as well as social media posts on local radiography pages. Descriptive and inferential statistics were used to analyse the collected data., Results: Almost half of the registered radiographers working in radiology departments in Malta (n = 101/203) completed the survey (49.7 % response rate). 61.4 % of participating radiographers indicated they 'often' use GCS in some patients, with 56.4 % stating they perceive GCS as an effective tool to protect the gonads from radiation exposure in DR. Equally, 56.4 % claimed that GCS use is guided by local rules and/or departmental protocols. While 58.4 % indicated that patients' gender does not impact their use of GCS, patients' age does influence their use. No statistically significant association was noted between radiographers' likeliness of using GCS and their gender, highest educational qualification, and/or years of experience., Conclusions: Some misconceptions and uncertainties among radiographers concerning the benefits and risks of using GCS were noted. Local radiology departments should look into their protocols and assess the need for an update aligned with the latest recommendations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: To describe and analyze the exposure to ionizing radiation of orthopedic residents., Method: A prospective study was carried out to evaluate the degree of exposure to ionizing radiation with a bandage dosimeter placed under the lead apron for medical residents for 10 months. An online survey measured the degree of knowledge about radiation safety., Results: 54 resident physicians participated. 55.6% report having knowledge of the existence of radiological protection equipment and 40.7% report that they had previous training in its use. 77.8% use the leaded apron and 31.5% use thyroid protection. 81.5% were positioned less than 1 meter from the source of the X-ray production of the arc in C. The total mean radiation exposure was 2.9 ± 2.17 mSv (95% confidence interval: 1.25-14.28; p = 0.424)., Conclusions: Orthopedic residents present radiation doses below the International Commission on Radiological Protection recommended limit. However, there is a lack of knowledge of radiation protection and as well as a lack of interest and ignorance of the adverse effects of radiation., (Copyright: © 2023 Permanyer.)

Recent publications have called into question the accuracy of reference tenth-value layer (TVL) data cited in official reports for linac primary concrete barriers. Doubts have arisen based on both experimental and theoretical evidence. Most of the standard reference TVL values trace back to a publication that appeared in 1984 that used beam spectra that are not representative of modern linacs. This study reports a new set of TVL data for concrete based on modern linac beam spectra and a definition of the barrier transmission that is consistent with its use in shielding calculations. TVL values have been computed for concrete using Monte Carlo simulation for beam energies of 4, 6, 10, 15, and 18 MV. The barrier transmission depends on the field size at the barrier and the distance from the distal surface of the barrier to the point of observation. The TVL values reported here lead to barrier transmission values that are up to a factor of 4 larger than those in official reports. The air kerma rate beyond the barrier does not obey an inverse square law as the barrier now acts like a new (non-point) source of radiation. For distance greater than 0.3 m from the distal side of the barrier, inverse square predictions of the air kerma rate are low by up to a factor of 2. The average energy of the transmitted photons declines rapidly for all beam energies with increasing barrier thickness up to a thickness of about 50 cm and then slowly increases with increasing thickness., (© 2022 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.)

Objectives: This clinical study evaluated the efficacy of a novel radiation shielding system for the cardiac catheterization laboratory designed to provide comprehensive protection that obviates the need for personal lead aprons., Background: Invasive Cardiologists are exposed to occupational health hazards related directly to radiation exposure (RE) and indirectly to the orthopedic burden of wearing only partially protective lead aprons. Innovations to reduce these risks are warranted. A novel comprehensive shielding system (Protego TM , Image Diagnostics Inc, Fitchburg, Ma) has been validated in pre-clinical studies to provide excellent radiation protection, sufficient for the State of Michigan to certify it for use without need for personal lead aprons., Methods: This clinical analysis measured RE to a single Physician operator utilizing the Protego TM shield (and not wearing personal lead apron) during routine cardiac catheterization procedures (diagnostic and interventional). RE was measured at both thyroid and waist level with a real-time dosimetry system (Raysafe TM , Billdal, Sweden), calculated on a median per case basis (mrems). Additional parameters collected included procedure type, access site, per case fluoroscopy time, and patient factors including body mass index., Results: In n=98 cases (25% diagnostic, 75% interventional including 22% chronic total occlusions), median/case RE was 0.4 mrems (thyroid) and 0.2 mrems (waist). RE=0 in 12 cases. In no case did radiation exposure exceed 3.2 mrems., Conclusion: The Protego TM shield system provides excellent RE protection to the Physician operator, without the need for personal lead aprons and has the potential to reduce catheterization laboratory occupational health hazards., (© 2022 Wiley Periodicals LLC.)

Objective: Cesium-131 brachytherapy is an adjunct for brain tumor treatment, offering potential clinical and radiation protection advantages over other isotopes including iodine-125. We present evidence-based radiation safety recommendations from an initial experience with Cs-131 brachytherapy in the resection cavities of recurrent, previously irradiated brain metastases., Methods: Twenty-two recurrent brain metastases in 18 patients were resected and treated with permanent Cs-131 brachytherapy implantation using commercially procured seed-impregnated collagen tiles (GammaTile, GT Medical Technologies). Exposure to intraoperative staff was monitored with NVLAP-accredited ring dosimeters. For patient release considerations, NCRP guidelines were used to develop an algorithm for modeling lifetime exposure to family and ancillary staff caring for patients based on measured dose rates., Results: A median of 16 Cs-131 seeds were implanted (range 6-46) with median cumulative strength of 58.72U (20.64-150.42). Resulting dose rates were 1.19 mSv/h (0.28-3.3) on contact, 0.08 mSv/h (0.01-0.35) at 30 cm, and 0.01 mSv/h (0.001-0.03) at 100 cm from the patient. Modeled total caregiver exposure was 0.91 mSv (0.16-3.26), and occupational exposure was 0.06 mSv (0.02-0.23) accounting for patient self-shielding via skull and soft tissue attenuation. Real-time dose rate measurements were grouped into brackets to provide close contact precautions for caregivers ranging from 1-3 weeks for adults and longer for pregnant women and children, including cases with multiple implantations., Conclusions: Radiological protection precautions were developed based on patient-specific emissions and accounted for multiple implantations of Cs-131, to maintain exposure to staff and the public in accordance with relevant regulatory dose constraints., (© 2022 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.)

