Comparing fetal phantoms with surrogate organs in female phantoms during CT exposure of pregnant patients.

With the rising use of Computed Tomography (CT) in diagnostic radiology, there are concerns regarding radiation exposure to sensitive groups, including pregnant patients. Accurately determining the radiation dose to the fetus during CT scans is essential to balance diagnostic efficacy with patient safety. This study assessed the accuracy of using the female uterus as a surrogate for fetal radiation dose during CT imaging. The study used common CT protocols to encompass various scenarios, including primary beam, scatter, and partial exposure. The computational program NCICT was used to calculate radiation doses for an adult female and a fetus phantom. The study highlighted that using the uterus for dose estimation can result in consistent underestimations of the effective dose, particularly when the fetus lies within the primary radiation beam. These discrepancies may influence clinical decisions, affecting care strategies and perceptions of associated risks. In conclusion, while the female uterus can indicate fetal radiation dose if the fetus is outside the primary beam, it is unreliable when the fetus is within the primary beam. More reliable abdomen/pelvic organs were recommended.

Exceeding radiation thresholds for cataract induction in diagnostic imaging: a paediatric case report.

This case report investigates the radiation dose received by a paediatric patient with a ventricular assist device who underwent four non-contrast brain computed tomography (CT) scans, two brain perfusion CT scans and two head angiographic CT scans. The total estimated absorbed dose to the lens of the eye is above the 500 mGy radiation-induced cataract threshold. It is recommended that this patient and those with similar imaging histories have routine follow-up with an ophthalmologist. It is also recommended that radiation dose tracking and an electronic medical alert program be implemented to allow the identification of patients who may exceed tissue reaction thresholds.

Radiation exposure to staff during fluoroscopic endoscopic procedures.

Objectives: Fluoroscopically guided procedures utilize ionizing radiation to assist in the diagnosis and treatment of the patient. The use of ionizing radiation is not without risk to the operator and other staff members present during endoscopic procedures. This study simulates radiation exposure during endoscopic retrograde cholangiopancreatography procedures under different shielded conditions and provides practical radiation safety recommendations, through easy-to-use visual guides. Methods: We obtained radiation exposure measurements at varying locations with different shielding setups surrounding a mobile C-arm fluoroscopic unit while imaging a patient equivalent phantom at different heights. Heat maps were generated for the various conditions to provide visual guides for radiation protection. Results: Different heat maps detailing various shielding methods have been generated to assist in determining the dose rate at varying locations surrounding the patient. The use of appropriate radiation protection could decrease the staff dose by up to 98%. Conclusion: Although minor per procedure, the magnitude of radiation exposure will accumulate over the staff's working life. As such, it is recommended that precautions be taken during fluoroscopically guided endoscopy procedures to ensure radiation is kept as low as reasonably achievable.

Imaging volumes during COVID-19: A Victorian health service experience.

BACKGROUND: The World Health Organisation declared the coronavirus disease 2019 (COVID-19) a pandemic on March 11, 2020. While globally, the relative caseload has been high, Australia's has been relatively low. During the pandemic, radiology services have seen significant changes in workflow across modalities and a reduction in imaging volumes. AIM: To investigate differences in modality imaging volumes during the COVID-19 pandemic across a large Victorian public health network. METHODS: A retrospective analysis from January 2019 to December 2020 compared imaging volumes across two periods corresponding to the pandemic's first and second waves. Weekly volumes across patient class, modality and mobile imaging were summed for periods: wave 1 (weeks 11 to 16 for 2019; weeks 63 to 68 for 2020) and wave 2 (weeks 28 to 43 for 2019; weeks 80 to 95 for 2020). Microsoft Power Business Intelligence linked to the radiology information system was used to mine all completed examinations. RESULTS: Summed weekly data during the pandemic's first wave showed the greatest decrease of 29.8% in adult outpatient imaging volumes and 46.3% in paediatric emergency department imaging volumes. Adult nuclear medicine demonstrated the greatest decrease of 37.1% for the same period. Paediatric nuclear medicine showed the greatest decrease of 47.8%, with angiography increasing by 50%. The pandemic's second wave demonstrated the greatest decrease of 23.5% in adult outpatient imaging volumes, with an increase of 18.2% in inpatient imaging volumes. The greatest decrease was 28.5% in paediatric emergency department imaging volumes. Nuclear medicine showed the greatest decrease of 37.1% for the same period. Paediatric nuclear medicine showed the greatest decrease of 36.7%. Mobile imaging utilisation increased between 57.8% and 135.1% during the first and second waves. A strong correlation was observed between mobile and non-mobile imaging in the emergency setting (Spearman's correlation coefficient = -0.743, P = 0.000). No correlation was observed in the inpatient setting (Spearman's correlation coefficient = -0.059, P = 0.554). CONCLUSION: Nuclear medicine was most impacted, while computed tomography and angiography were the least affected by the pandemic. The impact was less during the pandemic's second wave. Mobile imaging shows continuous growth during both waves.

COVID-19 pandemic and the effect of increased utilisation of mobile X-ray examinations on radiation dose to radiographers.

