ICRP Publication 139: Occupational Radiological Protection in Interventional Procedures

When the International X-ray and Radium Protection Committee [now the International Commission on Radiological Protection (ICRP)] was established back in 1928, its main concern was the occupational exposure of medical staff and the deterministic effects that were already being seen at this time. Old photographs showing doctors with missing fingers and scarred skin are a salient reminder to modern practitioners of the effects that radiation caused because the dangers were not appreciated and appropriate protection was not used. ICRP is celebrating its 90th anniversary in 2018, so it is timely that one of its publications should still have relevance in addressing occupational radiological protection of medically exposed workers (i.e. those involved in interventional procedures).

Interventional procedures using ionising radiation have revolutionised medicine in the last few decades for diagnosis, therapy, and palliation, resulting in more patients being offered treatments that would not have been possible previously. As technology continues to advance at an astonishing rate, so the interventional procedures become more complex, and some may take several hours to complete. New technologies also present new challenges for radiological protection, such as positron emission tomography-computed tomography guided interventions and selective internal radiation therapy.

Although the photographs of missing fingers are now a thing of the past, several studies have demonstrated increased opacities in the lens of the eye and, in some cases, cataracts among interventionalists. Education and training of personnel who perform and who are associated with interventional procedures cannot be emphasised enough, as good practices will reduce doses to patients and staff. A successful radiological protection programme for such procedures requires a team effort from all individuals involved, including doctors, nurses, radiographers, physicists, regulators, and administrators. In addition, staff need to be aware of the importance of wearing personal protective equipment, including dosimeters. Too often, dosimeters and protective lead glasses are not worn, either because of lack of volition or fear of recording high doses that may threaten continuing clinical practice. Interventionalists should take some responsibility for their own personal protection, and not just assume that this is the role of radiation supervisors and medical physicists. A change in behaviour is required to improve compliance with recommended personal protection, and education is key in achieving this goal.

Having worked as an interventional radiologist for nearly 30 years, I acknowledge that it takes a degree of self-discipline to constantly remember to wear several dosimeters, protective glasses, and a thyroid collar for each case, but keeping these items together and performing the same preparatory ritual is not difficult. One would hope that, nowadays, nearly all drivers setting off on a journey remember to put on their seat belt, and the start of an interventional procedure should include a similar routine with protective equipment.

Just over 100 years ago in 1916, several years before the existence of ICRP, Henry Ford gave an interview published in the Chicago Tribune in which he said:

History is more or less bunk … . We want to live in the present, and the only history that is worth a tinker’s damn is the history that we make today.

However, it can be argued that it is only by looking back at events of the past, and learning from them, that we can hope to adopt safer practices today and for the future. After all, this is at the core of ICRP’s business – to provide recommendations and guidance related to the use of ionising radiation – and, as demonstrated in this publication, medicine is a very important part of this. Some of the interventional procedures performed at the present time are likely to be obsolete in a couple of decades as they are superseded by the development of new treatments. If history had been considered ‘bunk’, we would not have the system of radiological protection that has evolved to date, but we should not forget that we are undoubtedly making history today.

CLAIRE COUSINS

CHAIR, ICRP

ICRP PUBLICATION 139

Approved by the Commission in October 2017

Abstract–In recent publications, such as Publications 117 and 120, the Commission provided practical advice for physicians and other healthcare personnel on measures to protect their patients and themselves during interventional procedures. These measures can only be effective if they are encompassed by a framework of radiological protection elements, and by the availability of professionals with responsibilities in radiological protection. This framework includes a radiological protection programme with a strategy for exposure monitoring, protective garments, education and training, and quality assurance of the programme implementation. Professionals with responsibilities in occupational radiological protection for interventional procedures include: medical physicists; radiological protection specialists; personnel working in dosimetry services; clinical applications support personnel from the suppliers and maintenance companies; staff engaged in training, standardisation of equipment, and procedures; staff responsible for occupational health; hospital administrators responsible for providing financial support; and professional bodies and regulators. This publication addresses these elements and these audiences, and provides advice on specific issues, such as assessment of effective dose from dosimeter readings when an apron is worn, estimation of exposure of the lens of the eye (with and without protective eyewear), extremity monitoring, selection and testing of protective garments, and auditing the interventional procedures when occupational doses are unusually high or low (the latter meaning that the dosimeter may not have been worn).

© 2018 ICRP. Published by SAGE.

Keywords: Occupational radiological protection; Interventional procedures; Exposure monitoring; Exposure of the lens of the eye; Protective garments

AUTHORS ON BEHALF OF ICRP

P. ORTIZ LÓPEZ, L.T. DAUER, R. LOOSE, C.J. MARTIN, D.L. MILLER,

E. VAÑÓ, M. DORUFF, R. PADOVANI, G. MASSERA, C. YODER