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intervention areas, and patient anatomy( Häusler et al., 2009; ICRP, 2007). Because IR performs interventions in several body regions( Hirsch et al., 2006; Rehani and Ortiz-Lopez, 2006; Theodorakou and Horrocks, 2003), specific protocols contribute to different levels of scattered radiation that reaches the staff( Faroux et al., 2018; Theodorakou and Horrocks, 2003). Given that scattered radiation is the primary source of occupational exposure, this underscores the importance of developing methodologies for more accurately estimating the dose received by interventional professionals( Miller et al., 2010; Rivera-Montalvo and Uruchurtu-Chavarín, 2020; Castrillón and Morales, 2020). In this context, Optically Stimulated Luminescence Dosimeters( OSL), such as nano- Dots and InLight are crucial. NanoDots are used for precise dose measurements in the lens of the eye, while InLight dosimeters monitor exposure in other body areas. Both are essential for a comprehensive assessment of radiation exposure due to their high sensitivity and accurate reading capabilities. NanoDots, being miniaturized and housed in light-proof casings, are ideal for clinical applications, while InLight provides detailed dose assessment for larger body areas.( Musa et al., 2019; Wong et al., 2019; Yukihara et al., 2014).
Since 2013, all fluoroscopic equipment has been required to record the protocol parameters used in each procedure, including fluoroscopy time, Air kerma, and Air kerma Area Product( P KA)( Miller et al., 2010). Studies have demonstrated that P KA is a reliable representative factor for patient dose management, providing a more useful predictor for stochastic effect risks when compared to Air kerma due to its consideration of the irradiated area( Bacchim Neto et al., 2017; Costa et al., 2023). For the operator dose, the use of P KA for exposure estimation also provides a valuable approach and serves as a reliable tool( IAEA, 2011)
Even though there has been recent interest in investigating the relation between equipment parameters and patient dose and risk indicator( Costa et al., 2023), there is still a lack of knowledge correlating patient and staff doses. In this study, we propose a methodology for estimating the effective dose of professionals in three interventional procedure modalities: coronary, cerebral, and peripheral, using the equipment’ s P KA indicator along with OSL dosimetry. This approach is a significant advancement over traditional techniques, as it offers a more agile and accurate method for assessing radiation exposure. The primary objective is to establish a reliable and efficient way to quantify the effective doses of the team by comparing equipment parameters with personal dosimetry. Through this, we aim to contribute to the enhancement of radiation safety practices and the protection of healthcare professionals in clinical settings.
2 Materials and methods
This study was conducted in the Hemodynamics Sector large Brazilian hospital, known for its wide range of interventional radiology procedures. The hospital adheres to a strict radiological protection program, ensuring compliance with national and international safety standards.
2.1 Fluoroscopy equipment
In this study, we utilized two advanced fluoroscopy systems in the Hemodynamics Sector. Coronary procedures were performed using the Innova IGS 520 equipment by GE Healthcare, while cerebral and extremity procedures were conducted with the Artis Zee equipment from Siemens. Both devices underwent rigorous quality control tests in accordance with national regulations. Additionally, prioritizing staff safety, the equipment featured floor and ceiling shields, and personal protective equipment( thyroid protectors, lead glasses, and lead aprons), along with automatic exposure control systems to adjust the radiation dose based on the patient’ s physical characteristics, optimizing safety and efficiency of the procedures.
Detailed specifications for each type of procedure using these systems, including projections during fluoroscopy procedures, are summarized in Table 1. This table also details key operational parameters, such as base kilovoltage( kV), frames per second, pulse width, and specific projections( e. g., RAO, LAO, AP) tailored for each type of procedure. This ensures comprehensive understanding of equipment setup and procedural protocols, adhering to the strict quality controls aligned with the Brazilian regulatory agency’ s standards for fluoroscopy protocols( Ministério da Saude, 2021).
Figure 1 presents a flowchart of the procedures adopted in this study. In all IR exams, personal and equipment dosimetry data were measured, and these results correlated.
2.2 IR procedures
The protocols were selected following a retrospective analysis, focusing on the total exposure time( fluoroscopy time) and the frequency of the procedures in clinical practice. We defined a reference profile with an average age of 65 years and a weight of 85.4 kg to streamline the analysis and ensure the reliability of radiation exposure data. Routine inspections by the radiological protection supervisor aided in the meticulous choice of protocols, giving preference to those with a higher radiation exposure risk.
2.3 Staff dosimetry
Following the recommendations of International Commission on Radiological Protection( ICRP) 139( López et al., 2018) our institution has been standardly monitoring interventionalists with a dosimeter placed on the chest over the lead apron. This monitoring is essential for assessing the radiation dose received by professionals in a clinical environment.
Expanding this practice, our study implemented the use of specific dosimeters for various body regions, acknowledging that scattered radiation in hemodynamics is not uniform. As per the recommendations of ICRP and the International Commission on Radiation Units and Measurements( ICRU)( Wambersie et al., 2005), we measured exposure not only on the chest but also in areas such as the lens, hands, feet, thyroid, and abdomen, using Hp( 3) dosimeters for eye monitoring, Hp( 0.07) for extremities, and Hp( 10) for the trunk, calibrated to assess the dose in soft tissues at a depth of 10 mm.