Personalized Feedback on Staff Dose in Fluoroscopy-Guided Interventions: A New Era in Radiation Dose Monitoring

Anna M Sailer, Laura Vergoossen, Leonie Paulis, Willem H van Zwam, Marco Das, Joachim E Wildberger, Cécile R L P N Jeukens, Anna M Sailer, Laura Vergoossen, Leonie Paulis, Willem H van Zwam, Marco Das, Joachim E Wildberger, Cécile R L P N Jeukens

Abstract

Purpose: Radiation safety and protection are a key component of fluoroscopy-guided interventions. We hypothesize that providing weekly personal dose feedback will increase radiation awareness and ultimately will lead to optimized behavior. Therefore, we designed and implemented a personalized feedback of procedure and personal doses for medical staff involved in fluoroscopy-guided interventions.

Materials and methods: Medical staff (physicians and technicians, n = 27) involved in fluoroscopy-guided interventions were equipped with electronic personal dose meters (PDMs). Procedure dose data including the dose area product and effective doses from PDMs were prospectively monitored for each consecutive procedure over an 8-month period (n = 1082). A personalized feedback form was designed displaying for each staff individually the personal dose per procedure, as well as relative and cumulative doses. This study consisted of two phases: (1) 1-5th months: Staff did not receive feedback (n = 701) and (2) 6-8th months: Staff received weekly individual dose feedback (n = 381). An anonymous evaluation was performed on the feedback and occupational dose.

Results: Personalized feedback was scored valuable by 76% of the staff and increased radiation dose awareness for 71%. 57 and 52% reported an increased feeling of occupational safety and changing their behavior because of personalized feedback, respectively. For technicians, the normalized dose was significantly lower in the feedback phase compared to the prefeedback phase: [median (IQR) normalized dose (phase 1) 0.12 (0.04-0.50) µSv/Gy cm2 versus (phase 2) 0.08 (0.02-0.24) µSv/Gy cm2, p = 0.002].

Conclusion: Personalized dose feedback increases radiation awareness and safety and can be provided to staff involved in fluoroscopy-guided interventions.

Keywords: Endovascular procedures; Interventional radiology; Occupational dose; Radiation dosimetry; Radiation exposure; Radiation monitoring; Radiation protection.

Conflict of interest statement

Conflict of interest

Anna M. Sailer, Laura Vergoossen, Marco Das, Joachim E. Wildberger and Cecile R. Jeukens received an institutional research Grant from Philips Healthcare, Best, The Netherlands.

Ethical Disclosure

The authors received an institutional research Grant from Philips Healthcare.

Informed Consent

This study was approved by the local ethical committee. Written informed consent was obtained from all employees included in this study. Informed consent was obtained from all patients included in the study; written informed consent was waived.

Figures

Fig. 1
Fig. 1
Example of a weekly personalized dose feedback form of a physician
Fig. 2
Fig. 2
Closed questions of the questionnaire to evaluate the personalized dose feedback among medical staff
Fig. 3
Fig. 3
Graphical representation of scores of medical staff’ answers on the questionnaire’s closed questions. Numbers in colored bars indicate percentages

