Efficacy of radiation attenuating caps in reducing radiation doses received at the cerebral level in interventional physicians: a systematic review.

BACKGROUND: Anecdotal reports are appearing in the scientific literature about cases of brain tumors in interventional physicians who are exposed to ionizing radiation. In response to this alarm, several designs of leaded caps have been made commercially available. However, the results reported on their efficacy are discordant. OBJECTIVE: To synthesise, by means of a systematic review of the literature, the capacity of decreasing radiation levels conferred by radiation attenuating devices (RAD) at the cerebral level of interventional physicians. METHODOLOGY: A systematic review were performed including the following databases: MEDLINE, SCOPUS, EBSCO, Science Direct, Cochrane Controlled Trials Register (CENTRAL), WOS, WHO International Clinical Trials Register, Scielo and Google Scholar, considering original studies that evaluated the efficacy of RAD in experimental or clinical contexts from January 1990 to May 2022. Data selection and extraction were performed in triplicate, with a fourth author resolving discrepancies. RESULTS: Twenty articles were included in the review from a total of 373 studies initially selected from the databases. From these, twelve studies were performed under clinical conditions encompassing 3801 fluoroscopically guided procedures, ten studies were performed under experimental conditions with phantoms, with a total of 88 procedures, four studies were performed using numerical calculations with a total of 63 procedures. The attenuation and effectiveness of provided by the caps analysed in the present review varying from 12.3% to 99.9%, y 4.9% to 91% respectively. CONCLUSION: RAD were found to potentially provide radiation protection, but a high heterogeneity in the shielding afforded was found. This indicates the need for local assessment of cap efficiency according to the practice.

Descripción de elementos de radioprotección y dosimetría en unidades de cardiología intervencionista sudamericanas: un estudio piloto / Radioprotection and dosimetry in Interventional cardiology units in South America. a pilot study

ANTECEDENTES: Las unidades de Cardiología intervencional han evidenciado un número creciente de procedimientos, cada vez más variados y complejos, lo cual podría eventualmente generar daños a los profesionales ocupacionalmente expuestos a radiaciones ionizantes (POEs) de no contar con los adecuados elementos de radioprotección y un uso correcto de ellos. OBJETIVO: Caracterizar la disponibilidad y utilización de los elementos de radioprotección y dosimetría de unidades de cardiología intervencionista de centros Sudamericanos. MATERIAL Y MÉTODOS: Se realizó una encuesta autoaplicada a 139 POEs, de ambos sexos de 7 países, a través de una plataforma on-line, se les consultó sobre características demográficas, dosimétricas y de radioprotección. RESULTADOS: Los elementos de radioprotección más tradicionales; delantales y cuellos plomados se utilizaron un 99,5 % y 98,4 % respectivamente, aquellos elementos más recientes como gafas, gorros y paños plomados solo alcanzaron un 36,8 %, 6,8 % y 34,2%, de utilización respectivamente, en cuanto a la utilización de los dosímetros, solo un 7,9 % lo hace apegado a las normas de la Organización Internacional de Energía Atómica (OIEA). CONCLUSIÓN: Se constató en la muestra analizada una falta de elementos de radioprotección y un uso inadecuado de ellos, urge realizar intervenciones educativas y técnicas para mejorar estos datos.

BACKGROUND: Due to the increasing number of interventional cardiology procedures currently performed, health professionals (POE) are exposed to ionizing radiation unless adequate protective elements are used. AIM: to describe the use of radioprotection elements and dosimetry in interventional cardiology laboratories in South America. METHODS: A self-administered survey was performed on 139 POE of both sexes and 7 countries using an online platform. Demographic data, dosimetry and characteristics of radioprotection analyzed. RESULTS: Commonly used radioprotective elements (lead aprons and collars) were used in 99.5% and 98% respectively. Recently introduced protection elements like lead goggles, caps and drapery were used in 36.8, 6.8 and 34.2% , respectively. Dosimetry according to the International Atomic Energy Commission (OIAE) was performed in only 7.9% of the procedures. CONCLUSION: there is a severe lack of adequate radioprotection during interventional cardiology procedures. Urgent measures, including technical implementation and educational interventions are needed to improve radioprotection in interventional cardiology.

