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Although the clinical value of fluoroscopically guided respiratory endoscopy (bronchoscopy) is clear, there have been very few studies on the radiation dose received by staff during fluoroscopically guided bronchoscopy. The International Commission on Radiological Protection (ICRP) is suggesting reducing the occupational lens dose limit markedly from 150 to 20 mSv/year, averaged over defined periods of five years. The purpose of this study was to clarify the current occupational eye dose of bronchoscopy staff conducting fluoroscopically guided procedures. We measured the occupational eye doses (3-mm-dose equivalent, Hp(3)) of bronchoscopy staff (physicians and nurses) over a 6-month period. The eye doses of eight physicians and three nurses were recorded using a direct eye dosimeter, the DOSIRIS. We also estimated eye doses using personal dosimeters worn at the neck. The mean ± SD radiation eye doses (DOSIRIS) to physicians and nurses were 7.68 ± 5.27 and 2.41 ± 1.94 mSv/6 months, respectively. The new lens dose limit, 20 mSv/year, may be exceeded among bronchoscopy staff, especially physicians. The eye dose of bronchoscopy staff (both physicians and nurses) was underestimated when measured using a neck dosimeter. Hence, the occupational eye dose of bronchoscopy staff should be monitored. To reduce the occupational eye dose, we recommend that staff performing fluoroscopically guided bronchoscopy wear Pb glasses. correct evaluation of the lens dose [Hp(3)] using an eye dosimeter such as the DOSIRIS is necessary for bronchoscopy staff., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Japanese Radiation Research Society and Japanese Society for Radiation Oncology.)

Interventional radiology procedures often involve lengthy exposure to fluoroscopy-derived radiation. We therefore devised a videofluoroscopic swallowing study (VFSS) procedure using a human phantom that proved to protect the patient and physician by reducing the radiation dose. We evaluated a new lead-shielding device and separately attached additional filters (1.0-, 2.0-, and 3.0-mm Al filters and a 0.5-mm Cu filter) during VFSS to reduce the patient's entrance skin dose (ESD). A monitor attached to the human phantom's neck measured the ESD. We also developed another lead shield (VFSS Shielding Box, 1.0-mm Pb equivalent) and tested its efficacy using the human phantom and an ionization chamber radiation survey meter with and without protection from scattered radiation at the physician's position on the phantom. We then measured the scattered radiation (at 90 and 150 cm above the floor) after combining the filters with the VFSS Shielding Box. With the additional filters, the ESD was reduced by 15.4-55.1%. With the VFSS Shielding Box alone, the scattered radiation was reduced by about 10% compared with the dose without additional shielding. With the VFSS Shielding Box and filters combined, the scattered radiation dose was reduced by a maximum of about 44% at the physician's position. Thus, the additional lead-shielding device effectively provided protection from scattered radiation during fluoroscopy. These results indicate that the combined VFSS Shielding Box and filters can effectively reduce the physician's and patient's radiation doses.

Videofluoroscopic swallowing study (VFSS) is considered the standard diagnostic imaging technique to investigate swallowing disorders and dysphagia. Few studies have been reported concerning the dose of radiation a patient receives and the scattering radiation dose received by a physician during VFSS. In this study, we investigated the dose of radiation (entrance skin dose, ESD) estimated to be received by a patient during VFSS using a human phantom (via a skin-dose monitor sensor placed on the neck of the human phantom). We also investigated the effective dose (ED) and dose equivalent (DE) received by a physician (wearing two personal dosimeters) during an actual patient procedure. One dosimeter (whole body) was worn under a lead apron at the chest, and the other (specially placed to measure doses received by the lens of the eye) outside the lead apron on the neck collar to monitor radiation doses in parts of the body not protected by the lead apron. The ESD for the patient was 7.8 mGy in 5 min. We estimated the average patient dose at 12.79 mGy per VFSS procedure. The physician ED and DE during VFSS were 0.9 mSv/year and 2.3 mSv/year, respectively. The dose of radiation received by the physician in this study was lower than regulatory dose limits. However, in accordance with the principle that radiation exposure should be as low as reasonably achievable, every effort should be made (e.g., wearing lead glasses) to reduce exposure doses.

