Radiation Protection of a Patient Undergoing an Orthopedic Procedure by Using a Mobile C-Arm X-Ray System

Modern medicine is unthinkable without X-rays. Accurate diagnosis, leading to effective treatment, is largely based on precise X-ray examinations. The creation of new, modern equipment and various medical procedures that meet the increased requirements are a priority in our time. X-ray examinations are of particular importance for the orthopedic and traumatological clinics, where they provide information about presence of a fracture in the patient’s body, about the concrete operation performed or about the effect of a suitable treatment. Along with their benefits X-rays have also a harmful effect. This requires special care to protect from this radiation. In this direction, research is constantly being done to improve the quality of radiation protection. Park MR, Lee KM and co-authors, compare the dose load obtained using C-arm and O-arm X-ray systems (which have the capability of combined 2D fluoroscopy and 3D computed tomography imaging). In their study, an orthopedic surgical procedure using C-arm and O-arm systems in 2D fluoroscopy modes was simulated. The radiation doses to susceptible organs of the operators were investigated. He results obtained show that the O-arm system delivered higher doses to the sensitive organs of the operator in all configurations [1]. The article of Stephen Balte briefly reviews the available technologies for measuring or estimation of patient skin dose in the interventional fluoroscopic environment, created by various X-ray equipment including C-arm systems. Given that many patients require multiple procedures, this documentation also aids in the planning of follow up visits [2]. Chong Hing Wong, Yoshihisa Kotani and co-authors evaluate the radiation exposures (RE) to the patient and surgeon during minimally invasive lumbar spine surgery with instrumentation using C-arm image intensifier or O-arm intraoperative CT. The results they get are in favor of the O-arm system [3]. The article “Virtual fluoroscopy for intraoperative C-arm positioning and radiation dose reduction” discusses positioning of an intraoperative C-arm system to achieve clear visualization of a particular anatomical feature by a system for virtual fluoroscopy (called FluoroSim) that could dramatically reduce time and received dose during the procedures. FluoroSim was found to reduce the radiation exposure required for C-arm positioning without reducing positioning time or accuracy, providing a potentially valuable tool to assist surgeons [4]. In our study, we performed practical measurements to show how the patient can be treated by applying most effective radiation protection when using a mobile C-arm X-ray system. For the study, we used exposure upon a phantom placed on the patient’s table. For an X-ray shielding, we used a protective apron with a lead equivalent of 1 mm, placed in two layers on the phantom. In each subsequent series of exposures, the protective apron was placed on the phantom, in a different position relative to the X-ray beam. The general conclusion of our study is that in order to obtain maximum protection from scattered radiation when using C-arm X-ray systems, the patient must be protected by a shielding with a suitable lead equivalent for the procedure performed which must be placed between patient’s body and X-ray tube, perpendicular to the X-ray beam pointed toward the region of interest.

Operando measurement of lattice deformation profiles of synchrotron radiation monochromator

This study presents a new method for characterizing the thermal lattice deformation of a monochromator with high precision under service conditions and first reports the operando measurements of nanoscale thermal lattice deformation on a double-crystal monochromator at different incident powers.The nanoscale thermal lattice deformation of the monochromator first crystal was obtained by analyzing the intensity of the distorted DuMond diagrams.DuMond diagrams of the 333 diffraction index,sensitive to lattice deformation,were obtained directly using a 2D detector and an analyzer crystal orthogonal to the monochromator.With increasing incident power and power density,the maximum height of the lattice deformation increased from 3.2 to 18.5 nm,and the deformation coefficient of the maximum height increased from 1.1 to 3.2 nm/W.The maximum relative standard deviation was 4.2%,and the maximum standard deviation was 0.1 nm.Based on the measured thermal deformations,the flux saturation phenomenon and critical point for the linear operation of the monochromator were predicted with increasing incident power.This study provides a simple solution to the problem of the lower precision of synchrotron radiation monochromator characterizations compared to simulations.

