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E Vano - One of the best experts on this subject based on the ideXlab platform.
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the international atomic energy agency action plan on Radiation Protection of patients and staff in interventional procedures achieving change in practice
Physica Medica, 2018Co-Authors: Virginia Tsapaki, Donald L. Miller, Madan M. Rehani, Ola Holmberg, Stephen Balter, C Cousins, P Miranda, E VanoAbstract:Abstract Introduction The International Atomic Energy Agency (IAEA) organized the 3rd international conference on Radiation Protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session. Material and methods The IAEA conference was conducted as a series of plenary sessions followed by various thematic sessions. “Radiation Protection of patients and staff in interventional procedures” session keynote speakers presented information on: 1) Risk management of skin injuries, 2) Occupational Radiation risks and 3) RP for paediatric patients. Then, a summary of the session-related papers was presented by a rapporteur, followed by an open question-and-answer discussion. Results Sixty-seven percent (67%) of papers came from Europe. Forty-four percent (44%) were patient studies, 44% were occupational and 12% were combined studies. Occupational studies were mostly on eye lens dosimetry. The rest were on scattered Radiation measurements and dose tracking. The majority of patient studies related to patient exposure with only one study on paediatric patients. Automatic patient dose reporting is considered as a first step for dose optimization. Despite efforts, paediatric IP Radiation dose data are still scarce. The keynote speakers outlined recent achievements but also challenges in the field. Forecasting technology, task-specific targeted education from educators familiar with the clinical situation, more accurate estimation of lens doses and improved identification of high-risk professional groups are some of the areas they focused on. Conclusions Manufacturers play an important role in making patients safer. Low dose technologies are still expensive and manufacturers should make these affordable in less resourced countries. Automatic patient dose reporting and real-time skin dose map are important for dose optimization. Clinical audit and better QA processes together with more studies on the impact of lens opacities in clinical practice and on paediatric patients are needed.
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occupational Radiation Protection in interventional radiology a joint guideline of the cardiovascular and interventional radiology society of europe and the society of interventional radiology
CardioVascular and Interventional Radiology, 2010Co-Authors: Donald L. Miller, Renato Padovani, E Vano, Gabriel Bartal, Stephen Balter, Robert G Dixon, Beth A Schueler, John F Cardella, Thierry De BaereAbstract:Fluoroscopically guided interventional procedures are performed in large numbers in Europe and in the United States. The number of procedures performed annually throughout the world has increased over the past 20 years [1]. The benefits of interventional radiology to patients are both extensive and beyond dispute, but many of these procedures also have the potential to produce patient Radiation doses high enough to cause Radiation effects and occupational doses to interventional radiologists high enough to cause concern [1–4]. A joint SIR–CIRSE guideline on patient Radiation management has addressed patient issues [3]. This guideline is intended to serve as a companion to that document and provides guidance to help minimize occupational Radiation dose. The Radiation dose received by interventional radiologists can vary by more than an order of magnitude for the same type of procedure and for similar patient dose [4]. Recently, there has been particular concern regarding occupational dose to the lens of the eye in interventional radiologists [2]. New data from exposed human populations suggest that lens opacities (cataracts) occur at doses far lower than those previously believed to cause cataracts [5, 6]. Statistical analysis of the available data suggests absence of a threshold dose, although if one does exist, it is possible that it is less than 0.1 Gy [7, 8]. Additionally, it appears that the latency period for Radiation cataract formation is inversely related to the Radiation dose [5]. Occupational Radiation Protection is a necessity whenever Radiation is used in the practice of medicine. It is especially important for image-guided medical procedures [4, 9]. These procedures may involve high Radiation dose rates in the interventional laboratory [10, 11]. Occupational Radiation Protection is necessary, not only during fluoroscopically guided procedures but also during CT-guided procedures, including CT fluoroscopy. CT fluoroscopy is not really fluoroscopy at all. It differs from conventional fluoroscopy in both equipment and technique. The Radiation Protection concerns for CT fluoroscopy differ somewhat, particularly in terms of avoiding an excessive Radiation dose to the interventional radiologist’s hands [12, 13]. Occupational Radiation Protection requires both the appropriate education and training for the interventional radiologist and the availability of appropriate Protection tools and equipment. Occupational Radiation Protection measures must also comply with local and national regulations, and should also consider the ergonomic detriment caused by personal protective devices [14–16]. Occupational Radiation Protection measures are necessary for all individuals who work in the interventional fluoroscopy suite. This includes not only technologists and nurses, who spend a substantial amount of time in a Radiation environment, but also individuals such as anesthesiologists who may be in a Radiation environment only occasionally. All of these individuals may be considered Radiation workers, depending on their level of exposure and on national regulations. All workers require appropriate monitoring, as well as Protection tools and equipment. They must also receive education and training appropriate to their jobs [14]. The level of training should be based on the level of risk. This guideline is intended to offer a basic review of the medical physics relevant to occupational Radiation safety and to provide advice and guidance to interventional radiologists who perform procedures with the guidance of ionizing Radiation and their staff. In this document, the emphasis is Radiation Protection during fluoroscopically guided procedures.
