Surgeon eye lens dose monitoring in interventional neuroradiology, cardiovascular and radiology procedures.

PURPOSE: This study investigated the radiation dose to surgeon eye lens for single procedure and normalised to exposure parameters for eight selected neuroradiology, cardiovascular and radiology interventional procedures. METHODS: The procedures investigated were diagnostic study, Arteriovenous Malformations treatment (AVM) and aneurysm embolization for neuroradiology procedures, Coronary Angiography and Percutaneous Transluminal Coronary Angioplasty (CA-PTCA), Pacemaker and Implantable Cardioverter-Defibrillator implantation (PM-ICD), Endovascular Aortic Repair (EVAR) and Fenestrated Endovascular Aortic Repair (FEVAR) for cardiovascular and electrophysiology procedures. CT-guided lung biopsy was also monitored. All procedures were performed with table-mounted and ceiling-suspended shields (0.5 mm lead equivalent thickness), except for FEVAR and PM-ICD where only a table mounted shield was present, and CT-guided lung biopsy where no shield was used. Dose assessment was performed using a dosemeter positioned close to the most exposed eye of the surgeon, outside the protective eyewear. RESULTS: The surgeon most exposed eye lens median Hp(3) equivalent dose for a single procedure, without protective eyewear contribution, was 18 µSv for neuroradiology diagnostic study, 62 µSv for AVM, 38 µSv for aneurysm embolization, 33 µSv for CA-PTCA, 39 µSv for PM-ICD, 49 µSv for EVAR, 2500 µSv for FEVAR, 153 µSv for CT-guided lung biopsy. CONCLUSIONS: In interventional procedures, the 20 mSv/year dose limit for surgeon eye lens exposure might be exceeded if shields or protective eyewear are not used. Surgeon eye lens doses, normalised to single procedures and to exposure parameters, are a valuable tool for determining appropriate radiation protection measures and dedicated eye lens dosemeter assignment.

Addressing the efficiency of X-ray protective eyewear: Proposal for the introduction of a new comprehensive parameter, the Eye Protection Effectiveness (EPE).

Radioprotection of the eye lens of medical staff involved in Surgical procedures is a subject of international debates since ICRP recommended, on 2011, a lower equivalent dose limit for the lens of the eye. In this work we address the effectiveness of different models of X-ray protective eyewear by relating actual dosimetry measurements to an ad hoc developed mathematical model, in order to disentangle the contribution of geometrical factors and shield capabilities. Phantom irradiation was carried out in fixed exposure conditions in angiographic room: we found that measured Dose Reduction Factors (DRF) strongly depend on the ergonomics of the investigated eyewear. Actually a very poor DRF was observed in the case of a glass model in spite of its high nominal attenuation, whereas a protective tool with low shielding capabilities such a visor resulted much more effective as a consequence of is shape (i.e. extended geometric protection of the eye lens). Our work highlights the need of the introduction of a specific parameter to quantify the effectiveness of the protection tools and able to predict their DRF by taking into account the geometry of the clinical condition of exposure. Aiming at making steps forward the standardization of the guidelines concerning the features of eye protective tools, we developed a simple mathematical model describing the eye lens irradiation geometry which allows the introduction, for each eyewear, of a comprehensive parameter, the Eye Protection Effectiveness (EPE), that, for any defined clinical irradiation condition and glass shielding capabilities and shape, defines the overall effective X-ray protection of the eyewear.

CT image quality assessment by a Channelized Hotelling Observer (CHO): Application to protocol optimization.

In this work we investigate the feasibility of employing a Channelized Hotelling model Observer (CHO) in a CT protocol optimization program with the aim at assuring that the scanners are working at their own best with regard to the quality of images and patient exposure. Although the benefit of using model observers in the clinical protocol optimization is evident, in the practice it is still to be investigated what are the pitfalls associated with this method. With this concern we focused on a clinical protocol for oncology of the abdomen. For the implementation of CHO, we designed a new phantom with the aim of minimizing the number of acquired images. After tuning the model according to a restricted data set, we applied it to the evaluation of a large data set of images obtained with different reconstruction algorithms and acquired on different scanners. Results were very encouraging about the usefulness of CHO for the mentioned purposes. For the first time, at our knowledge, the applicability of CHO was demonstrated for images reconstructed with both filtered back projection (FBP) and iterative (IR) algorithms on the same scanner as well as for images from different scanners, though produced by the same manufacturer. Instead it turned out that CHO was not applicable for the same purposes over images from another manufacturer.

AEC set-up optimisation with computed radiography imaging.

Phototimer set-up is a critical procedure for dose and image quality optimisation in computed radiography (CR) systems. While a conventional radiography automatic exposure control device (AEC) can be calibrated in order to gain a constant optical density on the film independent of beam quality and patient size, CR detectors present a high dynamic range which allows a much larger dose interval, but with different image quality levels. CR leads to a less frequent exam repetition, but may produce quite noisy images if the exposure level on the plate is not correct. The aim of this work is to evaluate the performance of a CR plate (Agfa MD40) in order to optimally calibrate an AEC device. The plate response has been characterised in terms of digital signal, exposure on the plate and signal-to-noise ratio for different beam qualities, in a patient of standard size.

Photon migration through a turbid slab described by a model based on diffusion approximation. II. Comparison with Monte Carlo results.

In our companion paper we presented a model to describe photon migration through a diffusing slab. The model, developed for a homogeneous slab, is based on the diffusion approximation and is able to take into account reflection at the boundaries resulting from the refractive index mismatch. In this paper the predictions of the model are compared with solutions of the radiative transfer equation obtained by Monte Carlo simulations in order to determine the applicability limits of the approximated theory in different physical conditions. A fitting procedure, carried out with the optical properties as fitting parameters, is used to check the application of the model to the inverse problem. The results show that significant errors can be made if the effect of the refractive index mismatch is not properly taken into account. Errors are more important when measurements of transmittance are used. The effects of using a receiver with a limited angular field of view and the angular distribution of the radiation that emerges from the slab have also been investigated.