Japan Network for Research and Information on Medical Exposures (J-RIME) released the primary diagnostic reference levels (DRLs 2015) to optimize/manage the radiation dose for interventional radiology (IVR) on June 7, 2015 in Japan. However, this DRLs 2015 has a wide range of selection bias for only certified IVR technologists' dates. Therefore, it is important to know the radiation dose including non-certified IVR technologists' facilities. In this study, we verified the fluoroscopy radiation dose rates for many IVR systems in the present situation. This study was conducted at 13 cardiac catheterization laboratories (18 X-ray systems) around Sendai. We measured the entrance doses at the patient entrance reference point (interventional reference point) using a 20-cm-thick acrylic plate and skin-dose monitor. Although the DRLs 2015 of IVR is 20 mGy/min, the result of a fluoroscopy radiation dose in 18 X-ray systems was median (inter quartile range: IQR), 24.4 (16.3, 35.5) mGy/min. The optimization/managing the radiation dose of IVR X-ray systems is an important issue. In addition, it is necessary to intensify the activities to raise awareness for DRLs 2015.

There are case reports of injuries caused by the radiation from interventional radiology (IVR) X-ray systems. Therefore, the management of radiation doses in IVR is important. However, no detailed report has evaluated image quality for a large number of IVR X-ray systems. As a result, it is unclear whether the image quality of the X-ray equipment currently used in IVR procedures is optimal. We compared the entrance surface doses and image quality of multiple IVR X-ray systems. This study was conducted in 2014 at 13 medical facilities using 18 IVR X-ray systems. We evaluated image quality and simultaneously measured the radiation dose. Entrance surface doses for fluoroscopy (duration, 1 min) and cineradiography (duration, 10 s) are measured using a 20-cm-thick acrylic plate and skin dose monitor. The image quality (such as spatial resolution and low-contrast detectability) of both fluoroscopy and cineradiography was evaluated using a QC phantom. For fluoroscopy, the average entrance surface dose using the 20-cm-thick acrylic plate was 13.9 (range 2.1-28.2) mGy/min. For cineradiography, the average entrance surface dose was 24.6 (range 5.1-49.3) mGy/10 s. We found positive correlations between radiation doses and image quality scores, in general, especially for fluoroscopy. The differences in surface dose among the 18 IVR X-ray systems were high (max/min, 9.7-fold for cineradiography; 13.4-fold for fluoroscopy). The differences in image quality scores (spatial resolution, low-contrast detectability, and dynamic range) were also very large. In general, there tended to be a correlation between radiation dose and image quality. Periodical measurements of the radiation dose and image quality of the X-ray equipment used for cineradiography and fluoroscopy in IVR are necessary. The need to minimize patient exposure requires that the dose be reduced to the minimum level that will generate an image with an acceptable degree of noise.

Objective: Cardiac interventional radiology (IR) can cause radiation injury to the staff who administer it as well as to patients. Although education in the basic principles of radiation is required for nurses, their level of radiation safety knowledge is not known. The present study used a questionnaire protocol to assess the level of radiation safety knowledge among hospital nurses., Methods and Results: A questionnaire to assess the level of training and current understanding of radiation safety was administered to 305 nurses in 2008 and again to 359 nurses in 2010. Our study indicates that nurses had insufficient knowledge about radiation safety, and that a high percentage of nurses were concerned about the health hazards of radiation. Moreover, more than 80% of the nurses expressed an interest in attending periodic radiation safety seminars. Annual radiation protection training for hospital staff (including nurses) is important., Conclusions: Our results suggest that nurses do not have sufficient knowledge of radiation safety and should receive appropriate radiation safety training. Many had a minimal understanding of radiation and thus had significant concerns about the safety of working with radiation. Periodic radiation safety education/training for nurses is essential.