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icrp special Radiation Protection issues in interventional radiology digital and cardiac imaging
Radiation Protection Dosimetry, 2005Co-Authors: E Vano, K FaulknerAbstract:The International Commission on Radiological Protection (ICRP) has published two reports giving recommendations dealing with the avoidance of deterministic injuries in interventional radiology and the management of patient dose in digital radiology in 2001 and 2004, respectively. Another document, on Radiation Protection for cardiologists performing fluoroscopically guided procedures, will be produced during 2005. This paper highlights some of the topics of the published reports, their relevance to European legislation on medical exposures and the importance of Radiation Protection research in underpinning the ICRP task groups' work in to producing these documents. It is also anticipated that the results, obtained in the cardiology work package of the European research project, will be used in the new document on Radiation Protection for cardiologists.
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dosimetric and Radiation Protection considerations based on some cases of patient skin injuries in interventional cardiology
British Journal of Radiology, 1998Co-Authors: E Vano, L Arranz, J M Sastre, C Moro, A Ledo, M T Garate, I MinguezAbstract:Recently, several cases of skin injuries have been detected in patients undergoing cardiac radiofrequency catheter ablation. These procedures were performed on a biplane X-ray system used in a large Spanish hospital for interventional cardiology procedures. Interventional procedures performed and Radiation lesions produced on patients are described. The Radiation lesions were mainly erythematous lesions and chronic radiodermatitis. Results of the dosimetric evaluations and an analysis of the operational aspects of radiological Protection are discussed. Poor image quality could have influenced the length of the procedures. Dose rate at the image intensifier entrance was within usual reported values in literature. However, the focus-to-skin distance for the horizontal X-ray beam was too short, resulting in a high skin dose rate. Additionally, X-ray beams are of fixed orientation, and accumulated skin dose in the patient's right side has been estimated as 11-15 Gy per procedure. In conclusion, practical Radiation Protection considerations to avoid further incidents of this sort are proposed, concerning the use of X-ray systems specially designed for interventional radiology, the improvement of cardiologists' training in Radiation Protection and routine patient dose measurements for complex interventional procedures.
Donald L. Miller - One of the best experts on this subject based on the ideXlab platform.
