The Effect of a Suspended Radiation Protection System on Occupational Radiation Doses During Infrarenal EVAR Procedures: A Randomised Controlled Study.

OBJECTIVE: To compare the protective effect of Zero Gravity (ZG) with conventional radiation protection during endovascular aneurysm repair (EVAR). Secondly, user experience was surveyed with a questionnaire on ergonomics. METHODS: This was a single centre, prospective, randomised, two arm trial where 71 consecutive elective infrarenal EVAR procedures were randomised into two groups: (1) operator using ZG and assistant using conventional protection (n = 36), and (2) operator and assistant using conventional radiation protection (n = 35). A movable floor unit ZG system consists of a lead shield (1.0 mm Pb equivalent) for the front of the body and 0.5 mm Pb equivalent acrylic shielding for the head and neck. The ZG also includes arm flaps of 0.5 mm Pb equivalent covering the arm up to the elbow. Deep dose equivalent values, Hp(10) were measured with direct ion storage dosimeters (DIS) placed on various anatomical regions of the operator (axilla, chest, abdomen, and lower leg). Personal dose equivalent values, Hp(3) to eye lenses were measured in the operating and assisting surgeon using thermoluminescence dosimeters. The study was registered at the US National Institute of Health #NCT04078165. RESULTS: Protection with the standard protection was superior in chest (0.0 vs. 0.1 µSv), abdomen (0.0 vs. 0.6 µSv), and lower leg (0.4 vs. 2.2 µSv) (p < .001). On the other hand, the ZG system yielded better shielding for the axilla (1.5 vs. 0.0 µSv) and eyes (6.3 vs. 1.1 µSv) of the operator. The use of ZG hampered the deployment of ancillary shields, which is particularly relevant for protection of the assisting surgeon. Users found ZG more cumbersome than conventional garments, it also impaired communication and reduced field of view. CONCLUSION: Both ZG and conventional radiation protection reduced radiation exposure. Conventional protection allows better manoeuvrability at the price of wider exposure of the upper arm and axilla. ZG indirectly impaired protection of the assistant.

Occupational radiation dose from gastrointestinal endoscopy procedures with special emphasis on eye lens doses in endoscopic retrograde cholangiopancreatography.

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) procedures may result in remarkable radiation doses to patients and staff. The aim of this prospective study was to determine occupational exposures in gastrointestinal endoscopy procedures, with a special emphasis on eye lens dose in ERCP. Methods Altogether 604 fluoroscopy-guided procedures, of which 560 were ERCPs belonging to four American Society for Gastrointestinal Endoscopy procedural complexity levels, were performed using two fluoroscopy systems. Personal deep-dose equivalent H p (10), shallow-dose equivalent H p (0.07), and eye lens dose equivalent H p (3) of eight interventionists and H p (3) for two nurse dosimeters were measured. Thereafter, conversion coefficients from kerma-area product (KAP) for H p (10), H p (0.07), and H p (3) were determined and dose equivalents per procedure to an operator and assisting staff were estimated. Further, mean conversion factors from H p (10) and H p (0.07) to H p (3) were calculated. Results The median KAP in ERCP was 1.0 Gy·cm 2 , with mobile c-arm yielding higher doses than a floor-mounted device ( P  < 0.001). The median H p (3) per ERCP was estimated to be 0.6 µSv (max. 12.5 µSv) and 0.4 µSv (max. 12.2 µSv) for operators and assisting staff, respectively. The median H p (10) and H p (0.07) per procedure ranged from 0.6 to 1.8 µSv. ERCP procedural complexity level ( P  ≤ 0.002) and interventionist ( P  < 0.001) affected dose equivalents. Conclusions Occupational dose limits are unlikely to be exceeded in gastrointestinal endoscopy practice when following radiation-hygienic working methods and focusing on dose optimization. The eye lens dose equivalent H p (3) may be estimated with sufficient agreement from the H p (10) and H p (0.07).

Winter condition variability decreases the economic sustainability of reindeer husbandry.

Wild and semidomesticated reindeer are one of the key species in Arctic and subarctic areas, and their population dynamics are closely tied to winter conditions. Difficult snow conditions have been found to decrease the calving success and survivability of reindeer, but the economic effects of variation in winter conditions on reindeer husbandry have not been studied. In this study, we combine state-of-the-art economic-ecological modeling with the analysis of annual reindeer management reports from Finland. These contain local knowledge of herding communities. We quantify the occurrence probabilities of different types of winters from annual management reports and analyze the effects of this variation in winter conditions on reindeer husbandry using an age- and sex-structured bioeconomic reindeer-lichen model. Our results show that difficult winters decrease the net revenues of reindeer husbandry. However, they also protect lichen pastures from grazing, thereby increasing future net revenues. Nonetheless, our solutions show that the variability of winter conditions overall decrease the net income of herders compared to constant winter conditions. Low lichen biomass appears to make reindeer management more sensitive to the effects of difficult winter conditions. We also found that it is economically sensible to use supplementary feeding during difficult winters, but the net revenues still decrease compared to average winters because of the high feeding costs. Overall, our analysis suggests that the increasing variability of winter conditions due to climate change will decrease net revenues in reindeer husbandry. This decrease will still occur even if the most extreme effects of climate change do not occur. This study shows that combining a state-of-the-art bioeconomic model and practitioner knowledge can bring compatible insights, ideas, results, and a bottom-up perspective to the discussion.