An Online Survey among Interventional Cardiologists (IC) assessed the knowledge (five questions) and practice of radiation safety (eleven questions). Out of 185 respondents, knowledge of annual radiation dose (2% knew), LAO cranial view giving maximum radiation (48%) and benefit of assessment of radiation exposure with dose area product (31%) was limited. Radiation safety was practiced "whenever I remember" in 37-59%. Radiation safety practices were optimal frame rate selection (32%), distancing from x-ray unit (17%), collimation use (30%), positioning the image detector close to chest (91%) and personal dosimeters use (40%). A major gap exists between knowledge and practice of radiation safety., (Copyright © 2022 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.)

Background: Proton imaging makes use of high-energy, low-intensity proton beams that fully traverse the patient and has been suggested to reduce range uncertainty in proton therapy. Upright patient positioning with proton imaging is being considered for a fixed beam room of a new proton therapy facility currently under construction. Considering that the yield and energy spectrum of secondary radiation from high-energy proton beams is proton beam energy dependent, an assessment of radiation shielding at the energies required for proton imaging should be performed prior to use. Furthermore, NCRP 144 recommends that pion production be considered for proton energies greater than 300 MeV, which are not typically utilized for proton therapy but may be required for proton imaging., Purpose: The purpose of this work was to determine whether proton treatment and imaging with an upright patient positioning system on a fixed beamline were acceptable from a radiation shielding perspective. This is the first report on radiation shielding assessment of proton imaging applications and includes consideration of pion production at the proton beam energy of 330 MeV., Methods: The Geant4 Monte Carlo toolkit was used for the radiation shielding assessment. The calculations consisted of the generation of secondary particle phase-space files by simulating the passage of high-energy proton beams in two target materials, and subsequent simulation of the secondary particles in the proton therapy facility geometry. Particle fluence was converted to operational and protection radiation safety quantities with a custom python script for assessment of instantaneous and annual doses, respectively., Results: The total yields of pions from a 330-MeV proton beam were many orders of magnitude less than that of neutrons and photons. Three-dimensional maps of ambient dose rate for a 330-MeV proton beam showed doses arising from secondary neutrons and photons far exceed those arising from pion production. Incorporating representative annual workloads into the calculation demonstrated that proton imaging doses outside the shielded area were negligible compared to those arising from proton therapy., Conclusions: Pion production has a negligible impact on the radiation shielding of proton imaging at 330 MeV relative to neutron and photon production. Radiation shielding designed for proton therapy is adequate for high-energy proton imaging applications., (© 2022 The Authors. Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Protection against occupational radiation exposure in clinical settings is important. This paper clarifies the present status of medical occupational exposure protection and possible additional safety measures. Radiation injuries, such as cataracts, have been reported in physicians and staff who perform interventional radiology (IVR), thus, it is important that they use shielding devices (e.g., lead glasses and ceiling-suspended shields). Currently, there is no single perfect radiation shield; combinations of radiation shields are required. Radiological medical workers must be appropriately educated in terms of reducing radiation exposure among both patients and staff. They also need to be aware of the various methods available for estimating/reducing patient dose and occupational exposure. When the optimizing the dose to the patient, such as eliminating a patient dose that is higher than necessary, is applied, exposure of radiological medical workers also decreases without any loss of diagnostic benefit. Thus, decreasing the patient dose also reduces occupational exposure. We propose a novel four-point policy for protecting medical staff from radiation: patient dose Optimization, Distance, Shielding, and Time (pdO-DST). Patient dose optimization means that the patient never receives a higher dose than is necessary, which also reduces the dose received by the staff. The patient dose must be optimized: shielding is critical, but it is only one component of protection from radiation used in medical procedures. Here, we review the radiation protection/reduction basics for radiological medical workers, especially for IVR staff., (© 2022. The Author(s), under exclusive licence to Japanese Society of Radiological Technology and Japan Society of Medical Physics.)

Occupational eye dose monitoring during interventional radiology and interventional cardiology is important to avoid radiation-induced cataracts. The aim of this study was to assess the eye dose correlation with neck dose and patient-related quantities for interventional cardiology physicians and nurses. The originality of this study lies in obtaining correlations between the location of the dosimeter and eye dose radiation readings among different procedures and practitioners. The doses were measured for each procedure (18 procedures of coronary angiography and 16 procedures of percutaneous coronary intervention) using an active personal dosimeter. The eye dose for physicians was not correlated with the neck dose. The eye dose for nurses had a good correlation with the neck dose during both coronary angiography (R 2  = 0.91) and percutaneous coronary intervention (R 2  = 0.93). Kerma-area product values may be used for a rough estimation of the eye dose for physicians during routine coronary angiography procedures (R 2  = 0.76). For nurses, the neck dose is a good proxy for the eye dose during coronary angiography and percutaneous coronary intervention procedures., (© 2022. Japanese Society of Radiological Technology and Japan Society of Medical Physics.)

Introduction: The use of ionising radiation in medicine accounts for the majority of radiation exposure from artificial sources. Therefore, all measures to safeguard against unnecessary radiation exposure must be taken. As radiographers are central to radiation protection, this study aimed to determine South African radiographers' attitude towards radiation protection, subjective norm and perceived behavioural control concerning radiation protection., Methods: This quantitative cross-sectional study used an online theory of a planned behaviour radiation protection questionnaire shared through social media platforms from August 2019 to February 2020. Diagnostic radiographers registered with the Health Professions Council of South Africa and employed at radiology departments in South Africa were invited to participate in the study., Results: Four hundred and seventeen radiographers in South Africa responded to the questionnaire. The majority of respondents (90%, n = 376) plan to use radiation protection; however, only 16% continuously used radiation protection in the past. Respondents felt that using radiation protection was extremely good (72.2%), pleasant (47%), beneficial (74.1%), rewarding (55.2%) and worth the time (52.5%); 57% of respondents indicated that using radiation protection takes longer to complete the examination. Respondents report that approval from patients (43.5%), patients' family (32%), radiographer coworkers (31%), radiology managers (47%) and radiologists (43.9%) is very much important to them., Conclusion: The study shows that even though fewer respondents use radiation protection at present, most respondents plan and intend to use radiation protection measures. Respondents felt that radiation protection was good and beneficial, with some respondents feeling that radiation protection is not worth the time, which coincide with lengthening the examination. Overall, South African radiographers' attitudes towards radiation protection, subjective norm, perceived behavioural control and radiation protection intention were high., (© 2021 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Veterinary workers use lead shielding for protection against harm from ionizing radiation during diagnostic imaging. Surface lead on shielding has been reported as a potential exposure hazard. The purpose of this prospective, analytical, descriptive study was to measure surface lead on lead-containing shielding in the field service and small animal radiology areas of a veterinary teaching hospital, and to examine potential risk factors for surface lead. Surface lead on a convenience sample of 54 lead shielding items was measured in a commercial laboratory using inductively coupled plasma mass spectrometry. The median and range of surface lead for aprons, thyroid collars, and gloves were 3.6 μg/dm 2 (range, 1.3-22.4 μg/dm 2 ), 23.1 μg/dm 2 (range, 2.6-116 μg/dm 2 ), and 134 μg/dm 2 (range, 1.5-155 μg/dm 2 ), respectively. In the final multivariable analysis, the mean surface lead on thyroid collars and gloves was higher than on aprons (relative differences 4.8, 95% confidence interval [CI] 2.2, 10.5, P < 0.001; and 9.5, 95% CI 4.4, 20.6, P < 0.001, respectively). The mean surface lead on shielding in the worst condition was higher than on shielding in the intermediate and best conditions (P < 0.001). Lead shielding provides effective protection against the harmful effects of ionizing radiation, and shielding should always be worn during radiation exposure. Based on our findings and the common use of lead shielding in veterinary workplaces, we recommend that employers inform workers of this hazard and provide training on steps to mitigate exposure, including the use of disposable gloves when wearing lead shielding and handwashing after use., (© 2021 American College of Veterinary Radiology.)