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the international atomic energy agency action plan on Radiation Protection of patients and staff in interventional procedures achieving change in practice
Physica Medica, 2018Co-Authors: Virginia Tsapaki, Donald L. Miller, Madan M. Rehani, Ola Holmberg, Stephen Balter, C Cousins, P Miranda, E VanoAbstract:Abstract Introduction The International Atomic Energy Agency (IAEA) organized the 3rd international conference on Radiation Protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session. Material and methods The IAEA conference was conducted as a series of plenary sessions followed by various thematic sessions. “Radiation Protection of patients and staff in interventional procedures” session keynote speakers presented information on: 1) Risk management of skin injuries, 2) Occupational Radiation risks and 3) RP for paediatric patients. Then, a summary of the session-related papers was presented by a rapporteur, followed by an open question-and-answer discussion. Results Sixty-seven percent (67%) of papers came from Europe. Forty-four percent (44%) were patient studies, 44% were occupational and 12% were combined studies. Occupational studies were mostly on eye lens dosimetry. The rest were on scattered Radiation measurements and dose tracking. The majority of patient studies related to patient exposure with only one study on paediatric patients. Automatic patient dose reporting is considered as a first step for dose optimization. Despite efforts, paediatric IP Radiation dose data are still scarce. The keynote speakers outlined recent achievements but also challenges in the field. Forecasting technology, task-specific targeted education from educators familiar with the clinical situation, more accurate estimation of lens doses and improved identification of high-risk professional groups are some of the areas they focused on. Conclusions Manufacturers play an important role in making patients safer. Low dose technologies are still expensive and manufacturers should make these affordable in less resourced countries. Automatic patient dose reporting and real-time skin dose map are important for dose optimization. Clinical audit and better QA processes together with more studies on the impact of lens opacities in clinical practice and on paediatric patients are needed.
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Recommendations for occupational Radiation Protection in interventional cardiology
Catheterization and Cardiovascular Interventions, 2013Co-Authors: Ariel Durán, Sim Kui Hian, John Le Heron, Renato Padovani, Donald L. Miller, Jon Heron, Eliseo VanoAbstract:The Radiation dose received by cardiologists during percutaneous coronary interventions, electrophysiology procedures and other interventional cardiology procedures can vary by more than an order of magnitude for the same type of procedure and for similar patient doses. There is particular concern regarding occupational dose to the lens of the eye. This document provides recommendations for occupational Radiation Protection for physicians and other staff in the interventional suite. Simple methods for reducing or minimizing occupational Radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in Radiation Protection for all interventional cardiology personnel, and the availability of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of Radiation Protection in the interventional suite. These recommendations for occupational Radiation Protection in interventional cardiology and electrophysiology have been endorsed by the Asian Pacific Society of Interventional Cardiology, the European Association of Percutaneous Cardiovascular Interventions, the Latin American Society of Interventional Cardiology, and the Society for Cardiovascular Angiography and Interventions.
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occupational Radiation Protection in interventional radiology a joint guideline of the cardiovascular and interventional radiology society of europe and the society of interventional radiology
CardioVascular and Interventional Radiology, 2010Co-Authors: Donald L. Miller, Renato Padovani, E Vano, Gabriel Bartal, Stephen Balter, Robert G Dixon, Beth A Schueler, John F Cardella, Thierry De BaereAbstract:Fluoroscopically guided interventional procedures are performed in large numbers in Europe and in the United States. The number of procedures performed annually throughout the world has increased over the past 20 years [1]. The benefits of interventional radiology to patients are both extensive and beyond dispute, but many of these procedures also have the potential to produce patient Radiation doses high enough to cause Radiation effects and occupational doses to interventional radiologists high enough to cause concern [1–4]. A joint SIR–CIRSE guideline on patient Radiation management has addressed patient issues [3]. This guideline is intended to serve as a companion to that document and provides guidance to help minimize occupational Radiation dose. The Radiation dose received by interventional radiologists can vary by more than an order of magnitude for the same type of procedure and for similar patient dose [4]. Recently, there has been particular concern regarding occupational dose to the lens of the eye in interventional radiologists [2]. New data from exposed human populations suggest that lens opacities (cataracts) occur at doses far lower than those previously believed to cause cataracts [5, 6]. Statistical analysis of the available data suggests