Purpose: There are no effective real-time direct skin dosimeters for interventional radiology. Such a scintillation dosimeter would be available if there was a suitable red emission phosphor in the medical x-ray range, since the silicon photodiode is a highly efficient device for red light. However, it is unknown whether there is a suitable red emission phosphor. The purpose of this study is to find a suitable red emission phosphor that can be used in x-ray dosimeters., Methods: Five kinds of phosphors which emit red light when irradiated with electron beams or ultraviolet rays in practical devices were chosen. For the brightness measurement, phosphor was put into transparent plastic cells or coated onto plastic sheets. The phosphors were irradiated with medical range x-rays [60-120 kV(peak), maximum dose rate of 160 mGymin-1], and the emission was measured by a luminance meter. Several characteristics, such as brightness, dose rate dependence, tube voltage dependence, and brightness stability, were investigated., Results: The luminescence of Y V O₄:Eu, (Y,Gd,Eu) BO₃, and Y₂O₃:Eu significantly deteriorated by 5%-10% when irradiated with continuous 2 Gy x-rays. The 0.5MgF₂⋅3.5MgO⋅GeO₂:Mn phosphor did not emit enough. Only the Y₂O₂S:Eu,Sm phosphor had hardly any brightness deterioration, and it had a linear relationship so that the x-ray dose rate could be determined from the brightness with sufficient accuracy. For the tube voltage dependence of the Y₂O₂S:Eu,Sm phosphor, the brightness per unit dose rate with 120 kV(peak) x-rays was 30% higher than that with 60 kV(peak) x-rays., Conclusions: Five kinds of phosphors were chosen as an x-ray scintillator for a real-time direct skin dosimeter. The Y V O₄:Eu, (Y,Gd,Eu)BO₃, and Y₂O₃:Eu phosphors had brightness deterioration caused by the x-rays. Only the Y₂O₂S:Eu,Sm phosphor had hardly any brightness deterioration, and it is a candidate for an x-ray scintillator for such a skin dosimeter.

Radiation protection for interventional radiology (IR) physicians is very important. Current IR X-ray systems tend to use flat-panel detectors (FPDs) rather than image intensifiers (IIs). The purpose of this study is to test the hypothesis that there is no difference in physician-received scatter radiation (PRSR) between FPD systems and II systems. This study examined 20 X-ray systems in 15 cardiac catheterisation laboratories (11 used a FPD and 9 used an II). The PRSR with digital cineangiography and fluoroscopy were compared among the 20 X-ray systems using a phantom and a solid-state-detector electronic pocket dosemeter. The maximum PRSR exceeded the minimum PRSR by ~12-fold for cineangiography and ~9-fold for fluoroscopy. For both fluoroscopy and digital cineangiography, the PRSR had a statistically significant positive correlation with the entrance surface dose (fluoroscopy, r = 0.87; cineangiography, r = 0.86). There was no statistically significant difference between the average PRSR of FPDs and IIs during either digital cineangiography or fluoroscopy. There is a wide range of PRSR among the radiography systems evaluated. The PRSR correlated well with the entrance surface dose of the phantom in 20 X-ray units used for IR. Hence, decreasing the dose to the patient will also decrease the dose to staff.

In this study, the entrance surface dose rates received by a phantom during cineangiography and fluoroscopy were compared. The X-ray conditions used in the measurements were those normally used in facilities performing percutaneous coronary intervention. Although, today, the entrance surface doses (cineangiography and fluoroscopy) of X-ray equipment used for cardiac interventional radiology (IVR) tends to be lower than they were previously, some equipment produces a high radiation dose. Therefore, the X-ray equipment used for cardiac IVR procedures must be maintained in good repair and must be carefully calibrated. In addition, periodic measurement of the radiation dose from the X-ray equipment used for both cineangiography and fluoroscopy for cardiac IVR is necessary. If the radiation dose of the X-ray system in use is too high, the IVR staff should determine the reason and make an effort to reduce it. Hence, the IVR staff must be adequately trained in radiation protection.