Análisis citogenético en linfocitos de trabajadores expuestos a radiación ionizante en una unidad de cardiología intervencional de Chile: estudio piloto y revisión de la literatura / Citogenetic effects upon lymphocyes in subjects exposed to ionizing radiadion in an interventional laboratory cardiology: pilot study and literature review

ANTECEDENTES: Un número creciente de artículos está llamando la atención en forma consistente sobre la eventual asociación que existe entre los denominados trabajadores ocupacionalmente expuestos a bajos niveles de radiación ionizante (POEs) y una mayor frecuencia de aberraciones cromosómicas, a nivel Sudamericano estos estudios son escasos. OBJETIVO: Evaluar la frecuencia de aberraciones cromosómicas en linfocitos de sangre periférica de POEs de un hospital y de sujetos sanos. Adicionalmente, se realizó una revisión exhaustiva de los artículos que a la fecha abordaron este tema. MATERIAL Y MÉTODO: Se condujo un análisis citogenético destinado a cuantificar las aberraciones cromosómicas en sangre periférica de linfocitos de 6 POEs de la unidad de Cardiología Intervencional y, como controles, 6 muestras de sujetos de la población general fueron analizadas. RESULTADOS: Se observó un importante contraste en el número de aberraciones cromosómicas presentadas en los POEs versus la población general no expuesta a radiaciones ionizantes, siendo esta de una relación de 6:1, respectivamente. CONCLUSIÓN: Los resultados preliminares indican una mayor frecuencia de aberraciones cromosómicas en los POEs versus la población general, sin embargo, se deberá esperar los resultados de la segunda fase de investigación, donde al ampliar la muestra en análisis se podrán obtener conclusiones estadísticamente significativas.

BACKGROUND: There is growing evidence of an increased number of chromosomes aberrations in subjects exposed to low levels of ionizing radiation (POEs). There are few studies on this subject in Latin America AIM: To evaluate the frequency of chromosome aberrations in lymphocytes obtained from peripheral blood in subjects working in laboratories where low levels of ionizing radiation are present and to compare these findings to those of unexposed subjects. METHODS: A cytogenic analysis to quantify chromosome aberrations was performed in 6 POs subjects from a cardiology invasive laboratory and 6 controls from a general unexposed population. RESULTS: Compared to controls, an approximately 6-fold increase in the number of chromosome aberrations was observed.in subjects exposed to ionizing radiation CONCLUSION: These preliminary results indicate that there is an increased number of chromosome aberrations in subjects exposed to low levels of ionizing radiation, as occurs in people working in a cardiology interventional laboratory. Studies in large numbers of subjects and preferably followed prospectively are needed to evaluate more precisely this effect.

[Lactococcus garvieae endocarditis in a patient undergoing chronic hemodialysis. First case report in Chile and review of the literature]. / Endocarditis por Lactococcus garvieae en un paciente sometido a hemodialisis crónica. Primer caso reportado en Chile y revisión de la literatura.

Reports of Lactococcus garvieae infections in humans are scarce, and only one of them in a patient under-going hemodialysis. We report the first case of Lactococcus garvieae infection in Chile, presenting as an infective endocarditis, ultimately fatal, in a patient with uncomplicated colonic diverticulosis and end stage renal failure undergoing chronic hemodialysis. We review the published cases and discuss the diagnostic and therapeutic challenges associated with this new, increasingly diagnosed pathogen, capable of producing serious infections in susceptible patients.