This commentary explores the challenges in radiation safety that derives from the inherent complexity of social-ecological systems. The framework needed to address the challenges acknowledges the characteristics of wicked problems in this era of postnormal science. My objective for this piece is to summarize relevant characteristics of social-ecological systems that underscore the importance, even the necessity, of adopting a holistic approach to radiation safety. This work builds on several publications that have come out of the ecosystems approach working group of the International Union of Radioecology. The nature of wicked problems is that they require meaningful engagement among diverse groups of affected stakeholders so that negotiated consensus regarding assessment and management for radiation safety can be achieved. I conclude by stating that this approach is complementary to the reference animal and plant approach, that it is consistent with the views for postnormal science, and it conforms with the United Nations Sustainable Development Goals (SDGS) that were adopted in 2015.

The Inter-Agency Committee on Radiation Safety (IACRS) was constituted in 1990, as a forum for collaboration and coordination between international bodies with regards to radiation safety. It consists today of representatives of eight intergovernmental member organizations (the European Commision, Food and Agriculture Organization, International Atomic Energy Agency (IAEA), International Labour Office, Organisation for Economic Co-operation and Development/ Nuclear Energy Agency (OECD/NEA), Pan American Health Organization, United Nations Scientific Committee on the Effects of Atomic Radiation and the World Health Organization) and five observer non-governmental organizations (International Commission on Radiological Protection, International Commission on Radiation Units & Measurements, International Electrotechnical Commission, International Radiation Protection Association and International Organization for Standardization). The IACRS provides a platform for interaction between these relevant international bodies to contribute to a common understanding of the scientific basis and legal framework for the application of the system of radiation protection, towards global harmonisation of radiation safety standards. The IACRS played a key role in the development of the International Basic Safety Standards (BSS) in 1996 and in its revision in 2014. Further, an IACRS specific Task Group-chaired by the IAEA-fosters the implementation of the BSS in a consistent and coherent manner in all Member States of the United Nations. The IACRS operates via a standing secretariat jointly provided by the IAEA and OECD/NEA and is chaired by one of its member organizations on a rotating basis for periods of about 18 months. This approach has proved to be effective and was the foundation for ensuring continuity of the work of the committee and at the same time allowing a rotating leadership for all member organizations. Currently, the IACRS is chaired by the WHO. The International Radiation Safety Framework under which the IACRS works is structured around four main areas: (a) science; (b) principles; (c) standards; and (d) practice. This paper presents briefly the mandates, roles and functions of the various international bodies that are relevant to the four above mentioned areas of work, discusses how these bodies coordinate their actions and complement each other to enhance radiation protection and safety worldwide and describes their contribution to the achievement of the Sustainable Development Goals. The paper also provides an overview of the main accomplishments of the IACRS since its inception 30 years ago, and an outlook on key challenges for its future activities., (Creative Commons Attribution license.)

Background: Health related quality of life (HRQoL), despite its potential bi-directional interaction with occupational risks, has not been extensively addressed among radiology technicians., Objective: To evaluate HRQoL among radiology technicians in relation to sociodemographic and occupational factors., Methods: A total of 115 radiology technicians who were employed in three big hospitals located in Istanbul province were included on a voluntary basis in this cross sectional questionnaire-based study conducted between June 2019 and August 2019. The questionnaire form elicited items on socio-demographic characteristics, occupational characteristics and the 36-item Short-form Health Survey (SF-36), respectively., Results: Overall, 94.8% of technicians confirmed previous training on radiation protection and safety, while 92.2% noted distrust in their knowledge on radiation protection and patient dosage. In addition, 47.8% of technicians noted seldom use of radiation protection measures and 55.7% noted distrust in reliability of radiation exposure measurements. The multiple regression analysis revealed that older age, female gender, working at a university hospital and seldom use of protection significantly predicted poor HRQoL (p = 0.042 to 0.001), while working in interventional radiology and having trust in radiation exposure measurements predicted better HRQoL (p = 0.006 to 0.001) in terms of certain domains., Conclusion: In conclusion, our findings revealed lack of trust in current self-knowledge on radiation protection and safety by majority of radiology technicians and seldom use of radiation protection measures by half of them, despite previously trained on radiation protection and safety. Certain occupational factors and factors related to radiation protection and safety were also amongst the significant determinants of poor HRQoL., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The use of hand-held dental X-ray units is increasing within Australia since their portability is advantageous in applications such as aged care. However, proximity of the operator to the X-ray unit raises radiation safety concerns. The aim of this study was to evaluate operator radiation exposure and methods of dose reduction for the Rextar X camera-style hand-held dental X-ray unit. Leakage and scattered radiation were measured using a solid state detector. Scatter was generated using a Perspex head phantom. Measurements of scattered radiation dose as a function of distance were made with and without a lead acrylic scatter shield (0.6 mm Pb equivalence at 100 kVp) attached to the X-ray unit. Without the scatter shield, doses to the operator from a single adult maxillary molar X-ray exposure were 0.69, 0.78 and 0.47 µGy at the left hand, right hand and eyes respectively. With the scatter shield attached, doses were reduced to 0.25, 0.12 and 0.15 µGy respectively, corresponding to a dose reduction of 64, 85 and 68%. The contribution from leakage radiation was insignificant in comparison. It is highly unlikely that an operator would reach occupational dose limits when using the Rextar X hand-held dental X-ray unit, even without the scatter shield in place. Nevertheless, it is strongly recommended that the scatter shield is attached to keep operator doses as low as reasonably achievable. Use of the scatter shield additionally ensures compliance with the Australian legislative requirement for a protective barrier and is considered a preferable alternative to X-ray protective clothing.