Radiation Dose from CT-Scan of Childhood’s Head: Results of the First Ivorian Survey in a Single Study Site

Objectives: This study aims to evaluate the level of X-ray doses used in childhood’s head as Local Diagnostic Reference Levels (LDRLs) in computed tomography (CT) at a university hospital in Côte d’Ivoire. The Diagnostic Reference Level (DRL) have been set up and used to prevent unusually high radiation doses used in radiology departments and is therefore an optimization tool for practices and procedures in medical X-ray imaging for the radiation protection of patients. Methods: A prospective study of volume CT dose index (CTDIvol) and dose length product (DLP) was performed on images of childhood’s head obtained from a CT-scanner of 64 bars equipped with the tube current modulation capability and manufactured by Hitachi Medical System. 122 CT-scan data from 55 childhood’s head were analyzed. The scan data were stratified in four age groups: Results: The 75th percentile of CTDIvol and DLP (set as LDRL) obtained with respect to the stratified age groups are: 22.5 mGy and 452.5 mGy∙cm, 27.7 mGy and 690.6 mGy∙cm, 28 mGy and 722.4 mGy∙cm, 33.6 mGy and 736.8 mGy∙cm respectively. These outcome values increase with respect to the age of pediatric patients and are comparable to DRLs values obtained internationally. Conclusions: Obtaining good image quality while using low dose in children’s head computed tomography for radiation protection require to setup more surveys in Côte d’Ivoire for regional and national DRL. We proposed through this survey LDRLs in terms of CTDIvol and DLP, comparable to international DRLs values. This survey will be strengthened by additional surveys in order to obtain national DRLs for the radiation protection of the child patient in Côte d’Ivoire.

Assessing high-energy x-ray and proton irradiation effects on electrical properties of P-GaN and N-GaN thin films

The effects of ionizing and displacement irradiation of high-energy x-ray and 2-MeV proton on GaN thin films were investigated and compared in this study.The electrical properties of both P-GaN and N-GaN,separated from power devices,were gauged for fundamental analysis.It was found that the electrical properties of P-GaN were improved as a consequence of the disruption of the Mg-H bond induced by high-dose x-ray irradiation,as indicated by the Hall and circular transmission line model.Specifically,under a 100-Mrad(Si)x-ray dose,the specific contact resistance pc of P-GaN decreased by 30%,and the hole carrier concentration increased significantly.Additionally,the atom displacement damage effect of a 2-MeV proton of 1×10^(13)p/cm^(2)led to a significant degradation of the electrical properties of P-GaN,while those of N-GaN remained unchanged.P-GaN was found to be more sensitive to irradiation than N-GaN thin film.The effectiveness of x-ray irradiation in enhancing the electrical properties of P-GaN thin films was demonstrated in this study.

L-shell x-ray fluorescence relative intensities for elements with 62≤Z≤83 at 18 keV and 23 keV by synchrotron radiation

The relative intensities of L-subshell x-ray fluorescence(XRF)for elements with atomic numbers 62≤Z≤83 were measured at two excitation energies,18 keV and 23 keV,using a synchrotron radiation source at a beamline of the Synchrotron Light Center for Experimental Science and Applications in the Middle East(SESAME),Jordan.The experimentally measured results of the relative intensities were compared with the calculated results using the subshell fluorescence yield and the Coster-Kronig transition probabilities recommended by Campbell and the values based on the Dirac-Hartree-Slater model by Puri.The experimental and theoretical results are in agreement.In this work,L XRF relative intensities for the elements Sm,Gd,Tb,Er,Ta,W,Re,Hg,Pb and Bi at energies of 18 keV and 23 keV were measured.

Importance of establishing radiation protection culture in Radiology Department

The increased use of ionization radiation for diagnostic and therapeutic purposes, the rapid advances in computed tomography as well as the high radiation doses delivered by interventional procedures have raised serious safety and health concerns for both patients and medical staff and have necessitated the establishment of a radiation protection culture(RPC) in every Radiology Department. RPC is a newly introduced concept. The term culture describes the combination of attitudes, beliefs, practices and rules among the professionals, staff and patients regarding to radiation protection. Most of the time, the challenge is to improve rather than to build a RPC. The establishment of a RPC requires continuing education of the staff and professional, effective communication among stakeholders of all levels and implementation of quality assurance programs. The RPC creation is being driven from the highest level. Leadership, professionals and associate societies are recognized to play a vital role in the embedding and promotion of RPC in a Medical Unit. The establishment of a RPC enables the reduction of the radiation dose, enhances radiation risk awareness, minimizes unsafe practices, and improves the quality of a radiation protection program. The purpose of this review paper is to describe the role and highlight the importance of establishing a strong RPC in Radiology Departments with an emphasis on promoting RPC in the Interventional Radiology environment.

