Radiation Protection - Eyes

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Radiation Protection - Eyes

• 4 Imaging Solutions, LLC
• Mark Struthers BBA, BSRT (R)(MR), CMRT, CIIP

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Fluoroscopy Diagnostic, Cardiac, Interventional
Procedures
The use of ionizing radiation is associated with
a risk of inducing malignant disease and causing
skin or eye damage to the patient and personnel.
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Cancer of the Eye
Radiation is associated with a small but definite
stochastic risk of inducing a malignant disease.
However, low-dose radiation exposure has also
been shown to induce an increase in the number of
circulating lymphocytes and chromosome
aberrations, which represent surrogate biomarkers
of cancer risk. The long-term cancer risk
increases with increasing cumulative dose, and
there is no known threshold value. Furthermore,
there is a deterministic risk of skin damage,
both to the patient and the operator, as well as
a risk of eye injury to the operator.
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Cataracts Associated with Ionizing Radiation
A new 2011 study of interventional cardiologists
and nurses in Malaysia found five times the
rate of cataracts in the group compared to
controls, suggesting that current radiation
protection thresholds may be too high to protect
providers from harm. The study, published online
in Catheterization and Cardiovascular
Interventions, found that cataract rates vary
according to the length of professional exposure,
as well as the level of eye protection operators
choose to wear.
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Occupational exposures received during
interventional cardiology procedures are the
highest doses received by health professionals.
August 2010
The Catheterization and Cardiovascular
Interventions study found
Even under normal working conditions, scatter
radiation around the patient may reach high
levels. With respect to ocular exposure, the
increasingly larger workload typical of many
modern catheterization suites, a lack of training
in radiation protection, and unavailability or
nonuse of radiation protection for the face and
head may result in doses to the eye sufficient to
cause cataracts.
Collaborating institutions included the
International Atomic Energy Agency (IAEA) in
Vienna, Austria Sarawak General Hospital in
Kuching, Malaysia Complutense University in
Madrid and Columbia University in New York City.
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Cataract formation is the primary ocular
complication associated with radiation exposure
to the eye.
A cataract generally manifests as cortical and
posterior subcapsular opacification of the lens,
the most radiosensitive eye tissue. Changes
resulting from exposure tend to appear first in
the posterior subcapsular region of the lens and
consist of small dots and vacuoles which, over
time, aggregate to form larger opacities. Thus,
cataract severity and latency are both related to
dose
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IAEA Recommendations
Catheterization and Cardiovascular Interventions
The results of the study showed a dose-dependent
increased risk of posterior lens opacities for
interventional cardiologists and nurses when
radiation protection tools were not used.
As a result, "there is an urgent need to
implement training programs in interventional
cardiology such as the standardized IAEA program,
which includes participants from more than 55
countries," they wrote. Knowledge of individual
dose levels helps increase awareness about
radiation. "Thus, good training, skilled
operators, and use of radiation protection
devices are essential elements in achieving a
safe working environment in the interventional
cardiology department.
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Whats the big deal?
The lens of the eye is the most vulnerable site
on the body for radiation damage. The radiation
dose to the eye has a cumulative effect, which
means it keeps multiplying day after day, month
after month, year after year.
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What About Exposure?
The current ICRP permissible limits are set at
150msv/year. However, new studies have shown that
people are developing cataracts at much lower
radiation doses than the permissible limits
allow. In addition, doctors are performing ever
increasing numbers of procedures per day and lens
doses often exceed the limit if between 30 and 40
procedures per month are performed. The threshold
for deterministic effects is exceeded after
several years of work on average. The lens dose
can also depend on the equipment being used
older equipment can produce more scatter
radiation and increase health risks.
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Why Wear Leaded Glasses?
A dangerous urban legend is the normal
prescription eyeglasses protect the eyes from
ionizing radiation WRONG!!! Proper use of
radiation protective eyewear reduces the
scattered radiation dose that reaches the eye to
only 2 to 3, resulting in only a few
microsieverts of eye exposure per procedure. This
sustainable exposure level will prevent long-term
PSC cataract formation. Lead glasses have evolved
from heavy, drab equipment into a lightweight and
stylish product that's convenient to wear. Lead
glasses are used by physicians and staff during
cardiac catheterization, interventional
radiology, electrophysiology, urological
procedures, pain management and orthopedic
surgery.
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Thank You
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