Objective: A number of cases of radiation-associated patient skin injury during percutaneous coronary intervention (PCI) have been reported. To protect against this complication, maximum skin dose to the patient should be monitored in real time. Unfortunately, in most cardiac intervention procedures, real-time monitoring of maximum skin dose is not possible. Angiographic X-ray units, however, display the patient's total entrance skin dose in real time. We therefore investigated the relation between maximum skin dose and total entrance skin dose to determine whether total entrance skin dose can be used to estimate maximum skin dose during PCI., Materials and Methods: The dose-area product was measured, and maximum skin dose and total entrance skin dose were calculated with a skin-dose-mapping software program. The target vessels of 194 PCI procedures were divided into four groups according to the American Heart Association (AHA) segment system., Results: The maximum skin dose constituted 48%, 52%, 50%, and 52% of the total entrance skin dose during PCI on AHA segments 1-3, 4, 5-10, and 11-15, respectively. There were significant correlations between maximum skin dose and total entrance skin dose during PCI (r = 0.894, 0.935, 0.859, and 0.898 for segments 1-3, 4, 5-10, and 11-15, respectively; p < 0.001)., Conclusion: Maximum skin dose during PCI is approximately 50% of the total entrance skin dose for each target vessel. Correlation between the two doses was very good. Total entrance skin dose is an effective predictor of maximum skin dose during PCI when the formula used is maximum skin dose = 0.5 x total entrance skin dose. Our results provide useful information for avoiding deterministic radiation skin injury to patients undergoing PCI.

Objectives: To investigate whether pulsed fluoroscopy reduces a patient's exposure compared with the exposure owing to conventional (continuous) fluoroscopy, we simulated the skin radiation doses of patients at cardiac catheterization facilities with various X-ray systems used in fluoroscopically guided intervention procedures., Background: Although many reports have noted that "pulsed fluoroscopy" provides important further reductions in radiation exposure, it has been determined that when comparing dose rates between different vendor systems, "pulsed fluoroscopy" does not reduce patients' exposure as compared with "conventional fluoroscopy"., Methods: We examined 13 X-ray systems; 10 used pulsed fluoroscopy and three used conventional fluoroscopy. The entrance surface doses with fluoroscopy were compared for the 13 X-ray systems by using acrylic plates (20-cm thick) and a skin dose monitor. The X-ray conditions used in the measurements were those normally used in the facilities performing percutaneous coronary intervention., Results: The average surface dose for systems from three different vendors producing conventional fluoroscopy systems was 23.93+/-2.77 mGy/min vs. an average surface dose of 22.52+/-4.50 mGy/min from five vendors of pulsed fluoroscopy systems (25, 30, and 50 pulses/sec) (P=0.646). The average entrance surface dose was significantly (P<0.0001) higher with conventional fluoroscopy and pulsed fluoroscopy at 25, 30, and 50 pulses/sec (23.05+/-3.78 mGy/min) than with pulsed fluoroscopy at 15 pulses/sec (13.86+/-3.22 mGy/min)., Conclusions: Pulsed fluoroscopy did not in itself reduce radiation exposure. In general, the use of pulsed fluoroscopy at a pulse rate lower than 25 pulses/sec should reduce the skin dose in fluoroscopically guided intervention procedures. Nevertheless, some X-ray systems are not designed to reduce the dose rate as the number of pulses per second is decreased. Physicians should be aware of the entrance surface dose of the X-ray system that they use for cardiac IVR., (Copyright (c) 2006 Wiley-Liss, Inc.)