Evaluation of a Suspended Personal Radiation Protection System vs. Conventional Apron and Shields in Clinical Interventional Procedures

Purpose: This clinical study compares conventional lead aprons and ancillary shields to a functionally weightless personal overhead-supported system with expanded coverage. Materials and Methods: Primary operators performed procedures (N = 126, fluoroscopy minutes = 1209) using one of 2 methods of radiation protection and wearing dosimeters on multiple body locations. Method “LAS” (Lead-Apron+Shields): lead skirt, vest, thyroid shield, with 100% use of under-table shield, side shield, and mobile suspended lead-acrylic shield. Method “Zgrav”: ZeroGravity system (CFI Medical Solutions) with variable use of shielding. The studied early model moving with the operator had a curved lead-acrylic head shield (0.5 mm Pb) and expansive lead apron (0.5 - 1.0 mm Pb) that covered leg to distal calf and proximal arm to elbow, and a drape that permitted sterile entry and exit. Study was institutional review board approved and HIPPA-compliant. Results: Measured with a sensitive electronic dosimeter, eye exposures were 99% (P 0.001) reduced for Zgrav with upgraded face shield vs. LAS, regardless of use or non-use of suspended shield with Zgrav. With optically stimulated luminescence (OSL) dosimeters, operator exposures, standardized to minutes of fluoroscopy and Fluoroscopic Patient Dose Area Product, were reduced by 87% - 100% for eye & head, neck, humerus, and tibia (Zgrav vs. LAS). Overall eye & head exposure reduction for entire study was 94%. Non-equivalence of torso exposures was not demonstrated. A brief user survey showed ergonomic advantages of Zgrav. Conclusion: Compared to conventional lead aprons with shields, the suspended system provided superior operator protection during interventional fluoroscopy, allowing operators to perform procedures without potentially obstructive shields.

Laser Device for the Protection of Biological Objects from the Damaging Action of Ionizing Radiation

Laser irradiation device for the protection of biological objects from the action of ionizing radiation to be used in practice has been manufactured （invention patent RU 2 428 228 C2）. Research of the action of y-radiation itself as well as of the combined action of laser devices on survival, weight, skin and the general mitotic index of the bone marrow cells （mitotic index of all nucleus-containing cells of the bone marrow） of C57BL/6 experimental young mice was carried out. The mice were irradiated with ionizing （whole body irradiation） and laser radiation, separately one by one in a special frame device. Laser radiation in the dose 1 mJ/cm^2 irradiated only the back of a mouse, or both the back and the abdomen of mice. In case of combined irradiation of mice, the time interval between two types of irradiation did not exceed 30 min. First, the mice were exposed to y-radiation then to laser radiation. The method of the laser radiation-protection of biological subjects contributes to an increase in the viability of mice, prevents the damages of skin and also increases the mitotic activity of mice bone marrow cells.

ICRPANDCHINESERADIATIONPROTECTIONCOMMUNITY

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Preparation of Modified Poly(ethylene terephthalate) Fibers and Their Properties of Ultraviolet Radiation Protection

Protection against solar ultraviolet radiation (UVR)among the general public has been increasing steadily.Poly( ethylene terephthalate) (PET) was blended with UVR protection agent and was spun into the modified fibers with the properties of UVR protection. An investigation on the properties using an ultraviolet spectrophotometer showed that the modified PET fabrics could be resistant to UVR more than 90% in the band of UV-B. The effect of the heat insulation and the mechanical properties of the fibers were also studied.

