Usefulness of augmented reality in radiological protection education and training for interventional radiologists.

OBJECTIVE: The aim of this work is to evaluate the usefulness of using augmented reality (AR) to train medical professionals in radiological protection (RP) in fluoroscopy. METHODS: A Microsoft HoloLens 2 device has been used to simulate a fluoroscopic device. The teaching scenario considers a Philips Azurion able to rotate to pre-defined gantry positions,a dorsal decubitus patient and a ceiling shield. Radiation exposures were simulated using the FLUKA Monte Carlo code. 11 radiologists were asked to reproduce their positioning as per a clinical procedure and to correctly position the ceiling shield. Then, they were presented with the radiation exposure of their choices and were able to further optimise it. After the session, they were asked to complete a questionnaire. RESULTS: Users rated the AR educational approach as Intuitive and relevant to RP education (35%) and inspiring to deepen their knowledge (18%). Nevertheless, a negative aspect was mainly the difficulty in dealing with the system (58%). Although the participants were radiologists, a minority recognised themselves as having accurate knowledge of the RP (18%), indicating a relevant knowledge gap. CONCLUSION: The usefulness of using AR in RP education for radiologists has been shown. The visual aid of such technology is likely to improve the consolidation of practical knowledge. ADVANCES IN KNOWLEDGE: The use of interactive teaching techniques has the possibility to both help radiology professionals consolidate their radiation protection training and confidence in their practices.

Impact of the incorrect use of lead drapes on staff and patient doses in interventional radiology.

To evaluate the usefulness of commercially available scatter reduction drapes in mitigating staff exposure in interventional radiology and the potential harmful effects of drape malpositioning in terms of exposure levels to both patients and staff. An anthropomorphic phantom was irradiated on an angiography device under three scenarios: no drape and correct and incorrect drape positioning. Different levels of incorrect drape positioning relative to the field-of-view (FOV) were evaluated: slight, mild and severe. Real-time dosimeter systems (positioned on the operator's eye, chest and thyroid) were used to evaluate accumulative doses and dose rates. Different obstruction levels were evaluated and compared to the observer's perception. Additionally, patient exposure was evaluated for all scenarios using a dose area product (DAP). Up to a mild obstruction, by using the drape a dose reduction of up to 86% was obtained while a severe obstruction produced a 1000% increase in exposure, respectively for all dosimeter positions compared to the use of no drape. A similar order of magnitude was observed for patient exposure. Good agreement was obtained for the observer perception of the FOV obstruction up to 25% of the FOV; for larger obstructions, an overestimate of the obstruction was observed. Patient lead drapes can reduce staff doses in interventional radiology procedures even when mildly malpositioned and obscuring the FOV. Special attention to protective drape positioning is necessary, since the severe obstruction of the FOV results in a large increase in both operator and patient exposure.

Endovascular aortic sealing with Nellix reduces intraoperative radiation dose when compared to endovascular aortic repair.

OBJECTIVE: To analyze radiation exposure during endovascular aortic sealing (EVAS) in comparison with standard endovascular aortic repair (EVAR) in clinical practice. METHODS: From December 2013 to October 2016 (35 months), 60 patients were analyzed for intraoperative radiation exposure during EVAR: 30 consecutive patients (mean age, 73.10 years; 28 male) received EVAS (Nellix Endologix); within the same time frame, 30 patients were treated with standard EVAR (mean age, 71.87 years; 30 male). An indirect dose analysis was performed for both groups of patients, including effective dose and cumulative air kerma. Furthermore, fluoroscopy time (FT), dose area product, and time of procedure were included in the study. RESULTS: The effective dose was significantly reduced in the EVAS group (3.72 mSv) compared with the group treated with standard EVAR (6.8 mSv; P ≤ .001). The cumulative air kerma was also lowered in EVAS (67.65 mGy vs 139 mGy in EVAR; P ≤ .001). FT for the entire group was 13 minutes and was shorter (P < .001) for EVAS (9 minutes) in comparison with EVAR (19 minutes). The dose area product for the entire cohort was 16.95 Gy.cm2 and was lower during EVAS (12.4 Gy.cm2) than during EVAR (22.6 Gy.cm2; P < .001). The median operating time for the entire group was 123.5 minutes and was significantly shorter (P < .01) for EVAS (119 minutes vs EVAR at 132 minutes). The FT shows a significant correlation with the patient's weight (P = .022), body mass index (P = .004), and time of procedure (P = .005). CONCLUSIONS: EVAS is associated with a relevant decrease in indirect measured radiation dose and time of procedure compared with standard EVAR. A relevant reduction in dose during EVAS is highly likely to result in lower exposure to radiation for physicians and staff. Such a result would be highly advantageous and calls for further analysis.