The new recommendation of the International Commission on Radiological Protection for occupational eye dose is an equivalent dose limit to the eye of 20 mSv year-1, averaged over a 5-year period. This recommendation is a drastic reduction from the previous limit of 150 mSv year-1. Hence, it is important to protect physicians' eyes from X-ray radiation. Particularly in interventional radiology (IVR) procedures, many physicians use protective lead (Pb) glasses to reduce their occupational exposure. This study assessed the shielding effects of novel 0.07 mm Pb glasses. The novel glasses (XR-700) have Pb-acrylic lens molded in three dimensions. We studied the novel type of 0.07 mm Pb glasses over a period of seven consecutive months. The eye dose occupational radiation exposure of seven IVR physicians was evaluated during various procedures. All IVR physicians wore eye dosimeters (DOSIRIS™) close to the left side of the left eye. To calculate the shielding effects of the glasses, this same type of eye dosimeter was worn both inside and outside of the Pb lenses. The average shielding effect of the novel glasses across the seven physicians was 61.4%. Our results suggest an improved shielding effect for IVR physicians that use these glasses. No physician complained that the new glasses were uncomfortable; therefore comfort is not a problem. The lightweight glasses were acceptable to IVR physicians, who often must perform long procedures. Thus, the novel glasses are comfortable and reasonably protective. Based on the results of this study, we recommend that IVR physicians use these novel 0.07 mm Pb glasses to reduce their exposure., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Japanese Radiation Research Society and Japanese Society for Radiation Oncology.)

Introduction: Eswatini remains one of the countries in Southern Africa without a regulating authority for radiation safety in the radiography departments. Quality control (QC) tests and radiation protection practices are unmonitored. This study sought to explore radiographers' perceptions regarding establishing a self-regulatory body that will formulate, implement and monitor compliance of standardised guidelines for radiation safety., Methods: A qualitative, exploratory and descriptive research approach was undertaken. Radiographers currently registered and practicing in Eswatini were purposively selected and invited to participate. Data was collected using semi-structured interviews. Audiotapes and field notes were used. Audio taped interviews were transcribed verbatim and then analyzed using qualitative content analysis., Results: Six themes emerged from the analysis of data, namely; a) awareness of the need for QC tests, b) radiation protection and safety in the radiography departments, c) radiographers' responsibility towards radiation protection, d) education and training in radiation safety for radiographers and other stakeholders, e) support from governmental and management structures and f) the need for the self-regulatory body in the radiography departments., Conclusion: The study demonstrated that there is awareness among radiographers in Eswatini that radiation safety practices are necessary in the radiography departments. Continuous education and training were deemed as imperative to improve radiation safety in the radiography departments. There is also support for the idea of establishing the self-regulatory body., Implications for Practice: The need for monitoring structures in order to ensure radiation safety in the radiography departments is highlighted in this study. Government officials and hospital management are crucial in ensuring radiation safety in radiography departments., Competing Interests: Conflict of interest statement None., (Copyright © 2020. Published by Elsevier Ltd.)

Purpose: To review and discuss how interventional technologists and other health care professionals can better reduce the potentially harmful effects of ionizing radiation., Methods: A literature search was conducted using PubMed. Studies that investigated the biologic effects of ionizing radiation and methods of protection were included. Findings pertaining to radiation effects and protection were reported. Selected studies were assigned a level of evidence based on existing guidelines., Results: Radiation exposure can result in many health issues, including skin necrosis, radiation burns, cataracts, hair loss, birth defects, and cancers. Although understanding of radiation safety and radiobiology has greatly increased during the past century, radiation exposure in a medical setting still remains a risk to patients and health care providers. A thorough understanding of radiation safety, including the principles of time, distance, shielding, and technique, is essential. Patient factors also are important to consider., Discussion: All health care personnel should wear lead or lead-equivalent aprons and thyroid shields. Protective eyewear also is recommended in addition to the use of protective screens. Detachable drapes suspended from the sides of the table can reduce the dose greatly to the lower extremities of health care personnel and should be used when possible. Hoods might be beneficial, but proper use of a protective screen likely offers more benefit. Protective drapes placed on the surface of the patient can reduce dose to the operator but can be expensive and can increase dose to patients. Use of radiodense gloves and caps is not recommended. Patient shielding should not be a part of routine practice, as it offers no or negligible benefit and can increase dose and compromise image quality., Conclusion: Technologists and health care professionals need to be aware of dose reduction strategies and should be seen as the gatekeeps to keep themselves, their coworkers, and patients safe. By adhering to evidence-based recommendations, technologists can keep the harmful effects of occupational radiation exposure to a minimum., (© 2021 American Society of Radiologic Technologists.)