absence of a threshold dose, although if one does exist, it is possible that it is less than 0.1 Gy [7, 8]. Additionally, it appears that the latency period for Radiation cataract formation is inversely related to the Radiation dose [5]. Occupational Radiation Protection is a necessity whenever Radiation is used in the practice of medicine. It is especially important for image-guided medical procedures [4, 9]. These procedures may involve high Radiation dose rates in the interventional laboratory [10, 11]. Occupational Radiation Protection is necessary, not only during fluoroscopically guided procedures but also during CT-guided procedures, including CT fluoroscopy. CT fluoroscopy is not really fluoroscopy at all. It differs from conventional fluoroscopy in both equipment and technique. The Radiation Protection concerns for CT fluoroscopy differ somewhat, particularly in terms of avoiding an excessive Radiation dose to the interventional radiologist’s hands [12, 13]. Occupational Radiation Protection requires both the appropriate education and training for the interventional radiologist and the availability of appropriate Protection tools and equipment. Occupational Radiation Protection measures must also comply with local and national regulations, and should also consider the ergonomic detriment caused by personal protective devices [14–16]. Occupational Radiation Protection measures are necessary for all individuals who work in the interventional fluoroscopy suite. This includes not only technologists and nurses, who spend a substantial amount of time in a Radiation environment, but also individuals such as anesthesiologists who may be in a Radiation environment only occasionally. All of these individuals may be considered Radiation workers, depending on their level of exposure and on national regulations. All workers require appropriate monitoring, as well as Protection tools and equipment. They must also receive education and training appropriate to their jobs [14]. The level of training should be based on the level of risk. This guideline is intended to offer a basic review of the medical physics relevant to occupational Radiation safety and to provide advice and guidance to interventional radiologists who perform procedures with the guidance of ionizing Radiation and their staff. In this document, the emphasis is Radiation Protection during fluoroscopically guided procedures.
Eliseo Vano - One of the best experts on this subject based on the ideXlab platform.
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Recommendations for occupational Radiation Protection in interventional cardiology
Catheterization and Cardiovascular Interventions, 2013Co-Authors: Ariel Durán, Sim Kui Hian, John Le Heron, Renato Padovani, Donald L. Miller, Jon Heron, Eliseo VanoAbstract:The Radiation dose received by cardiologists during percutaneous coronary interventions, electrophysiology procedures and other interventional cardiology procedures can vary by more than an order of magnitude for the same type of procedure and for similar patient doses. There is particular concern regarding occupational dose to the lens of the eye. This document provides recommendations for occupational Radiation Protection for physicians and other staff in the interventional suite. Simple methods for reducing or minimizing occupational Radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in Radiation Protection for all interventional cardiology personnel, and the availability of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of Radiation Protection in the interventional suite. These recommendations for occupational Radiation Protection in interventional cardiology and electrophysiology have been endorsed by the Asian Pacific Society of Interventional Cardiology, the European Association of Percutaneous Cardiovascular Interventions, the Latin American Society of Interventional Cardiology, and the Society for Cardiovascular Angiography and Interventions.
Renato Padovani - One of the best experts on this subject based on the ideXlab platform.
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Recommendations for occupational Radiation Protection in interventional cardiology
Catheterization and Cardiovascular Interventions, 2013Co-Authors: Ariel Durán, Sim Kui Hian, John Le Heron, Renato Padovani, Donald L. Miller, Jon Heron, Eliseo VanoAbstract:The Radiation dose received by cardiologists during percutaneous coronary interventions, electrophysiology procedures and other interventional cardiology procedures can vary by more than an order of magnitude for the same type of procedure and for similar patient doses. There is particular concern regarding occupational dose to the lens of the eye. This document provides recommendations for occupational Radiation Protection for physicians and other staff in the interventional suite. Simple methods for reducing or minimizing occupational Radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in Radiation Protection for all interventional cardiology personnel, and the availability of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of Radiation Protection in the interventional suite. These recommendations for occupational Radiation Protection in interventional cardiology and electrophysiology have been endorsed by the Asian Pacific Society of Interventional Cardiology, the European Association of Percutaneous Cardiovascular Interventions, the Latin American Society of Interventional Cardiology, and the Society for Cardiovascular Angiography and Interventions.