An Investigation of Radiation Protection Status in Radiology Centers of Kurdistan in 2014-2015

Using personal protective equipment (PPE) properly and following available rules and regulations in the field of ionizing radiation protection can significantly decrease these harms. If these equipment and facilities are not available in diagnostic radiation centers or are not used properly, radiographers’ and people’s health will be jeopardized. To date, no study has examined the protective condition against radiation in diagnostic radiation centers of Kurdistan province. The present study, therefore, was an attempt to address this gap. This cross-sectional study was conducted in 2014-2015 among 35 diagnostic radiation centers of Kurdistan. Data were collected through a checklist (which was developed based on the available radiation protection laws), a survey for patients and their caregivers, and insite observation and dosimetry. The radiation health expert of the province proceeded to each of the radiology centers personally. Upon arrival to each center, he informed health physics officials of the centers about the study and collected data through observation, interview, and the checklist. On the other hand, in order to examine radiation leakage in different modes of imaging session, dosimetry was conducted by the use of an environmental dosimeter (Fluke 451 manufactured in the United States). The collected data were analyzed through Excel. It was found that in 67.3% of the cases, there was personal protective equipment for patients and their caregivers (robes, thyroid strap, gonadal shield, glasses, and lead gloves). Furthermore, this equipment and other physical holders were used for patients and their caregivers in 75.7% of the cases. This rate was 87.6% for pregnant women. In addition, we found that around 94% of the personnel went through medical examinations every six or twelve months, a rate that was much higher than that found in Nohi’s study. When it comes to improving the indices of protection against radiation in radiation centers, it seems that adding the proposed items in this study to the present data collection form (form 110 used for urban areas) or designing a new form will change the attitude toward the concept of protection. This will highlight the importance of this topic and will result in decision makers’ more serious attempts to promote the protection condition.

Bioflavonoids as Important Component of Biological Protection from Ionizing Radiation

New advances in the area of deciphering the mechanism for a possible modification of the biological effects of radiation exposure at the genetic level make it possible to distinguish the group of radiation protective agents having their own specific features in the implementation of their beneficial effects. The mechanism of the radioprotective action of bioflavonoids is worthy of a detailed analysis in view of their great biological importance. Radiobiological studies show that antioxidants can reduce the radiation damage to membranes and favor more adequate energy dependent adaptive and reparative processes after the exposure to radiation. Bioflavonoids are significant component of “biological protection” for a enhance of resistance of the body to environmental factors that are adverse for human health, including ionizing radiation, with reducing the risk of carcinogenic effects and decreasing the biological age. The best practical value of bioflavonoids, can be considered as the agents for prophylaxis against the development of oxidative stress. These are the reasons why the administration of natural antioxidants have a pathogenetic justification for exposures to chronic (months, years) low-rate-dose ionizing radiation. These agents were previously and are currently being developed for use during long-term, low-ratedose exposures to radiation, under conditions of long space missions. Acting as low-dose stressors through a hormetic mechanism and a “substrate” support of adaptive shifts radiomodulators results in an increase in the antioxidant defense of the body and the rearrangement of its functioning in the new environment with the modulation of gene expression of antioxidant response elements by activation of Nrd2/KeapI and Sirtuin/FoxO pathways and a decrease in the transcription factor NF-κB.

RADIATION HAZARD AND PROTECTION OF LOW ENERGY ACCELERATORS

In this paper, the origin and type of radiation hazards as well as the main aspects of radiation protection for low-energy accelerators are discussed in general, and the problems of radiation protection and the experimental results of the operational monitoring of the five accelerators in the institute of Nuclear Science and Technology,Sichuan University, namely, one 1.2 M cyclofron, two Cockroft-waltons and two Van de Graafts, as well as a powerful electron accelerator for industrial irradiation are described. The discussion and evaluation are made according to the requirments of the National standards GB 5172-85.

Knowledge and Practices of Health Professionals on the Optimization of Radiation Protection in Diagnostic Radiology in Children and Adults in the General Referral Hospitals of Bukavu in South Kivu, DRC

The aim of this research was to assess the knowledge and practices of radiological versus non-radiological health professionals on the optimisation of radiation protection in paediatric and adult radiology in BUKAVU hospitals. To achieve this, we surveyed a convenience sample of 73 health professionals including 23 radiologists working in the hospitals surveyed to assess knowledge and level of implementation of radiation protection principles. Also, physical parameters were taken for the calculation of entry doses in paediatric and adult radiology units for comparison with the International Commission on Radiological Protection (ICRP) diagnostic reference levels. After analysis of the data, the following was found: although radiologists have sufficient knowledge of radiation protection standards, technical constraints do not allow them to observe the dose limitation principle recommended by the ICRP. This is why several radiology departments, including those of the HPGRB, the MWANZI clinic and CIRIRI hospital, have proved to be very irradiating for children. However, radiologists and non-radiologists alike do not contribute positively to the optimisation of radiation protection in the diagnostic use of X-rays. Therefore, support in the implementation of radiation protection principles and regular monitoring of the units as well as replacement of non-standard equipment is necessary to promote patient and environmental safety by optimising radiation protection.

