Radiation Protection - Eyes

4 Imaging Solutions, LLC

Mark Struthers BBA, BSRT (R)(MR), CMRT, CIIP

The use of ionizing radiation is associated with a risk of inducing malignant disease and causing skin or eye damage to the patient and personnel.

Fluoroscopy – Diagnostic, Cardiac, Fluoroscopy – Diagnostic, Cardiac, Interventional ProceduresInterventional Procedures

Cancer of the Eye

Radiation is associated with a small but definite stochastic risk of inducing a malignant disease. However, low-dose radiation exposure has also been shown to induce an increase in the number of circulating lymphocytes and chromosome aberrations, which represent surrogate biomarkers of cancer risk.

The long-term cancer risk increases with increasing cumulative dose, and there is no known threshold value. Furthermore, there is a deterministic risk of skin damage, both to the patient and the operator, as well as a risk of eye injury to the operator.

Cataracts Associated with Ionizing Radiation

A new 2011 study of interventional cardiologists and nurses in Malaysia found five times the rate of cataracts in the groupcompared to controls, suggesting that current radiation protection thresholds may be too high to protect providersfrom harm.

The study, published online in Catheterization and Cardiovascular Interventions, found that cataract rates vary according to the length of professional exposure, as well as the level of eye protection operators choose to wear.

““Occupational exposures received during interventional cardiology procedures Occupational exposures received during interventional cardiology procedures are the highest doses received by health professionals.” – August 2010are the highest doses received by health professionals.” – August 2010

The Catheterization and Cardiovascular Interventions study found:

Even under normal working conditions, scatter radiation aroundthe patient may reach high levels.

With respect to ocular exposure, the increasingly larger workload typical of many modern catheterization suites, a lack of training in radiation protection, and unavailability or nonuse of radiation protection for the face and head may result in doses to the eye sufficient to cause cataracts.

Collaborating institutions included the International Atomic Energy Agency (IAEA) in Vienna, Austria; SarawakCollaborating institutions included the International Atomic Energy Agency (IAEA) in Vienna, Austria; SarawakGeneral Hospital in Kuching, Malaysia; Complutense University in Madrid; and Columbia University in New York City.General Hospital in Kuching, Malaysia; Complutense University in Madrid; and Columbia University in New York City.

Cataract formation is the primary ocular complication associated with radiation exposure to the eye.

A cataract generally manifests as cortical and posterior subcapsular opacification of the lens, the most radiosensitive eye tissue. Changes resulting from exposure tend to appear first in the posterior subcapsular region of the lens and consist of small dots and vacuoles which, over time, aggregate to form larger opacities.

Thus, cataract severity and latency are both related to dose

IAEA RecommendationsIAEA Recommendations

Catheterization and Cardiovascular Interventions

The results of the study showed a dose-dependent increased risk of posterior lens opacities for interventional cardiologists and nurses when radiation protection tools were not used.

As a result, "there is an urgent need to implement training programs in interventional cardiology such as the standardized IAEA program, which includes participants from more than 55 countries," they wrote. Knowledge of individual dose levels helps increase awareness about radiation. "Thus, good training, skilled operators, and use of radiation protection devices are essential elements in achieving a safe working environment in the interventional cardiology department.”

What’s the big deal?

The lens of the eye is the most vulnerable site on the body for radiation damage. The radiation dose to the eye has a cumulative effect, which means it keeps multiplying day after day, month after month, year after year.

What About Exposure?

The current ICRP permissible limits are set at 150msv/year. However, new studies have shown that people are developing cataracts at much lower radiation doses than the permissible limits allow. In addition, doctors are performing ever increasing numbers of procedures per day and lens doses often exceed the limit if between 30 and 40 procedures per month are performed. The threshold for deterministic effects is exceeded after several years of work on average. The lens dose can also depend on the equipment being used; older equipment can produce more scatter radiation and increase health risks.

Why Wear Leaded Glasses?

A dangerous urban legend is the normal prescription eyeglasses protect the eyes from ionizing radiation – WRONG!!!

Proper use of radiation protective eyewear reduces the scattered radiation dose that reaches the eye to only 2% to 3%, resulting in only a few microsieverts of eye exposure per procedure. This sustainable exposure level will prevent long-term PSC cataract formation. Lead glasses have evolved from heavy, drab equipment into a lightweight and stylish product that's convenient to wear. Lead glasses are used by physicians and staff during cardiac catheterization, interventional radiology, electrophysiology, urological procedures, pain management and orthopedic surgery.

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