Objectives: The aim of this review is to explore the impact of educational interventions on clinicians' knowledge of radiation protection., Key Findings: Following a comprehensive search of MEDLINE and EMBASE from 2000 to 2018, 1795 studies were identified, eight of which met the criteria for this review. All eight studies utilised pretest-posttest designs and involved the education of medical students or doctors. All studies reported an increase in participants' knowledge of radiation protection, five of which were statistically significant. In two studies, over half of participants stated that education received would impact on their future imaging requesting practice., Conclusion: Whilst a range of educational interventions have been shown to improve knowledge of radiation protection, there was wide variation in the study settings and type of educational programmes delivered. No studies assessed long-term knowledge retention or the impact on clinical practice. Therefore, robust research is needed to accurately measure the impact of educational programmes on knowledge of radiation protection in the UK and the implications this may have on referral practices., Implications for Practice: This review revealed that educational interventions are effective in increasing participants' knowledge levels of radiation protection. It is necessary to assess and ensure that this improvement in knowledge actually translates into an impact on referral practice/behaviour. The ideal outcome being that fewer unnecessary examinations are requested and our patients are protected from a needless increased radiation burden., Competing Interests: Conflict of interest statement There was no funding sources for this work., (Copyright © 2020 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Introduction: Radiation protection knowledge is essential for medical personnel in ensuring that the possible risks do not outweigh the benefits of diagnostic imaging. This study aimed to assess the radiation protection knowledge of radiographers in Cyprus., Methods: A cross-sectional study was carried out among radiographers in Cyprus through the Cyprus Society of Registered Radiologic Technologists & Radiation Therapy Technologists. The study was a quantitative descriptive analysis, using a questionnaire with 22 multiple-choice questions. Analysis of the data was done using the statistical software Stata, by performing mean knowledge score comparisons by different participants' characteristics, using t-test and analysis of variance test. Statistical significance was assumed as a p-value < 0.05., Results: The answers provided for each question indicate that some areas of radiation protection are less known compared to others, as there is quite a wide range of correct-to-incorrect ratios. The analysis based on participant characteristics in relation to overall radiation effects knowledge, identified important determinants, namely the workplace of the participant (p = 0.006), the type of work licence the participant held at the time of the questionnaire (p = 0.024), and the years of clinical experience of the participant (p = 0.021)., Conclusion: The study showed that the levels of knowledge in radiation protection are of a very good standard. However, work is needed to clarify the specifics of dose limits and the national radiation protection legislation with regards to informing patients about the possible effects of ionising radiation., Implications for Practice: The study results indicate the importance of educating radiographers about the requirements of national radiation protection legislation and how this new knowledge can be linked with practise., Competing Interests: Conflict of interest statement None., (Copyright © 2019 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Objective: To quantify the effects of different imaging settings on radiation exposure to the operator and surgical team in a hybrid operating room (OR)., Methods: Measurements to determine scatter radiation in different imaging and geometry settings using an anthropomorphic phantom were performed in a hybrid OR equipped with a robotic C arm interventional angiography system (Artis Zeego; Siemens Healthcare, Erlangen, Germany). The radiation dose (RD) was measured with seven calibrated Philips DoseAware active electronic dosimeters and a Raysafe Xi survey detector, which were placed at different locations in the hybrid OR. The evaluated set ups included low dose, medium dose, and high dose fluoroscopy for abdomen; fluoroscopy fade; roadmap; and digital subtraction angiography (DSA), all using 20 s exposures. The effect of magnification, tube angulation, field size, source to skin distance, and RADPAD protection shields were assessed. Finally RD during cone beam computed tomography (CBCT) was obtained., Results: In the operator position the initial settings with low dose fluoroscopy caused a RD of 1.03 μGy. The use of fluorofade did not increase the radiation dose (1.02 μGy), whereas the roadmap increased it threefold (2.84 μGy). The RD with "normal fluoro" was 4.13 μGy and increased to 6.44 μGy when high dose fluoroscopy mode was used. Magnification or field size varying from 42 cm to 11 cm led the RD to change from 0.86 μGy to 2.10 μGy. Decreasing the field of view to 25% of the initial size halved the RD (0.48 μGy). The RDs for the left anterior oblique 30° and right anterior oblique 30° were 3.26 μGy and 1.63 μGy, respectively. DSA increased the cumulative dose 33 fold but the RADPAD shield decreased the DSA RD to 4.92 μGy. The RD for CBCT was 47.2 μGy., Conclusion: Radiation exposure to operator and personnel can be significantly reduced during hybrid procedures with proper radiation protection and dose optimisation. A set of six behavioural rules were established., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

X-ray regulations and room design methodology vary widely across Canada. The Canadian Organization of Medical Physicists (COMP) conducted a survey in 2016/2017 to provide a useful snapshot of existing variations in rules and methodologies for human patient medical imaging facilities. Some jurisdictions no longer have radiation safety regulatory requirements and COMP is concerned that lack of regulatory oversight might erode safe practices. Harmonized standards will facilitate oversight that will ensure continued attention is given to public safety and to control workplace exposure. COMP encourages all Canadian jurisdictions to adopt the dose limits and constraints outlined in Health Canada Safety Code 35 with the codicil that the design standards be updated to those outlined in NCRP 147 and BIR 2012., (© 2019 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)

Introduction: Urologists are increasingly exposed to fluoroscopy, which can cause cellular damage. Appropriate awareness and safety precautions concerning fluoroscopy are necessary and likely should be a focus during training. We sought to assess radiation safety knowledge among Urology residents in the United States. Methods: A 19-question survey was constructed to assess radiation safety training, knowledge, behavior, and attitudes. The survey was sent through REDCap™ (Research Electronic Data Capture) to all Urology program directors and coordinators in the United States with a request to distribute to their residents. The survey was closed after 3 weeks. Results: One hundred thirty-six urology trainees responded during the study period. Thirteen percent learned fluoroscopic radiation safety formally, 46% informally, 35% both informally and formally, and 6% no education. Forty-six percent reported radiation safety being part of their curriculum. When asked about directional X-ray travel and exposure, only 54% answered correctly. Regarding conditions related to radiation exposure, 94% believe infertility is potentially related, 83% cataracts, 93% leukemia and lymphoma, 57% central nervous system tumors, 77% birth defects, and 4% diabetes. Regarding protection, 9% wear lead-lined glasses, 30% dosimeters, 99% thyroid shields, 0% lead gloves, 97% lead apron, 26% lead shield, and 0% nothing. Regarding fluoroscopy machine settings, 7% knew the machine used was set to continuous, 73% pulse, and 21% were unsure. Sixty-six percent had awareness of the directional travel of the machine routinely used. Regarding safety techniques, 99% knew decreasing time and 100% knew wearing protective materials decrease exposure. However, when asked about distance and exposure, 55% answered incorrectly. Most respondents believe radiation safety is important (89%) and desire more formal education (64%). Conclusions: Trainees lack sufficient knowledge in several key areas regarding radiation safety. Formal education may be considered during training and is desired by trainees. This education is likely needed to ensure trainees learn methods to keep them safe during their career.

