Extremity doses of medical staff involved in interventional radiology and cardiology: Correlations and annual doses (hands and legs)

An intensive measurement campaign was launched in different hospitals in Europe within work package 1 of the ORAMED project (Optimization of RAdiation protection for MEDical staff). Its main objective was to obtain a set of standardized data on extremity and eye lens doses for staff in interventional radiology (IR) and cardiology (IC) and to optimize staff protection. The monitored procedures were divided in three main categories: cardiac, general angiography and endoscopic retrograde cholangio-pancreatography(ERCP) procedures. Using a common measurement protocol, information such as the protective equipment used (lead table curtain, transparent lead glass ceiling screen, patient shielding, whole body shielding or special cabin etc.) as well as Kerma Area Product (KAP) values and access of the catheter were recorded. This study was performed with a final database of more than 1300 procedures performed in 34 European hospitals. Its objectives were firstly to determine if the measured extremity doses could be correlated to the KAP values; secondly to check if the doses to the eyes could be linked to the doses to the hands (finger or wrist positions) and finally if the doses to the fingers could be estimated based on the doses to the wrists. General correlations were very difficult to find and their strength was mostly influenced by three main parameters: the X-ray tube configuration, the room collective radioprotective equipment and the access of the catheter. The KAP value can provide a simple mean to estimate the extremity doses of the operator given that it is assessed correctly for the operator when he is actually using the X-ray tube. Moreover, this study showed that the doses to the left finger are strongly correlated to the doses to the left wrist when no ceiling shield is used. It is also possible to estimate the doses to the eyes given the doses to the left finger or left wrist but the X-ray tube configuration and the access have to be considered. The annual finger doses of three workers were estimated and were found to exceed the 3/10thof the annual limit. Therefore, for the hands routine monitoring is necessary especially for interventional cardiology procedures, except for ERCP procedures. If the table shield is properly used, leg doses can be reduced significantly and no routine monitoring is necessary. -- Highlights: ► Data on extremity and eye lens doses was collected in order to optimize staff protection. Correlations were investigated and extremity annual doses were estimated. ► If assessed correctly, the Kerma area product value can provide a simple mean to estimate the extremity doses of the operator. ► For certain X-ray tube configuration and access, doses to the left finger or left wrist can help estimating eye lens doses. ► Hands should be routinely monitored whereas it is not necessary for the legs if they are properly shielded.