Endocarditis por Lactococcus garvieae en un paciente sometido a hemodialisis crónica. Primer caso reportado en Chile y revisión de la literatura / Lactococcus garvieae endocarditis in a patient undergoing chronic hemodialysis. First case report in Chile and review of the literature

Resumen Los casos reportados de infección por Lactococcus garvieae son escasos y sólo uno asociado a hemodiálisis. Comunicamos el caso de endocarditis infecciosa de curso fatal por L. garvieae en un paciente con una enfermedad renal crónica sometido a hemodiálisis y portador de diverticulosis colónica no complicada. Se realiza una revisión de los casos publicados y se discuten los actuales desafíos diagnósticos y terapéuticos de este patógeno, capaz de producir infecciones graves y potencialmente fatales en pacientes susceptibles. Este sería el segundo caso de infección asociada a hemodiálisis y el primero reportado en Chile.

Reports of Lactococcus garvieae infections in humans are scarce, and only one of them in a patient under-going hemodialysis. We report the first case of Lactococcus garvieae infection in Chile, presenting as an infective endocarditis, ultimately fatal, in a patient with uncomplicated colonic diverticulosis and end stage renal failure undergoing chronic hemodialysis. We review the published cases and discuss the diagnostic and therapeutic challenges associated with this new, increasingly diagnosed pathogen, capable of producing serious infections in susceptible patients.

[Radiation protection provided by tungsten bismuth caps during interventional cardiology]. / ¿Es eficiente la protección anti-radiación otorgada por gorros de pabellón de tungsteno-bismuto en cardiología intervencionista?

BACKGROUND: The effectiveness against radiation of tungsten bismuth caps, used in interventional cardiology is not well known. AIM: To determine the degree of radiation protection conferred by these caps in real work conditions. MATERIAL AND METHODS: We compared the gross electric charges received at brain lobe levels by three occupationally exposed professionals who participated in 22 consecutive procedures, inside and outside of the tungsten bismuth cap. RESULTS: The median electric charges outside and inside the cap were 3.71 (range 1.46-5.62) and 2.2 (range 1.29-3.93) nC, which correspond to a 40% radiation attenuation. However, the protection was heterogeneous. CONCLUSIONS: Tungsten bismuth caps provide an adequate attenuation, but its degree is heterogeneous.

¿Es eficiente la protección anti-radiación otorgada por gorros de pabellón de tungsteno-bismuto en cardiología intervencionista? / Radiation protection provided by tungsten bismuth caps during interventional cardiology

Background: The effectiveness against radiation of tungsten bismuth caps, used in interventional cardiology is not well known. Aim: To determine the degree of radiation protection conferred by these caps in real work conditions. Material and Methods: We compared the gross electric charges received at brain lobe levels by three occupationally exposed professionals who participated in 22 consecutive procedures, inside and outside of the tungsten bismuth cap. Results: The median electric charges outside and inside the cap were 3.71 (range 1.46-5.62) and 2.2 (range 1.29-3.93) nC, which correspond to a 40% radiation attenuation. However, the protection was heterogeneous. Conclusions: Tungsten bismuth caps provide an adequate attenuation, but its degree is heterogeneous.

¿Son reproducibles las mediciones dosimétricas a bajas dosis en cardiología intervencionista? / Are dosimetric measurements at low doses reproducible in interventional cardiology?

Abstract. There are several methods for measuring the absorbed radiation dose of occupationally exposed professionals, but it is unknown if these are reproducible at low doses. The aim of this study is to determine the level of reproducibility of thermoluminescent dosimeters (TLD) and optically stimulated luminescence dosimeters (OSL) in simulated conditions. A reproducibility study was performed using two types of dosimeters, which were placed in the location of medical interventionist work area inside the catheter laboratory. An anthropomorphic phantom was used as a patient and the same projections, collimation and radiographic techniques that were employed in the past 30 angiographies, an examination considered as low exposure in the context of interventional cardiology. Lin's concordance coefficient correlation was calculated, obtaining a value of -0.006 with a 95% CI of -0.069 to 0.056 for TLD dosimeters with OSL. The data obtained showed poor reproducibility at low doses of radiation.