References

    1. Bartal G, Vano E, Paulo G, Miller DL. Management of patient and staff radiation dose in interventional radiology: current concepts. Cardiovasc Intervent Radiol. 2014;37:289–298. doi: 10.1007/s00270-013-0685-0.
    1. International Commission On Radiological Protection. ICRP ref 4825-3093-1464. . Accessed 2016.
    1. Council NR. Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase II. Washington: The National Academies; 2006.
    1. Sailer AM, Schurink GW, Bol ME, et al. Occupational radiation exposure during endovascular aortic repair. Cardiovasc Intervent Radiol. 2015;38:827–832. doi: 10.1007/s00270-014-1025-8.
    1. Sutton DG, Williams JR. Radiation shielding for diagnostic radiology. London: British Institute of Radiology; 2012. pp. 74–77.
    1. Schueler BA, Vrieze TJ, Bjarnason H, Stanson AW. An investigation of operator exposure in interventional radiology. Radiographics. 2006;26:1533–1541. doi: 10.1148/rg.265055127.
    1. Vano E, Fernandez JM, Sanchez R. Occupational dosimetry in real time. Benefits for interventional radiology. Radiat Measurements. 2011;46:1262–1265. doi: 10.1016/j.radmeas.2011.04.030.
    1. Bartal G, Roguin A, Paulo G. Call for implementing a radiation protection culture in fluoroscopically guided interventional procedures. Am J Roentgenol. 2016;206:1110–1111. doi: 10.2214/AJR.15.15986.
    1. Mundigl S. Modernisation and consolidation of the European radiation protection legislation: the new euratom basic safety standards directive. Radiat Prot Dosimetry. 2014;164:9–12. doi: 10.1093/rpd/ncu285.
    1. International Commissionon Radiological Protection. The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication103.AnnICRP2007;37:1–332.
    1. Basic safety standards for protection against the dangers arising from exposure to ionising radiation, Council Directive 2013/59/EURATOM (2013). Accessed Sept 21 2016.
    1. ICRP Publication 74: conversion coefficients for use in radiological protection against external radiation. 1997Annals of the ICRP. vol 26(3). Elsevier, Oxford
    1. International Commission On Radiological Protection. ICRP ref 4825-3093-1464. Accessed 2016.
    1. Rajaraman P1, Doody MM, Yu CL, Preston DL, Miller JS, Sigurdson AJ, Freedman DM, Alexander BH, Little MP, Miller DL, Linet MS. Cancer Risks in U.S. Radiologic Technologists Working With Fluoroscopically Guided Interventional Procedures, 1994–2008.
    1. Mahmud E, Reeves R. The evidence supporting radiation safety methods-working towards zero operator exposure. J Imaging Interv Radiol. 2016;2:1–21.
    1. Meisinger QC, Stahl CM, Andre MP, Kinney TB, Newton IG. Radiation protection for the fluoroscopy operator and staff. Am J Roentgenol. 2016;19:1–10.
    1. Stahl CM, Meisinger QC, Andre MP, Kinney TB, Newton IG. Radiation risk to the fluoroscopy operator and staff. Am J Roentgenol. 2016;207:737–744. doi: 10.2214/AJR.16.16555.
    1. Domienik J, Brodecki M, Carinou E, Donadille L, Jankowski J, Koukorava C, Krim S, Nikodemova D, Ruiz-Lopez N, Sans-Mercé M, Struelens L, Vanhavere F. Extremity and eye lens doses in interventional radiology and cardiology procedures: first results of the ORAMED project. Radiat Prot Dosimetry. 2011;144:442–447. doi: 10.1093/rpd/ncq508.
    1. Vanhaverea F, Carinoub E, Domienikc J, Donadilled L, Ginjaumee M, Gualdrinif G, Koukoravab C, Krima S, Nikodemovag D, Ruiz-Lopezh N, Sans-Merceh M, Struelensa L. Measurements of eye lens doses in interventional radiology and cardiology: Final results of the ORAMED project. Radiat Measurements. 2011;46:1243–1247. doi: 10.1016/j.radmeas.2011.08.013.
    1. Sanchez R, Vano E, Fernandez JM, Gallego JJ. Staff radiation doses in a real-time display inside the angiography room. Cardiovasc Interv Radiol. 2010;33:1210–1214. doi: 10.1007/s00270-010-9945-4.
    1. Poudel S, Weir L, Dowling D, Medich DC. Changes in occupational radiation exposures after incorporation of a real-time dosimetry system in the interventional radiology suite. Health Phys. 2016;111(2 Suppl 2):S166–S171. doi: 10.1097/HP.0000000000000546.
    1. Heilmaier C, Kara L, Zuber N, Berthold C, Weishaupt D. Combined use of a patient dose monitoring system and a real-time occupational dose monitoring system for fluoroscopically guided interventions. J Vasc Interv Radiol. 2016;27:584–592. doi: 10.1016/j.jvir.2015.11.033.
    1. Baumann F, Katzen BT, Carelsen B, Diehm N, Benenati JF, Peña CS. The effect of realtime monitoring on dose exposure to staff within an interventional radiology setting. Cardiovasc Intervent Radiol. 2015;38:1105–1111. doi: 10.1007/s00270-015-1075-6.
    1. James RF, Wainwright KJ, Kanaan HA, et al. Analysis of occupational radiation exposure during cerebral angiography utilizing a new real time radiation dose monitoring system. J Neurointerv Surg. 2015;7:503–508. doi: 10.1136/neurintsurg-2014-011215.
    1. Sandblom V, Mai T, Almén A, et al. Evaluation of the impact of a system for real-time visualisation of occupational radiation dose rate during fluoroscopically guided procedures. J Radiol Prot. 2013;33:693–702. doi: 10.1088/0952-4746/33/3/693.
    1. Mangiarotti M, D’Ercole L, Quaretti P, Moramarco L, Lafe E, Zappoli Thyrion F. Evaluation of an active personal dosimetry system in interventional radiology and neuroradiology: Preliminary results. Radiat Prot Dosimetry 2015 Dec 8. pii: ncv502.
    1. Christopoulos G, Papayannis AC, Alomar M, et al. Effect of a real-time radiation monitoring device on operator radiation exposure during cardiac catheterization: the radiation reduction during cardiac catheterization using real-time monitoring study. Circ Cardiovasc Interv. 2014;7:744–745. doi: 10.1161/CIRCINTERVENTIONS.114.001974.

Source: PubMed

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