Aim: Queensland has current radiation-protection guidelines; however, with the absence of data exploring compliance and implementation, the efficacy is unknown. The aim of the present study was to investigate the knowledge and attitudes on radiation protection among private North Queensland (NQ) dentists., Methods: A quantitative methodology was employed in an observational and descriptive study using questionnaires for data collection., Results: Of the 154 questionnaires distributed, 63 were completed and returned. The respondents' knowledge concerning the technical details of their equipment was limited, with 31.5% and 47% not knowing the tube voltage and current utilized for their machines, respectively. In total, 23.8% of dentists had limited knowledge about the speed of the conventional film they used, 90.5% of respondents agreed that the role of imaging in dentistry is important, and 75.8% dentists reported the thyroid as the most important organ to protect during dental radiography. Their knowledge regarding position-distance rule was reasonably adequate; 80.3% of the dental practices appeared to follow the Australian Radiation Protection and Nuclear Safety Agency guidelines, 95.2% preferred taking radiographs if it was only urgent, and 69.8% identified a need for spreading awareness regarding radiation protection., Conclusions: An opportunity and need for further continuing education was identified among NQ dentists to ensure safety of patients., (© 2018 John Wiley & Sons Australia, Ltd.)

Background: There is great variability in radiation safety practices in cardiac catheterization laboratories around the world., Methods: We performed an international online survey on radiation safety including interventional cardiologists, electrophysiologists, interventional radiologists, and vascular surgeons., Results: A total of 570 responses were received from various geographic locations, including the United States (77.9%), Asia (7.9%), Europe (6.8%), Canada (2.8%), and Mexico and Central America (2.1%). Most respondents (73%) were interventional cardiologists and 23% were electrophysiologists, with 14.4 ± 10.2 years in practice. Most respondents (75%) were not aware of their radiation dose during the past year and 21.2% had never attended a radiation safety course; 58.9% are "somewhat worried" and 31.5% are "very worried" about chronic radiation exposure. Back pain due to lead use was reported by 43.0% and radiation-related health complications including cataracts and malignancies were reported by 6.3%. Only 37.5% of respondents had an established radiation dose threshold for initiating patient follow-up. When comparing United States operators with the other respondents, the former were more likely to attend radiation safety courses (P<.001), wear dosimeters (P<.001), know their annual personal radiation exposure (P<.001), and have an established patient radiation dose threshold (P<.001). They were also more likely to use the fluoro store function, under-table shields, leaded glasses, ceiling lead glass, and disposable radiation shields, and were more concerned about the adverse effects of radiation., Conclusions: Radiation safety is of concern to catheterization laboratory personnel, yet there is significant variability in radiation protection practices, highlighting several opportunities for standardization and improvement.

The ocular lens is one of the most susceptible structures in the body to radiation damage. Unfortunately, much of the traditional academic and regulatory thinking on thresholds to develop radiation-induced opacities or cataracts has proven to be false. Individual vulnerability to the effects of radiation is extremely variable, largely because each individual is variably genetically equipped to repair the damage caused by radiation. Therefore many people, including some unsuspecting interventional radiologists may have no, or almost no, threshold at all for cataract development after radiation injury. For most others, if there is a threshold it is a fraction of what was previously thought. These new data have become apparent during the same time period when unprecedented numbers of physicians and medical staff have been exposed to unprecedented doses of scatter radiation as the number and complexity of fluoroscopic guided procedures has exploded. Increased rates of radiation lens damage have already been documented in physicians and support staff working in interventional medicine. As there is a latency period of years to decades for lens injury to fully evolve it is quite possible the true incidence will not be known for some time. Strategies to minimize the potential risks encountered in interventional medicine include radiation safety best practices, passive and personal barrier protection, and philosophical approach to interventional radiology practice. Ignore this article at your peril., (Copyright © 2018. Published by Elsevier Inc.)

Objectives: This study was performed to determine if the use of an accessory lead shield is associated with a reduction in radiation exposure among staff members during cardiac catheterization., Background: Accessory lead shields that protect physicians from scatter radiation are standard in many catheterization laboratories, yet similar shielding for staff members is not commonplace., Methods: Real-time radiation exposure data were prospectively collected among nurses and technologists during 764 consecutive catheterizations. The study had 2 phases: in phase I (n = 401), standard radiation protection measures were used, and in phase II (n = 363), standard radiation protection measures were combined with an accessory lead shield placed between the staff member and patient. Radiation exposure was reported as the effective dose normalized to dose-area product (E DAP )., Results: Use of an accessory lead shield in phase II was associated with a 62.5% lower E DAP per case among technologists (phase I: 2.4 [4.3] μSv/[mGy × cm 2 ] × 10 -5 ; phase II: 0.9 [2.8] μSv/[mGy × cm 2 ] × 10 -5 ; p < 0.001) and a 63.6% lower E DAP per case among nurses (phase I: 1.1 [3.1] μSv/[mGy × cm 2 ] × 10 -5 ; phase II: 0.4 [1.8] μSv/[mGy × cm 2 ] × 10 -5 ; p < 0.001). By multivariate analysis, accessory shielding remained independently associated with a lower E DAP among both technologists (34.2% reduction; 95% confidence interval: 20.1% to 45.8%; p < 0.001) and nurses (36.4% reduction; 95% confidence interval: 19.7% to 49.6%; p < 0.001)., Conclusions: The relatively simple approach of using accessory lead shields to protect staff members during cardiac catheterization was associated with a nearly two-thirds reduction in radiation exposure among nurses and technologists., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Children with congenital or acquired heart disease can be exposed to relatively high lifetime cumulative doses of ionizing radiation from necessary medical imaging procedures including radiography, fluoroscopic procedures including diagnostic and interventional cardiac catheterizations, electrophysiology examinations, cardiac computed tomography (CT) studies, and nuclear cardiology examinations. Despite the clinical necessity of these imaging studies, the related ionizing radiation exposure could pose an increased lifetime attributable cancer risk. The Image Gently "Have-A-Heart" campaign is promoting the appropriate use of medical imaging studies in children with congenital or acquired heart disease while minimizing radiation exposure. The focus of this manuscript is to provide a comprehensive review of radiation dose management and CT performance in children with congenital or acquired heart disease.