Resumen. Existen varios métodos para medir la dosis de radiación absorbida por los profesionales ocupacionalmente expuestos, pero se desconoce si estos son reproducibles entre sí a bajas dosis. El objetivo del estudio fue determinar el grado de reproducibilidad entre los dosímetros termoluminiscentes (TLD) y los dosímetros luminiscentes ópticamente estimulados (OSL), en condiciones simuladas. Se realizó un estudio de reproducibilidad, empleando 2 tipos de dosímetros, los cuales se dispusieron en la ubicación de trabajo del médico intervencionista dentro del pabellón. Se empleó un fantoma antropomórfico como paciente y se replicaron las mismas proyecciones, colimación y técnicas radiológicas empleadas en las últimas 30 coronariografías, examen considerado de baja exposición en el contexto de cardiología intervencionista. Se aplicó el coeficiente de correlación de concordancia de Lin, obteniéndose un valor de -0,006 con un IC al 95% de -0,069 a 0,056 para los dosímetros TLD con OSL. Los datos obtenidos mostraron una escasa reproducibilidad a bajas dosis de radiación.

[Protection against ionizing radiation by leaded glass googles during interventional cardiology]. / ¿Es suficiente la protección otorgada por gafas plomadas en cardiología intervencionista?

BACKGROUND: It is not known whether leaded glass goggles with 0.25 mm Pb equivalency, used in interventional cardiology procedures, attenuate radiation below the levels established by the latest recommendation of the International Commission on Radiological Protection (ICRP). AIM: To assess if the degree of attenuation of the secondary ionizing radiation achieved by the use of 0.25 mm Pb leaded glass goggles, in occupationally exposed workers in interventional cardiology procedures, meets the latest ICRP recommendations. MATERIAL AND METHODS: A prospective investigation was carried out to compare the eye exposure to secondary ionizing radiation received by occupationally exposed personnel in a 9 months period. A set of two thermo luminescent dosimeters was arranged in the front and back of leaded glass goggles in a cohort of seven members of an interventional cardiology service, exposed to 1057 consecutive procedures. RESULTS: The monthly dose equivalent measurement performed in front of the goggles ranged between 1.1 and 6.5 mSv, for paramedics and interventional cardiologists. The radiation measured in the back of the glass varied between 0.66 and 2.75 mSv, respectively. The degree of attenuation of the dose at eye level ranged from 40% to 57.7%, respectively. The projected annual exposure would reach 33 mSv for the interventional cardiologist. CONCLUSIONS: With a similar load of work and wearing 0.25 mm Pb equivalent glass goggles, interventional cardiologists will exceed the crystalline equivalent dose limit recommended by the ICRP (20 mSv/year averaged over the past 5 years).

¿Es suficiente la protección otorgada por gafas plomadas en cardiología intervencionista? / Protection against ionizing radiation by leaded glass googles during interventional cardiology

Background: It is not known whether leaded glass goggles with 0.25 mm Pb equivalency, used in interventional cardiology procedures, attenuate radiation below the levels established by the latest recommendation of the International Commission on Radiological Protection (ICRP). Aim: To assess ifthe degree of attenuation of the secondary ionizing radiation achieved by the use of 0.25 mm Pb leaded glass goggles, in occupationally exposed workers in interventional cardiology procedures, meets the latest ICRP recommendations. Material and Methods: A prospective investigation was carried out to compare the eye exposure to secondary ionizing radiation received by occupationally exposed personnel in a 9 months period. A set of two thermo luminescent dosimeters was arranged in the front and back of leaded glass goggles in a cohort ofseven members of an interventional cardiology service, exposed to 1057 consecutive procedures. Results: The monthly dose equivalent measurement performed in front ofthe goggles ranged between 1.1 and 6.5 mSv, for paramedics and interventional cardiologists. The radiation measured in the back of the glass varied between 0.66 and 2.75 mSv, respectively. The degree of attenuation of the dose at eye level ranged from 40% to 57.7%, respectively. The projected annual exposure would reach 33 mSvfor the interventional cardiologist. Conclusions: With a similar load ofwork and wearing 0.25 mm Pb equivalent glass goggles, interventional cardiologists will exceed the crystalline equivalent dose limit recommended by the ICRP (20 mSv/year averaged over the past 5 years).