Objective: Real-time maximum dose monitoring of the skin is unavailable on many of the X-ray machines that are used for cardiac intervention procedures. Therefore, some reports have recommended that physicians record the fluoroscopic time for patients undergoing fluoroscopically guided intervention procedures. However, the relationship between the fluoroscopic time and the maximum radiation skin dose is not clear. This article describes the correlation between the maximum radiation skin dose and fluoroscopic time for patients undergoing cardiac intervention procedures. In addition, we examined whether the correlations between maximum radiation skin dose and body weight, fluoroscopic time, and dose-area product (DAP) were useful for estimating the maximum skin dose during cardiac intervention procedures., Materials and Methods: Two hundred consecutive cardiac intervention procedures were studied: 172 percutaneous coronary interventions and 28 cardiac radiofrequency catheter ablation (RFCA) procedures. The patient skin dose and DAP were measured using Caregraph with skin-dose-mapping software., Results: For the RFCA procedures, we found a good correlation between the maximum radiation skin dose and fluoroscopic time (r = 0.801, p < 0.0001), whereas we found a poor correlation between the maximum radiation skin dose and fluoroscopic time for the percutaneous coronary intervention procedures (r = 0.628, p < 0.0001). There was a strong correlation between the maximum radiation skin dose and DAP in RFCA procedures (r = 0.942, p < 0.0001). There was also a significant correlation between the maximum radiation skin dose and DAP (r = 0.724, p < 0.0001) and weight-fluoroscopic time product (WFP) (r = 0.709, p < 0.0001) in percutaneous coronary intervention procedures., Conclusion: The correlation between the maximum radiation skin dose with DAP is more striking than that with fluoroscopic time in both RFCA and percutaneous coronary intervention procedures. We recommend that physicians record the DAP when it can be monitored and that physicians record the fluoroscopic time when DAP cannot be monitored for estimating the maximum patient skin dose in RFCA procedures. For estimating the maximum patient skin dose in percutaneous coronary intervention procedures, we also recommend that physicians record DAP when it can be monitored and that physicians record WFP when DAP cannot be monitored.

In 2011, the International Commission on Radiological Protection (ICRP) recommended a significant reduction in the lens-equivalent radiation dose limit, thus from an average of 150 to 20 mSv/year over 5 years. In recent years, the occupational dose has been rising with the increased sophistication of interventional radiology (IVR); management of IVR staff radiation doses has become more important, making real-time radiation monitoring of such staff desirable. Recently, the i3 real-time occupational exposure monitoring system (based on RaySafeTM) has replaced the conventional i2 system. Here, we compared the i2 and i3 systems in terms of sensitivity (batch uniformity), tube-voltage dependency, dose linearity, dose-rate dependency, and angle dependency. The sensitivity difference (batch uniformity) was approximately 5%, and the tube-voltage dependency was <±20% between 50 and 110 kV. Dose linearity was good (R2 = 1.00); a slight dose-rate dependency (~20%) was evident at very high dose rates (250 mGy/h). The i3 dosimeter showed better performance for the lower radiation detection limit compared with the i2 system. The horizontal and vertical angle dependencies of i3 were superior to those of i2. Thus, i3 sensitivity was higher over a wider angle range compared with i2, aiding the measurement of scattered radiation. Unlike the i2 sensor, the influence of backscattered radiation (i.e., radiation from an angle of 180°) was negligible. Therefore, the i3 system may be more appropriate in areas affected by backscatter. In the future, i3 will facilitate real-time dosimetry and dose management during IVR and other applications. [ABSTRACT FROM AUTHOR]

Interventional radiology (IVR) procedures are associated with increased radiation exposure and injury risk. Furthermore, radiation eye injury (i.e., cataract) in IVR staff have also been reported. It is crucial to protect the eyes of IVR physicians from X-ray radiation exposure. Many IVR physicians use protective Pb eyeglasses to reduce occupational eye exposure. However, the shielding effects of Pb eyeglasses are inadequate. We developed a novel shield for the face (including eyes) of IVR physicians. The novel shield consists of a neck and face guard (0.25 mm Pb-equivalent rubber sheet, nonlead protective sheet). The face shield is positioned on the left side of the IVR physician. We assessed the shielding effects of the novel shield using a phantom in the IVR X-ray system; a radiophotoluminescence dosimeter was used to measure the radiation exposure. In this phantom study, the effectiveness of the novel device for protecting against radiation was greater than 80% in almost all measurement situations, including in terms of eye lens exposure. A large amount of scattered radiation reaches the left side of IVR physicians. The novel radiation shield effectively protects the left side of the physician from this scattered radiation. Thus, the device can be used to protect the face and eyes of IVR physicians from occupational radiation exposure. The novel device will be useful for protecting the face (including eyes) of IVR physicians from radiation, and thus could reduce the rate of radiation injury. Based on the positive results of this phantom study, we plan to perform a clinical experiment to further test the utility of this novel radiation shield for IVR physicians. [ABSTRACT FROM AUTHOR]

