Practical Aspects of Radiation Protection in Interventional Radiology

The rise in the frequency of interventional procedures over recent years is due to the significant benefits of interventional radiology. Patients may be treated as an out-patient for clinical conditions, which would have otherwise needed surgery, i.e., a more traumatic and expensive treatment. In some circumstances, for example in neuroradiology the aneurysm may be inoperable surgically and interventional radiology is the only method of treatment. The growth in interventional radiology therefore reflects a drive towards better, safer and more cost effective medicine. Certain types of interventional radiology procedures are quite complicated and may involve the use of extended fluoroscopy times and the use of high dose rates. In some cases reappearance of the original disease, such as restenosis, may lead to repeated interventions. This combination together with a lack of quality control in x-ray systems, has led deterministic effects in the skin of patients ranging from transient erythema to necrosis. In a few cases, staff doses reached the levels of deterministic effects, such as dot-like sub-capsular opacities (cataracts) and small dot-like paranuclear opacities and discrete posterior sub-capsular condensations in both eyes. A review of the reported cases of deterministic effects reveals that the working conditions in those cases were extreme. From these lessons, measures for preventing deterministic effects are straightforward and are given in this paper. In addition to these straightforward measures, a more comprehensive approach includes review of technical factors used in protocols and exploratory research of the potential for dose guidance (reference) levels as a tool for optimization.