Natural Radiation Protection and Analysis in Underground Caverns

Underground caverns have important military and civilian uses, but their internal natural radiation may endanger human health, and it is necessary to implement protection. The protective measures taken for an underground cavern in Chongqing have obvious effects. The results show that cleaning the radiation source in the environment and sealing the gap of the hole can re-duce the natural radiation intensity inside the cavern to a certain extent, reducing the ambient temperature can significantly reduce the natural radiation intensity inside the cavern, the use of press-in ventilation can greatly reduce the natural radiation intensity inside the cavern, the cumulative drop can reach 25.63%, and the protective effect is obvious. These protective measures can be used in underground caverns to improve the safety of military and civilian activities.

Capacity Building and Transfer of Know-how in Radiation Protection. Dissemination of Enetrap Projects Results

The ENETRAP （European Network on Education and Training in RAdiological Protection） project series, since the first edition in 2005 till the current ENETRAP III, always have been the objective to maintain a high level of competence in radiation protection （RP）, assuring the continued development of suitable well-trained personnel and adequate knowledge management. This objective is crucial to ensure future safe use of ionizing radiations （IR） and the development of new technologies in a safe way. A big effort and lot of work has been done in these 11 years including the new definitions in the BSS for RP Expert （RPE）, RP Officer （RPO） and Medical Physics Expert （MPE） which are the basis for future national development and implementation and adequate the high-level education and training （E＆T） in the countries. In order to manage all the valuable results of the projects and to distribute them to the society, is required a tool, developed with this specific propose, that will be the object of this paper.

Occupational Eye Lens Radiation Dose While Performing Interventional Procedures over 18 Months Using a Face-Shield Equipped Suspended Radiation Protection System

Background: Numerous studies have demonstrated increasing evidence for cataractogenesis at lower levels of ionizing radiation than previously believed, with some suggesting possible absence of a threshold. Genetic differences between individuals also result in increased susceptibility in some operators, who might not be aware. European occupational exposure limits have been reduced and operators are seeking protective measures. Objective: To evaluate the protective effect of a face-shield equipped suspended protection system (Zero-Gravity®, TIDI Products, Neenah, WI) along with adherence to safety practices against radiation dose to the eye lens for an interventional radiologist performing a wide variety of procedures. Materials and Methods: In this institutional review board-approved single-institution study, one interventional radiologist wore a highly sensitive personnel monitoring dosimeter badge on the cap near the left eye while performing 299 procedures (3690 fluoroscopy minutes) over 18 consecutive months while utilizing the suspended protection system along with adherence to other generally recommended safety practices and movement away from the field during angiographic power injections. Dosimetry reports and procedural information were retrospectively reviewed. Results: Total lens dose equivalent to the left eye over 18 months was 0.11 mSv (annualized dose = 0.073 mSv, or 7.3 mRem). The patient-dose-area product standardized dose of 0.00576 μSv/Gy⋅cm2 is well below reports of conventional lead aprons, shields, and protective eyewear. Conclusion: Eye exposures were kept to near-background levels using the materials and methods of this study while performing a wide variety of complex procedures from all positions around the patient.

Study on Compliance with Radiation Protection Rules in the Medical Imaging Department of Pr Bocar Sidy Sall Hospital of Kati (Mali)