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occupational Radiation Protection in interventional radiology a joint guideline of the cardiovascular and interventional radiology society of europe and the society of interventional radiology
CardioVascular and Interventional Radiology, 2010Co-Authors: Donald L. Miller, Renato Padovani, E Vano, Gabriel Bartal, Stephen Balter, Robert G Dixon, Beth A Schueler, John F Cardella, Thierry De BaereAbstract:Fluoroscopically guided interventional procedures are performed in large numbers in Europe and in the United States. The number of procedures performed annually throughout the world has increased over the past 20 years [1]. The benefits of interventional radiology to patients are both extensive and beyond dispute, but many of these procedures also have the potential to produce patient Radiation doses high enough to cause Radiation effects and occupational doses to interventional radiologists high enough to cause concern [1–4]. A joint SIR–CIRSE guideline on patient Radiation management has addressed patient issues [3]. This guideline is intended to serve as a companion to that document and provides guidance to help minimize occupational Radiation dose. The Radiation dose received by interventional radiologists can vary by more than an order of magnitude for the same type of procedure and for similar patient dose [4]. Recently, there has been particular concern regarding occupational dose to the lens of the eye in interventional radiologists [2]. New data from exposed human populations suggest that lens opacities (cataracts) occur at doses far lower than those previously believed to cause cataracts [5, 6]. Statistical analysis of the available data suggests absence of a threshold dose, although if one does exist, it is possible that it is less than 0.1 Gy [7, 8]. Additionally, it appears that the latency period for Radiation cataract formation is inversely related to the Radiation dose [5]. Occupational Radiation Protection is a necessity whenever Radiation is used in the practice of medicine. It is especially important for image-guided medical procedures [4, 9]. These procedures may involve high Radiation dose rates in the interventional laboratory [10, 11]. Occupational Radiation Protection is necessary, not only during fluoroscopically guided procedures but also during CT-guided procedures, including CT fluoroscopy. CT fluoroscopy is not really fluoroscopy at all. It differs from conventional fluoroscopy in both equipment and technique. The Radiation Protection concerns for CT fluoroscopy differ somewhat, particularly in terms of avoiding an excessive Radiation dose to the interventional radiologist’s hands [12, 13]. Occupational Radiation Protection requires both the appropriate education and training for the interventional radiologist and the availability of appropriate Protection tools and equipment. Occupational Radiation Protection measures must also comply with local and national regulations, and should also consider the ergonomic detriment caused by personal protective devices [14–16]. Occupational Radiation Protection measures are necessary for all individuals who work in the interventional fluoroscopy suite. This includes not only technologists and nurses, who spend a substantial amount of time in a Radiation environment, but also individuals such as anesthesiologists who may be in a Radiation environment only occasionally. All of these individuals may be considered Radiation workers, depending on their level of exposure and on national regulations. All workers require appropriate monitoring, as well as Protection tools and equipment. They must also receive education and training appropriate to their jobs [14]. The level of training should be based on the level of risk. This guideline is intended to offer a basic review of the medical physics relevant to occupational Radiation safety and to provide advice and guidance to interventional radiologists who perform procedures with the guidance of ionizing Radiation and their staff. In this document, the emphasis is Radiation Protection during fluoroscopically guided procedures.
Stephen Barnard - One of the best experts on this subject based on the ideXlab platform.
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Radiation Protection of the eye lens in medical workers basis and impact of the icrp recommendations
British Journal of Radiology, 2016Co-Authors: Stephen Barnard, Elizabeth A Ainsbury, Roy A Quinlan, Simon BoufflerAbstract:The aim of this article was to explore the evidence for the revised European Union basic safety standard (BSS) Radiation dose limits to the lens of the eye, in the context of medical occupational Radiation exposures. Publications in the open literature have been reviewed in order to draw conclusions on the exposure profiles and doses received by medical Radiation workers and to bring together the limited evidence for cataract development in medical occupationally exposed populations. The current status of relevant Radiation-Protection and monitoring practices and procedures is also considered. In conclusion, medical Radiation workers do receive high doses in some circumstances, and thus working practices will be impacted by the new BSS. However, there is strong evidence to suggest that compliance with the new lower dose limits will be possible, although education and training of staff alongside effective use of personal protective equipment will be paramount. A number of suggested actions are given with the aim of assisting medical and associated Radiation-Protection professionals in understanding the requirements.