Objective: To determine the benefits, risks, and limitations associated with wrapping a patient with lead shielding during fluoroscopy-guided kyphoplasty procedures as a way to reduce operator radiation exposure., Materials and Methods: An anthropomorphic phantom was used to mimic a patient undergoing a kyphoplasty procedure under fluoroscopic guidance. Radiation measurements of the air kerma rate (AKR) were made at several locations and under various experimental conditions. First, AKR was measured at various angles along the horizontal plane of the phantom and at varying distances from the phantom, both with and without a lead apron wrapped around the lower portion of the phantom (referred to here as phantom shielding). Second, the effect of an operator's apron was simulated by suspending a lead apron between the phantom and the measurement device. AKR was measured for the four shielding conditions-phantom shielding only, operator apron only, both phantom shielding and operator apron, and no shielding. Third, AKR measurements were made at various heights and with varying C-arm angle., Results: At all locations, the phantom shielding provided no substantial protection beyond that provided by an operator's own lead apron. Phantom shielding did not reduce AKR at a height comparable to that of an operator's head., Conclusions: Previous reports of using patient shielding to reduce operator exposure fail to consider the role of an operator's own lead apron in radiation protection. For an operator wearing appropriate personal lead apparel, patient shielding provides no substantial reduction in operator dose.

Background: European recommendations suggest that medical students should be taught radiation safety before entering clinical practice., Aim: The aim of this study was to produce a summative assessment of radiation protection training in medical school in Ireland., Materials and Methods: A web-based questionnaire was distributed to the 2014 intern population (n = 683) via network intern-coordinators. The survey encompassed knowledge of radiation dose in X-ray investigations, laws governing the prescribing of radiation and complications of radiation exposure to staff and patients., Results: Response rate was 14.2% (97/683) with all Irish medical schools represented. 64% of interns reported no formal training in radiation safety. 80% correctly identified MRI and 94% US as not posing a radiation risk. 54% identified CT PET as emitting the highest radiation dose to patients. Only 32% correctly identified one CT abdomen/pelvis as equivalent to the dose from 300 to 500 chest X-rays and 22% correctly identified the theoretical lifetime risk of cancer induction from CT abdomen/pelvis as 1 in 2000. While 71% thought it was very important that prescribers should be aware of patient radiation dose and 28% thought it was moderately important, 74% were not aware of any laws governing the prescribing of radiology investigations., Conclusion: Currently, there is little formal radiation safety training in Irish medical schools. Knowledge of radiation dose and the laws governing prescribing is limited among qualifying interns. Implementation of a formal radiation safety curriculum in Irish Medical Schools would adhere to EU guidelines and improve prescriber knowledge, patient, and personal radiation safety.

Perioperative team members and patients are frequently exposed to radiation during operative and other invasive procedures. The use of equipment that emits radiation (eg, a fluoroscopy unit) is beneficial for diagnosing and treating patients but carries the risk of harm if team members do not follow radiation safety guidelines. Perioperative team members should implement safety precautions for themselves and their patients when radiation is used. This Back to Basics article addresses the basics of radiation safety and the precautions that perioperative team members should implement in the perioperative setting., (Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.)

Surgeons should aim to keep radiation exposure "As Low As Reasonably Achievable (ALARA)" during intramedullary nailing and other minimally invasive surgical procedures. This requires understanding the principles of ionizing radiation and methods for minimizing exposure risk. The main source of radiation exposure to surgical personnel during fluoroscopy is from scattered radiation. Since radiation scatter is mainly directed towards the fluoroscopy source, the best configuration during surgery to reduce radiation dose to the surgeon is to position the fluoroscopic source below the operating room table and the image collector above the table. During cross table imaging, the surgeon should stand on the side with the image collector to minimize their exposure to radiation scatter. To reduce scattered radiation the patient must be placed as close to the image collector and as far away from the x-ray tube as possible. Standing farther away from the patient can exponentially reduce radiation exposure. The hands usually have the greatest dose exposure to radiation during surgical procedures, but they are far less radiosensitive than the eyes or thyroid. To minimize exposure to the hands, a surgeon should use the hands-off technique taking fluoroscopic images only when his or her hands are farthest from the radiographic field. Lead gowns, lead thyroid shields, and lead glasses, further reduces an individual's exposure to radiation., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The purpose of this study was to develop spreadsheet workbooks that assist in the radiation safety counseling of 131 I therapy patients and their families, providing individualized guidelines that avoid imposing overly conservative restrictions on family members and others. Methods: The mathematic model included biphasic patient radionuclide retention. The extrathyroidal component was a cylindric volume with a diameter corresponding to the patient's size and included patient self-absorption, whereas the thyroidal component was a point source whose transmission was reduced by self-absorption. A separate model in which the thyroid, extrathyroid, and bladder compartments fed serially from one to the next was developed to depict the radionuclide levels within the patient and to estimate the activity entering the environment at each urination. Results: The system was organized into a set of 4 workbooks: the first to be used with ablation patients prepared using thyrogen, the second with ablation patients prepared by deprivation, the third with hyperthyroid patients, and the fourth with the unusual hyperthyroid patient who finds the restrictions to be oppressive and returns 5-10 d after administration for a measurement and reassessment. The workbooks evaluated the radiation field strength external to the patient and indicated restrictions based on selected dose limits. To assist physicians in suggesting contamination precautions, the workbooks also evaluated the radioactivity present within the patient and the estimated discharge into the environment as a function of time. Conclusion: The workbooks that were developed assist the radiation safety counselor in individualizing radiation protection procedures for the family of patients undergoing 131 I therapy. The workbook system avoids overly conservative assumptions while permitting selection of appropriate dose limits for each individual., (© 2017 by the Society of Nuclear Medicine and Molecular Imaging.)