It is important to evaluate the radiation eye dose (3 mm dose equivalent, Hp (3)) received by physicians during computed tomography fluoroscopy (CTF)-guided biopsy, as physicians are close to the source of scattered radiation. In this study, we measured the radiation eye dose in Hp (3) received by one physician during CTF in a timeframe of 18 months using a direct eye dosimeter, the DOSIRISTM. The physician placed eye dosimeters above and under their lead (Pb) eyeglasses. We recorded the occupational radiation dose received using a neck dosimeter, gathered CT dose-related parameters (e.g., CT-fluoroscopic acquisition number, CT-fluoroscopic time, and CT-fluoroscopic mAs), and performed a total of 95 procedures during CTF-guided biopsies. We also estimated the eye dose (Hp (3)) received using neck personal dosimeters and CT dose-related parameters. The physician eye doses (right and left side) received in terms of Hp (3) without the use of Pb eyeglasses for 18 months were 2.25 and 2.06 mSv, respectively. The protective effect of the Pb eyeglasses (0.5 mm Pb) on the right and left sides during CTF procedures was 27.8 and 37.5%, respectively. This study proved the existence of significant correlations between the eye and neck dose measurement (right and left sides, R2 = 0.82 and R2 = 0.55, respectively) in physicians. In addition, we found significant correlations between CT-related parameters, such as CT-fluoroscopy mAs, and radiation eye doses (right and left sides, R2 = 0.50 and R2 = 0.52, respectively). The eye dose of Hp (3) received in CTF was underestimated when evaluated using neck dosimeters. Therefore, we suggest that the physician involved in CTF use a direct eye dosimeter such as the DOSIRIS for the accurate evaluation of their eye lens dose. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the dose distribution and lens doses associated with C-arm cone-beam computed tomography (CBCT), using a head phantom, and to estimate the contribution ratio of C-arm CBCT to each patient's lens dose during interventional neuroradiology ('lens dose ratio') in 109 clinical cases. In the phantom study, the peak skin doses and respective right and left lens doses of C-arm CBCT were as follows: 63.0 ± 1.9 mGy, 19.7 ± 1.4 mGy and 21.9 ± 0.8 mGy in whole brain C-arm CBCT and 39.2 ± 1.4 mGy, 4.7 ± 0.9 mGy and 3.6 ± 0.3 mGy in high-resolution C-arm CBCT. In the clinical study, the lens dose ratios were 25.4 ± 8.7% in the right lens and 19.1 ± 9.8% in the left lens. This study shows that, on average, ~25% of patients' total lens dose was contributed by C-arm CBCT. [ABSTRACT FROM AUTHOR]