Objective: Evaluate the level of compliance with radiation protection rules in the medical imaging department of the University Hospital Center (CHU) of Kati. Methodology: This was a cross-sectional and descriptive study carried out in the medical imaging department of Pr Bocar Sidy Sall (BSS) Hospital of Kati. A questionnaire was developed and sent to the staff of the medical imaging department. The assessment focused on the radiation protection of personnel, radiation protection measures for patients, the delimitation and signage of zoning as well as the application of radiation protection principles. Results: Twenty-one people participated in the study, 90% of whom were men. The 30 - 39 age group was predominant with 61.90%. 33.33% of the staff knew the principles of radiation protection;86% of our sample knew the basic rules of radiation protection. The majority of the staff in the imaging department (61.90%) had a perfect knowledge of protective equipment. For 76% of our workforce, the limits of the radiation doses received are regulated in Mali. 76% of those surveyed have not taken any additional training in radiation protection. The doors are closed during the X-ray examination for 76.19% of the respondents and 95% of the staff put themselves behind the sealed screen during the examination. For 81% of the respondents, the design of the premises met radiation protection standards. 62% of practitioners have a dosimeter and 80% of them wear it during their shift. For 62% of our sample, the change of the dosimeter is quarterly. The systematic request for DDR (date of last menstrual period) in women and the adaptation of the delivered dose to the patient’s morphology was only carried out by 65% of practitioners. The majority of staff (81%) did not benefit from medical surveillance, while for 55% of respondents the level of radiation protection in the establishment was average. Conclusion: This study enabled us to highlight the shortcomings in terms of radiation protection within the imaging department of the CHU Kati.

Inventory of Radiation Protection in Hospitals of Level III in Senegal

The aim of this study was to evaluate the level of protection of employees who are exposed to radiation in a level III hospital establishment. It was a descriptive cross-sectional survey of six months’ duration, involving eight level III Hospitals (Aristide Le Dantec, Fann, Hoggy, Hear, Abass Ndao, Pikine, Touba, and Thiès) in Senegal. Sixty-one of the one hundred questionnaires were recovered (overall response rate of 61%). The population of the study was mainly female (54.1%). The average age was 38.57 with extremes ranging from 23 to 65 years old. In the places where ionizing radiation sources are handled, only at the Aristide Le Dantec Hospital did we find a “competent person in radiation protection”. This explained the lack of a classification of employees and work areas. Forty out of sixty-one (73.77%) had no knowledge of the basic principles of radiation protection (justification, optimisation, dose limitation) and had not ever taken radiation holidays. For radiovigilance, exposure time limits to ionizing radiation concerned only 29/61 or 47.54% of the study population. The inverse square law of distance was known by only 40 workers, of whom 15 had no compliance. We found the presence of dosifilms in only 7/61 or 11.47% of the workers. On the other hand, the use of lead aprons was well established and concerned 57/61 workers, i.e., 93.44%. In sum, ionizing radiation causes adverse health effects. The absence of a good radiation protection culture in Senegal requires the presence of at least 4 to 5 competent persons in radiation protection for quality training of workers in radiobiology, radiopathology and radiation protection.

Factors Affecting Compliance towards Radiation Protection Equipment among Radiographers:A Cross Sectional Study

Background:Radiographers were at risk of x-ray radiation.Ministry of Heath of Indonesia made a regulation act no.33 year 2007 to secure radiographers on ionizing radiations by using radiation protection equipment(RPE).Objective:This study identified the factors affecting compliance towards RPE among radiographers and determined the correlation between influencing factors and compliance towards RPEs.Methods:The study conducted a quantitative descriptive-correlational design in a cross sectional approach.A total of 103 radiographers answered the online self administered questionnaires from 9 government hospitals at Jakarta,Indonesia.Results:It was identified that personal factors were the knowledge and motivations while the availability of RPEs and standard operating procedures were environmental factors.The knowledge(p=0.001,r=0.321)and motivations(p=0.018,r=0.232),and availability of RPE(p=0.138,r=0.146)and standard operating procedures(p=0.023,r=0.224)were factors affecting a compliance to RPEs.It was however determined that gender(p=0.251,r=0.113),and place of work(p=0.479,r=0.070)were not correlated to both personal and environmental factors.On the contrary,age(p=0.031,r=0.212),highest educational attainment(p=0.039,r=0.203),years of experience(p=0.001,r=0.336),and training(p=0.001,r=0.341)influenced both personal and environmental factors affecting compliance of radiographers towards RPEs.Findings:It was found that Dr.Cipto Mangunkusumo(p=0.271),Persahabatan(p=0.133),Fatmawati(p=0.357),Otak Nasional(p=0.238),Pasar Rebo(p=0.356),Tarakan(0.255),and Koja(p=0.199)hospitals were not probable to comply towards RPEs.Only Infeksi Sulianti Suroso(p=0.21),and Budhi Asih(p=0.0002)hospitals were most probable to comply towards RPEs.