Background: Reports of left-sided brain malignancies among interventional cardiologists have heightened concerns regarding physician radiation exposure. This study evaluated the impact of a suspended lead suit and robotic system on physician radiation exposure during percutaneous coronary intervention (PCI)., Methods: Real-time radiation exposure data were prospectively collected from dosimeters worn by operating physicians at the head- and chest-level during consecutive PCI cases. Exposures were compared in three study groups: 1) manual PCI performed with traditional lead apparel; 2) manual PCI performed using suspended lead; and 3) robotic PCI performed in combination with suspended lead., Results: Among 336 cases (86.6% manual, 13.4% robotic) performed over 30weeks, use of suspended lead during manual PCI was associated with significantly less radiation exposure to the chest and head of operating physicians than traditional lead apparel (chest: 0.0 [0.1] μSv vs 0.4 [4.0] μSv, p<0.001; head: 0.5 [1.9] μSv vs 14.9 [51.5] μSv, p<0.001). Chest-level radiation exposure during robotic PCI performed in combination with suspended lead was 0.0 [0.0] μSv, which was significantly less chest exposure than manual PCI performed with traditional lead (p<0.001) or suspended lead (p=0.046). In robotic PCI the median head-level exposure was 0.1 [0.2] μSv, which was 99.3% less than manual PCI performed with traditional lead (p<0.001) and 80.0% less than manual PCI performed with suspended lead (p<0.001)., Conclusions: Utilization of suspended lead and robotics were observed to result in significantly less radiation exposure to the chest and head of operating physicians during PCI., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: In the design of nuclear medicine treatment and examination rooms, an important consideration is the shielding required for ionizing radiation from the radioactive isotopes used. The shielding in the walls is normally limited to a height lower than the actual ceiling height. The direct radiation, possibly with build-up correction, can be calculated relatively easily. However, little data are available to estimate the dose contribution from ionizing radiation traveling over the wall shielding and scattering off the ceiling. We aim to determine the contribution of the ceiling scatter to the radiation dose outside nuclear medicine rooms., Methods: Monte Carlo simulations were performed using Gate for different heights of lead shielding in the wall, and different ceiling heights. A point source in air of 99m Tc (141 keV), 131 I (365 keV) or 18 F (511 keV) was placed 1.0 m above the floor, 3.0 m from the lead shielding. Simulations of ceiling scatter only and for the total radiation dose were performed for these 3 isotopes, 5 different ceiling heights and 4-8 different wall shielding heights, resulting in a total of 165 simulations. This allowed us to compare the contribution of the radiation passing through the shielding and the ceiling scatter., Results: We find that the shielding required for the primary radiation, measured in half-value layers, is an important factor in determining the relative contribution of ceiling scatter. When more than about 4 half-value layers of shielding are used, ceiling scatter becomes the dominant factor and should be taken into account in the shielding design. In many practical cases for low energy photons (e.g. from 99m Tc; 141 keV; half-value layer of 0.26 mm lead), 2 mm of lead is used and ceiling scatter is a dominating factor contributing >~70% of the dose outside the shielded room. For higher energies (e.g. 18 F; 511 keV; half-value layer of 3.9 mm lead) the ceiling scatter is typically less than about 15% when 8 mm of lead shielding is used., Conclusions: We have performed simulations that allow an estimation of the contribution of ceiling scatter to the radiation dose outside a room, based on the ceiling height, shielding height, and isotope used. This will allow for improved shielding designs in nuclear medicine departments., (© 2017 American Association of Physicists in Medicine.)

Adverse health effects of radiation exposure to staff in cardiac catheterisation laboratories have been well documented in the literature. Examples include increased risk of cataracts as well as possible malignancies. These risks can be partly mitigated by reducing scatter radiation exposure to staff during diagnostic and interventional cardiac procedures. There are currently commercially available radiation protection tools, including radioprotective caps, gloves, eyewear, thyroid collars, aprons, mounted shields, table skirts and patient drapes to protect staff from excessive radiation exposure. Furthermore, real-time dose feedback could lead to procedural changes that reduce operator dose. The objective of this review is to examine the efficacy of these tools and provide practical recommendations to reduce occupational radiation exposure with the aim of minimising long-term adverse health outcomes., (Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

In recent years, the management of patient doses in medical imaging has evolved as concern about radiation exposure has increased. Efforts and techniques to reduce radiation doses are focussed not only on the basis of patient safety, but also on the fundamentals of justification and optimisation in cooperation with international organisations such as the International Commission on Radiological Protection, the International Atomic Energy Agency, and the World Health Organization. The Image Gently campaign in children and Image Wisely campaign in adults to lower radiation doses have been initiated in the USA. The European Association of Nuclear Medicine paediatric dosage card, North American consensus guidelines, and Nuclear Medicine Global Initiative have recommended the activities of radiopharmaceuticals that should be administered in children. Diagnostic reference levels (DRLs), developed predominantly in Europe, may be an important tool to manage patient doses. In Korea, overexposure to radiation, even from the use of medical imaging, has become a public issue, particularly since the accident at the Fukushima nuclear power plant. As a result, the Korean Nuclear Safety and Security Commission revised the technical standards for radiation safety management in medical fields. In parallel, DRLs for nuclear medicine procedures have been collected on a nationwide scale. Notice of total effective dose from positron emission tomography-computed tomography for cancer screening has been mandatory since mid-November 2014., (© The International Society for Prosthetics and Orthotics.)

Background: Although (131) I-metaiodobenzylguanidine ((131) I-MIBG) therapy is increasingly used for children with high-risk neuroblastoma, a paucity of lead-lined rooms limits its wider use. We implemented radiation safety procedures to comply with New York City Department of Health and Mental Hygiene regulations for therapeutic radioisotopes and administered (131) I-MIBG using rolling lead shields., Procedure: Patients received 0.67 GBq (18 mCi)/kg/dose (131) I-MIBG on an IRB-approved protocol (NCT00107289). Radiation safety procedures included private room with installation of rolling lead shields to maintain area dose rates ≤0.02 mSv/hr outside the room, patient isolation until dose rate <0.07 mSv/hr at 1 m, and retention of a urinary catheter with collection of urine in lead boxes. Parents were permitted in the patient's room behind lead shields, trained in radiation safety principles, and given real-time radiation monitors., Results: Records on 16 (131) I-MIBG infusions among 10 patients (age 2-11 years) were reviewed. Mean ± standard deviation (131) I-MIBG administered was 17.67 ± 11.14 (range: 6.11-40.59) GBq. Mean maximum dose rates outside treatment rooms were 0.013 ± 0.008 mSv/hr. Median time-to-discharge was 3 days post-(131) I-MIBG. Exposure of medical staff and parents was below regulatory limits. Cumulative whole-body dose received by the physician, nurse, and radiation safety officer during treatment was 0.098 ± 0.058, 0.056 ± 0.045, 0.055 ± 0.050 mSv, respectively. Cumulative exposure to parents was 0.978 ± 0.579 mSv. Estimated annual radiation exposure for inpatient nurses was 0.096 ± 0.034 mSv/nurse. Thyroid bioassay scans on all medical personnel showed less than detectable activity. Contamination surveys were <200 dpm/100 cm(2) ., Conclusions: The use of rolling lead shields and implementation of specific radiation safety procedures allows administration of high-dose (131) I-MIBG and may broaden its use without dedicated lead-lined rooms., (© 2016 Wiley Periodicals, Inc.)