A review on the science and practical applications of radiology

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A review on the science and practical applications of radiology

Most relevant data and recommendations from about papers have been analysed and classified in the following topics: The major findings of the review can be summarised as follows: At present, several dosemeters are available for eye lens monitoring and calibration procedures are being developed.

However, in practice, very often, alternative methods are used to assess the dose to the eye lens. A summary of correction factors found in the literature for the assessment of the eye lens dose is provided.

These factors can give an estimation of the eye lens dose when alternative methods, such as the use of a whole body dosemeter, are used. A wide range of values is found, thus indicating the large uncertainty associated with these simplified methods.

Reduction factors from most common protective devices obtained experimentally and using Monte Carlo calculations are presented. The paper concludes that the use of a dosemeter placed at collar level outside the lead apron can provide a useful first estimate of the eye lens exposure.

However, for workplaces with estimated annual equivalent dose to the eye lens close to the dose limit, specific eye lens monitoring should be performed. Finally, training of the involved medical staff on the risks of ionising radiation for the eye lens and on the correct use of protective systems is strongly recommended.

Radiation exposure can cause injuries in the eye lens that may progress in the loss of the eye lens function caused by the formation of lens opacities and cataract.

The ICRP Report recommended a review of the non-cancerous effects of ionising radiation on normal tissues in the low dose range. This triggered many epidemiological studies Worgul et alChodick et alCiraj-Bjelac et alRehani et alVano et al which suggested that the threshold dose for the loss of the eye lens function could be lower than previously considered or that there is no threshold at all.

For this reason ICRP reportset the threshold value for the absorbed dose to the eye lens at 0. Based on this, the ICRP have recommended that for occupational exposure a dose limit for the eye lens of 20 mSv in a year, averaged over defined periods of 5 years, should be applied, with no single year exceeding 50 mSv ICRP The new limit is a substantial reduction of the previously recommended annual eye lens limit of mSv.

This raises serious questions and causes implications for workers occupationally exposed to radiation, especially in the medical field in the interventional personnel, since the number of fluoroscopically guided procedures has grown in the last decades UNSCEAR In addition, this topic has become of concern for many national and international professional organisations which made an effort to analyse the implications and to provide an assessment of the impact of the implementation of the new dose limit Bouffler et alBroughton et alBroughton et al a.

ICRP has already underlined the need for further collaboration, clarification and changes to working practices derived from this change Boal and PinakBolch et alBroughton et al b. Interventional cardiologists and radiologists, who are exposed to the scattered radiation from the patient, are among the professional groups that receive the highest doses to the eyes Donadille et alKim et al Evidence on eye lens injuries associated with exposure to ionising radiation was firstly observed in the USA Junk et allater in Latin America Vano et al and Malaysia Ciraj-Bjelac et al More recent studies were also performed in Finland Mrena et alFrance Jacob et al and in Latin America again Vano et al Despite their methodological limitations, these studies demonstrated that interventional cardiologists and radiologists as well as nursing staff have an increased risk of lens opacities especially in cases where radiation protection tools are not in place or are not regulary used.

Before the reduction of the dose limit for the eye lens ICRPeye lens dosimetry was seldom performed in practice for two reasons: To bridge the gap, many studies have explored alternative methods to assess the dose to the eye lens.

A review on the science and practical applications of radiology

Some of the approaches were based on the correlation between the eye lens doses with patient dose as it is recorded by the Kerma Area Product KAP values Buls et alVano et alDonadille et alKim et alEfstathopoulos et alBor et alDauer et alMartinAntic et al in order to have a first estimation of the dose delivered to the eye lens of the operator without using an extra dosemeter.

On the other hand, other researchers have tried to find a correlation between the eye lens dose and doses recorded by dosemeters worn on various parts of the body Clerinx et alMartinKrim et alSanchez et alFarah et al The idea was to use the whole body or even the extremity dosemeters to evaluate the eye lens dose.

However, the practices concerning the number and position of the whole body dosemeters vary from country to country and from operator to operator.

Regardless the methodological approach, the aim of all the above mentioned studies was to focus on the professional groups who are at excess risk due to the increased eye lens doses as well as to contribute to the improvement of the radiation protection for these professional categories.

Practical aspects on the eye lens monitoring arrangements are also given. Challenges of today in eye lens monitoring A very few studies have addressed the importance of eye lens monitoring since the early 90s Janssen et al InICRP in publication 85 ICRP highlighted the risk of eye lens injuries to physicians and staff performing interventional procedures and recommended to wear an additional dosemeter at collar level, above the lead apron to have an indication of the head eye dose.

The question of how to estimate the doses to the eye lens employing a single dosemeter was also investigated by Clerinx et al They proposed to use an unprotected collar dosemeter, calibrated in terms of Hp 0. A similar approach was followed by Martin and Magee for monitoring the exposed personnel, but they suggested using a head band dosemeter or a dosemeter attached to the protective eyewear to get more accurate results, in particular when the operator appears likely to reach the public dose limit of 15 mSv European Commission The ideal situation in eye lens monitoring would be the assessment of the personal dose equivalent at depth 3 mm, Hp 3without seriously underestimating it.

The definition of Hp 3 is based on the assumption that the absorbed dose at depth 2. The real challenge in the field is either to use an extra eye lens dosemeter properly calibrated in terms of Hp 3or to use the patient dose values or other personal dosemeters already worn by the operators and calibrated in other dosimetric quantities and estimate the eye lens dose using a correlation coefficient.

Both of the solutions present problems that have to be solved. Moreover, the eye lens dosemeter has to be worn as close as possible to the eye lens in order to reduce the inaccuracy of eye lens dose estimate.

A review on the science and practical applications of radiology

This may not be comfortable for the operator who usually wears eye lens glasses for protection. Another issue is where to position the dosemeter: As regards the use of indirect measurements and a correlation coefficient, there are many studies which have already shown the poor correlation between the eye lens dose and the KAP values Antic et al Practical applications such as case reports, operative and diagnostic tests, and laboratory and x-ray reports demonstrate the use of medical terminology in practice.

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Coherence-enhanced synchrotron radiology: simple theory and practical applications - IOPscience