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IS THERE A CUT-OFF POINT FOR POTENTIALLY RADIATION-INDUCED DISEASES?

Well established is that during fluoroscopy assisted interventions, depending on factors such as patient obesity, procedural complexity and fluoroscopy time, medical practitioners are subjected to relatively high radiation exposure.¹

The current standards and practices are based on the premise that any radiation dose may result in unfavorable health effects.²'³ The risks for radiation-induced diseases are associated with uncertainties regarding biological effects and individual sensitivity.⁴'⁵ Being exposed to harmful radiation may cause diseases such as: anxiety/depression⁶, cancer⁷ and cognitive impairments.⁸'⁹

Alarmingly, over 50% of OR staff do not feel adequately protected from the scatter radiation.¹⁰ However, the risk for developing radiation-induced diseases is still an ongoing debate among experts.¹¹

OCCUPATIONAL HEALTH RISKS THAT MAY BE RELATED TO RADIATION EXPOSURE:

+ anxiety/depression⁶

+ tumors/cancer⁷

+ cognitive impairments⁸'⁹

REPORTED ERGONOMIC ISSUES:

+ back/neck pain from using heavy and uncomfortable radiation protection devices.¹²

A study on brain tumors occurring in medical practitioners with exposure to ionizing radiation documented 85% left sided malignancy.

Data available for 35 of 45 cases on the side of the brain involved. The malignancy was left-sided in 30 (85%), midline in one, and right-sided in four cases. This accumulation of left-sided versus right-sided tumors could be due to the operator's routine working position in which the left side of the head is closest to the scatter radiation coming from the patient.⁷

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2. ICRP, 2018. Occupational radiological protection in interventional procedures. ICRP Publication 139. Ann. ICRP 47(2).
3. Miller, D.L., et al., 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 Interventional Radiology, 2010. 33(2): p. 230-9.
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9. El-Sayed, T., Patel, A. S., Cho, J. S., Kelly, J. A., Ludwinski, F. E., Saha, P., ... & Gill, J. (2017). Radiation-induced DNA damage in operators performing endovascular
aortic repair. Circulation, 136(25), 2406-2416.
10. O’Sullivan N., Naughton A., McKevitt K., Boyle E., Egan B., Tierney S., Intra-Operative Radiation Safety; Who does what? Who knows what? Department of Vascular Surgery, Tallaght University Hospital, Dublin 24, Ireland.
11. Roguin, A., & Nolan, J. (2021). Radiation protection in the cardiac catheterisation lab: best practice. Heart, 107(1), 76-82.
12. 1. Bjersgård A., En studie på strålskyddskläder, dess användning och användarnas rörelsemönster med ett ergonomiskt perspektiv. Centre for Health Technology Halland (HCH), Halmstad University, Sweden, 2015