INTRODUCTION: The use of ionising radiation results in occupational exposure to medical imaging professionals, requiring routine monitoring. This study aims to assess the effect of increased utilisation of mobile X-ray units, mobile imaging of non-routine body regions and radiographer work practice changes for impact on staff radiation dose during the early stages of the COVID-19 pandemic. METHODS: A retrospective analysis of general radiology departments across two metropolitan hospitals was performed. Personal radiation monitor exposure reports between January 2019 and December 2020 were analysed. Statistical analysis was conducted using a Mann-Whitney U test when comparing each quarter, from 2019 to 2020. Categorical data were compared using a Chi-squared test. RESULTS: Mobile X-ray use during the pandemic increased approximately 1.7-fold, with the peak usage observed in September 2020. The mobile imaging rate per month of non-routine body regions increased from approximately 6.0-7.8%. Reported doses marginally increased during Q2, Q3 and Q4 of 2020 (in comparison to 2019 data), though was not statistically significant (Q2: P = 0.13; Q3: P = 0.31 and Q4 P = 0.32). In Q1, doses marginally decreased and were not statistically significant (P = 0.22). CONCLUSION: Increased utilisation and work practice changes had no significant effect on reported staff radiation dose. The average reported dose remained significantly lower than the occupational dose limits for radiation workers of 20 mSv.

THE EFFICACY OF RADPAD AS A RADIATION PROTECTION TOOL IN CT FLUOROSCOPY GUIDED LUNG BIOPSIES.

Computed tomography fluoroscopy is now the preferred technique for percutaneous lung biopsies. However, concern regarding operator and patient radiation dose remains, which warrants further exploration into dose optimisation tools. This phantom-study aims to assess the dose reduction capabilities of RADPAD, a single-use patient drape designed to decrease staff exposure to scattered radiation. Dosemeters at the waist and eye levels were used to determine the whole-body and lens exposure during simulated lung biopsy procedures while using RADPAD and other combinations of personal protective equipment. RADPAD resulted in a 36% and 38% dose reduction for whole-body and eye exposure, respectively. However, when used in combination with radioprotective eyewear and aprons, RADPAD did not reduce the radiation dose further. Consequently, the use of standard personal protective equipment is a more cost-effective option for staff dose reduction. RADPAD is useful in the reduction of radiation dose to unprotected regions.

Radiation Dose Associated With Over Scanning in Neck CT.

The increasing utilization of computed tomography scans exposes patients to significant amounts of radiation. One of the factors that can result in unnecessary radiation dose is scanning beyond the clinically indicated anatomical region. This study aims to assess the optimization in overscan frequency, scan length, and radiation dose following targeted educational talks aimed to address a routinely over scanned protocol; the computed tomography Neck. A targeted radiation awareness talk regarding scan adherence as a method of radiation dose optimization was delivered to all medical imaging technologists employed at a large teaching hospital. An audit of the radiation dose associated with computed tomography Neck protocols was conducted in the month before, a month after and 1 year after the awareness talk. Results show that following the radiation awareness talks there was a 15% reduction in overscan frequency, an average over scan length reduction of 33% and a 20% reduction in overall radiation dose. The targeted nature of the talk, explicitly addressing scan range in the neck region, significantly reduced radiation dose to the patients. The results of this study are effective in illustrating the potential clinical radiation dose saving from strict adherence to scan range.

Radiation Exposure to Staff and Patient During Videofluoroscopic Swallowing Studies and Recommended Protection Strategies.

Videofluoroscopic swallowing studies expose both the patients and the staff to ionising radiation. Although the radiation exposure is considered low compared to other diagnostic procedures, it is still prudent to keep the radiation dose as low as reasonably achievable. This review aims to summarise the latest literature pertaining to staff and patient radiation dose, as well as to make evidence-based recommendations on dose optimisation strategies. The evidence shows that patient radiation dose is low; nonetheless, care must be taken for patients that require multiple examinations. There are limited studies measuring the staff dose during videofluoroscopic swallowing procedures. However, the operator may receive radiation doses approaching 1 mSv per year. Recommendations for radiation protection strategies are summarised.

Feasibility of using ultra-low pulse rate fluoroscopy during routine diagnostic coronary angiography.

INTRODUCTION: Coronary angiogram, while a powerful diagnostic tool in coronary artery disease, is not without an associated risk from ionising radiation. There are a number of factors that influence the amount of radiation the patient receives during the procedure, some of which are under the control of the operator. One of these is an adjustment of the fluoroscopic pulse rate. This study aims to assess the feasibility of using ultra-low pulse rate (3 pulses per second(pps)) fluoroscopy during routine diagnostic coronary angiogram procedures and the effect it has on fluoroscopy time, diagnostic clarity and radiation dose. METHODS: A retrospective study of three operators each undertaking 50 coronary angiogram procedures was performed. One of the operators used a pulse rate of 3 pps and 6 pps for fluoroscopic screening while the control groups used the standard 10 pps mode utilised at this centre. RESULTS: Results demonstrated no reduction of diagnostic clarity, up to a 58% reduction in Dose Area Product and no increase in fluoroscopy time with the 3 pps setting. CONCLUSIONS: Findings from this pilot study suggest that utilisation of ultra-low pulse rate fluoroscopy in routine transfemoral diagnostic coronary angiography in the catheterisation laboratory is feasible.