Purpose: Cardiac resynchronization therapy (CRT) often requires a long fluoroscopic time and protection from scatter radiation. This study reports on scatter radiation levels during CRT, with and without additional shielding, and using standard or low pulse rate fluoroscopy.Materials and Methods: Additional lead-shielding drape (0.35-mm lead equivalent) was used on the left side of the table and pulsed fluoroscopy was performed at rates of 10 pulses/s (usual rate) and 7.5 pulses/s (low pulse rate). Fluoroscopy scatter radiation was measured for both pulse rates using an acrylic phantom with a radiation survey meter, both with and without the additional lead-shielding drape.Results: With the additional lead-shielding drape, the fluoroscopy scatter radiation was reduced by 74.3% at 10 pulses/s and 78.6% at 7.5 pulses/s. If the fluoroscopy was changed from 10 pulses/s to 7.5 pulses/s, the scattered radiation at the primary physician's position was reduced by 24.0%. The combined use of additional shielding drape and low pulse rate fluoroscopy reduced scatter radiation by over 80%.Conclusion: Additional lead-shielding drape and low pulse rate fluoroscopy are effective in reducing the scattered radiation dose to physicians and nurses during CRT. [ABSTRACT FROM AUTHOR]

Radiation protection/evaluation during interventional radiology (IVR) poses a very important problem. Although IVR physicians should wear protective aprons, the IVR physician may not tolerate wearing one for long procedures because protective aprons are generally heavy. In fact, orthopedic problems are increasingly reported in IVR physicians due to the strain of wearing heavy protective aprons during IVR. In recent years, non-Pb protective aprons (lighter weight, composite materials) have been developed. Although non-Pb protective aprons are more expensive than Pb protective aprons, the former aprons weigh less. However, whether the protective performance of non-Pb aprons is sufficient in the IVR clinical setting is unclear. This study compared the ability of non-Pb and Pb protective aprons (0.25- and 0.35-mm Pb-equivalents) to protect physicians from scatter radiation in a clinical setting (IVR, cardiac catheterizations, including percutaneous coronary intervention) using an electric personal dosimeter (EPD). For radiation measurements, physicians wore EPDs: One inside a personal protective apron at the chest, and one outside a personal protective apron at the chest. Physician comfort levels in each apron during procedures were also evaluated. As a result, performance (both the shielding effect (98.5%) and comfort (good)) of the non-Pb 0.35-mm-Pb-equivalent protective apron was good in the clinical setting. The radiation-shielding effects of the non-Pb 0.35-mm and Pb 0.35-mm-Pb-equivalent protective aprons were very similar. Therefore, non-Pb 0.35-mm Pb-equivalent protective aprons may be more suitable for providing radiation protection for IVR physicians because the shielding effect and comfort are both good in the clinical IVR setting. As non-Pb protective aprons are nontoxic and weigh less than Pb protective aprons, non-Pb protective aprons will be the preferred type for radiation protection of IVR staff, especially physicians. [ABSTRACT FROM AUTHOR]

In recent years, endovascular treatment of aortic aneurysms has attracted considerable attention as a promising alternative to traditional surgery. Hybrid operating room systems (HORSs) are increasingly being used to perform endovascular procedures. The clinical benefits of endovascular treatments using HORSs are very clear, and these procedures are increasing in number. In procedures such as thoracic endovascular aortic repair (TEVAR) and endovascular aortic repair (EVAR), wires and catheters are used to deliver and deploy the stent graft in the thoracic/abdominal aorta under fluoroscopic control, including DSA. Thus, the radiation dose to the patient is an important issue. We determined radiation dose indicators (the dose–area product (DAP) and air karma (AK) parameters) associated with endovascular treatments (EVAR and TEVAR) using a HORS. As a result, the mean ± standard deviation (SD) DAPs of TEVAR and EVAR were 323.7 ± 161.0 and 371.3 ± 186.0 Gy × cm2, respectively. The mean ± SD AKs of TEVAR and EVAR were 0.92 ± 0.44 and 1.11 ± 0.54 Gy, respectively. The mean ± SD fluoroscopy times of TEVAR and EVAR were 13.4 ± 7.1 and 23.2 ± 11.7 min, respectively. Patient radiation dose results in this study of endovascular treatments using HORSs showed no deterministic radiation effects, such as skin injuries. However, radiation exposure during TEVAR and EVAR cannot be ignored. The radiation dose should be evaluated in HORSs during endovascular treatments. Reducing/optimizing the radiation dose to the patient in HORSs is important. [ABSTRACT FROM AUTHOR]