Staff eye lens dose in interventional radiology and cardiology in Finland.

PURPOSE: The aim of this study was to investigate the eye lens and whole-body radiation doses to interventional radiology and cardiology staff in two Finnish hospitals. METHODS: Simultaneous measurements of personal dose equivalent quantities Hp(3) and Hp(10) were conducted in clinical conditions during different radiological and cardiological interventional procedures. In order to study the feasibility to estimate eye lens dose with Hp(10) measured over the protective apron or thyroid shield, the ratio between measured Hp(3) and Hp(10) was investigated. RESULTS AND CONCLUSIONS: Applying the obtained ratio on Hp(10) records from national dose register showed that only a small number of interventional radiologists and cardiologists in Finland may exceed eye lens equivalent dose levels of 20 mSv per year or 100 mSv in five consecutive years, but likely do not exceed 50 mSv in a single year. For the most Finnish interventionalists, the eye lens dose is well below 10 mSv per year. Nurses and radiographers assisting in interventions are, on average, less exposed than interventionalists, and will not exceed 20 mSv per year. Based on our results, Hp(10) measured over the protective apron or thyroid shield provides a conservative estimate of the eye lens dose for interventional radiologists and cardiologists, provided that appropriate protective glasses are used.

ESTIMATION OF OCCUPATIONAL RADIATION EXPOSURE FOR MEDICAL WORKERS IN RADIOLOGY AND CARDIOLOGY IN THE UNITED ARAB EMIRATES: NINE HOSPITALS EXPERIENCE.

PURPOSE: Occupational radiation exposure for medical workers in radiology and cardiology was analyzed in nine hospitals in the UAE between 2002 and 2016. The purpose of the study was to determine the time trend and the differences in occupational radiation exposure among worker groups and hospitals in the country. METHODS: Readings of 5700 thermoluminescence dosimeters (TLDs) were obtained from 1011 medical workers and grouped into 5 worker groups (radiographers, diagnostic radiologists, nurses, cardiologists and physicians). RESULTS: The mean annual effective dose was from 0.38 to 0.62 mSv per worker. Even though an increase in the collective effective dose has been noticed during the study period, no significant time trend was observed in the mean effective dose. Furthermore, cardiologists received higher mean and maximum effective doses than the other worker groups. CONCLUSION: The annual effective doses were below the limits set by national legislation and international standards, and for the average worker, the likelihood of high exposure is small. However, improvements in radiation protection practices could be implemented to reduce occupational radiation dose to cardiologists, who were the most exposed worker group in this study.

Potential occupational exposures in diagnostic and interventional radiology: statistical modeling based on Finnish national dose registry data.

BACKGROUND: Radiation worker categorization and exposure monitoring practices must be proportional to the current working environment. PURPOSE: To analyze exposure data of Finnish radiological workers and to estimate the magnitude and frequency of their potential occupational radiation exposure, and to propose appropriate radiation worker categorization. MATERIAL AND METHODS: Estimates of the probabilities of annual effective doses exceeding certain levels were obtained by calculating the survival function of a lognormal probability density function (PDF) fitted in the measured occupational exposure data. RESULTS: The estimated probabilities of exceeding annual effective dose limits of 1 mSv, 6 mSv, and 20 mSv were in the order of 1:200, 1:10,000, and 1:500,000 per person, respectively. CONCLUSION: It is very unlikely that the Category B annual effective dose limit of 6 mSv could even potentially be exceeded using modern equipment and appropriate working methods. Therefore, in terms of estimated effective dose, workers in diagnostic and interventional radiology could be placed into Category B in Finland. Current national personal monitoring practice could be replaced or supplemented using active personal dosimeters, which offer more effective means for optimizing working methods.

Parameterization and validation of an ungulate-pasture model.

Ungulate grazing and trampling strongly affect pastures and ecosystems throughout the world. Ecological population models are used for studying these systems and determining the guidelines for sustainable and economically viable management. However, the effect of trampling and other resource wastage is either not taken into account or quantified with data in earlier models. Also, the ability of models to describe the herbivore impact on pastures is usually not validated. We used a detailed model and data to study the level of winter- and summertime lichen wastage by reindeer and the effects of wastage on population sizes and management. We also validated the model with respect to its ability of predicting changes in lichen biomass and compared the actual management in herding districts with model results. The modeling efficiency value (0.75) and visual comparison between the model predictions and data showed that the model was able to describe the changes in lichen pastures caused by reindeer grazing and trampling. At the current lichen biomass levels in the northernmost Finland, the lichen wastage varied from 0 to 1 times the lichen intake during winter and from 6 to 10 times the intake during summer. With a higher value for wastage, reindeer numbers and net revenues were lower in the economically optimal solutions. Higher wastage also favored the use of supplementary feeding in the optimal steady state. Actual reindeer numbers in the districts were higher than in the optimal steady-state solutions for the model in 18 herding districts out of 20. Synthesis and applications. We show that a complex model can be used for analyzing ungulate-pasture dynamics and sustainable management if the model is parameterized and validated for the system. Wastage levels caused by trampling and other causes should be quantified with data as they strongly affect the results and management recommendations. Summertime lichen wastage caused by reindeer is higher than expected, which suggests that seasonal pasture rotation should be used to prevent the heavy trampling of winter lichen pastures during summer. In the present situation, reindeer numbers in northernmost Finland are in most cases higher than in the management solutions given by the model.