Radiation exposure to sonographers from nuclear medicine patients: A review.

Following nuclear medicine scans a patient can be a source of radiation exposure to the hospital staff, including sonographers. Sonographers are not routinely monitored for occupational radiation exposure as they do not commonly interact with radioactive patients or other sources of ionizing radiation. This review aims to find evidence relating to the risk and amount of radiation the sonographer is exposed to from nuclear medicine patients. It is established in the literature that the radiation exposure to the sonographer following diagnostic nuclear medicine studies is low and consequently the risk is not significant. Nevertheless, it is paramount that basic radiation safety principles are followed to ensure any exposure to ionizing radiation is kept as low as reasonably achievable. Practical recommendations are given to assist the sonographer in radiation protection. Nuclear medicine therapy procedures may place the sonographer at higher risk and as such consultation with a Radiation Safety Officer or Medical Physicist as to the extent of exposure is recommended.

A Review of Radiation Protection Solutions for the Staff in the Cardiac Catheterisation Laboratory.

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.

An assessment of nursing staffs' knowledge of radiation protection and practice.

Although the exposure to nursing staff is generally lower than the allowable radiation worker dose limits, awareness and overcoming fears of radiation exposure is essential in order to perform routine activities in certain departments. Furthermore, the nursing staff, whether they are defined as radiation workers or not, must be able to respond to any radiological emergencies and provide care to any patient affected by radiation. This study aims to gauge the awareness of radiation safety among the nursing staff at a major hospital in different departments and recommend if further radiation safety training is required. A prospective multiple choice questionnaire was distributed to 200 nurses in 9 different departments. The questionnaire tested knowledge that would be taught at a basic radiation safety course. 147 nurses (74%) completed the survey with the average score of 40%. Furthermore, 85% of nurses surveyed felt there was a need for radiation safety training in their respective departments to assist with day to day work in the department. An increase in radiation safety materials that are specific to each department is recommended to assist with daily work involving radiation. Moreover, nursing staff that interact with radiation on a regular basis should undertake radiation safety courses before beginning employment and regular refresher courses should be made available thereafter.

Awareness of radiation dose associated with common diagnostic procedures in emergency departments: A pilot study.

BACKGROUND: The large number of diagnostic procedures undertaken in emergency departments (ED) is vital to the early diagnosis and treatment of patients. The use of ionising radiation in diagnosis adds a lifetime attributable risk (LAR) of cancer depending on the region imaged, the frequency of imaging, and dose per exposure. AIMS: This pilot study aims to assess the degree of radiation awareness amongst ED doctors at major metropolitan and regional health services in Australia, in terms of the dose and risks associated with common imaging. Secondary aims were to provide a template to practically evaluate ED doctor radiation awareness, identify factors impacting upon radiation awareness (e.g., location, seniority of doctor), and to suggest practical means to improve radiation awareness. METHODS: Physicians in the EDs of two major health services (one regional and one metropolitan) in Australia were surveyed and asked to compare the radiation dose from each procedure to what the general population is exposed to naturally from background radiation. Additionally, the physicians were asked to estimate the LAR of cancer from each diagnostic procedure. These estimates were compared to literature-sourced values to assess the accuracy of physician responses. RESULTS: Results showed that there was significant variance with regard to knowledge of dose and risk, and that respondents tended to greatly overexaggerate the radiation levels and risk associated with diagnostic imaging. Despite failing to attribute correct values, in many cases, respondents ranked scans correctly. Responses comparing differences amongst the two health services and amongst different levels of medical hierarchy largely overlapped with no clear difference between these factors. CONCLUSION: Physicians reported low confidence in their knowledge of radiation awareness and indicated the need for additional education, which would assist them in communicating the risks to patients. Furthermore, such education would assist physicians in tailoring their diagnostic imaging requests so as to minimise radiation levels in patients.

Computed tomography overexposure as a consequence of extended scan length.

INTRODUCTION: This study aimed to raise awareness around the increased effective dose as scan length chosen is increased from standard protocol METHODS: The Monte Carlo-based software CT-Expo (G. Stamm (Medizinische Hochschule Hannover, Hannover, Germany) and H.D. Nagel (SASCRAD, Buchholz, Germany)) was used to simulate the effective dose increase as the scanned region of the standard protocol increased. RESULTS: The results of this study show that for scans with a high computed tomography dose index (CTDI)vol the patient could be exposed to an extra 1 mSv within 6 cm of overscan. Protocols that investigated large scan areas may not see a significant relative dose reduction because of the use of a lower CTDIvol ; however, radiation exposure should be kept as low as reasonably achievable. CONCLUSION: There is significant dose optimisation potential when strictly adhering to appropriate scan lengths within each imaging protocol wherever possible.