Radiation Protection Pavilion Information Material

The CIRSE Radiation Protection Subcommittee has compiled a selection of scientfic information materials to keep our Members informed, including articles, posters, guidelines and presentations. 

I. Occupational Health Hazards in Interventional Radiology

Occupational health hazards of working in the interventional laboratory: a multisite case control study of physicians and allied staff. Orme NM, Rihal CS, Gulati R, Holmes DR Jr, Lennon RJ, Lewis BR, McPhail IR, Thielen KR, Pislaru SV, Sandhu GS, Singh M. Journal of the American College of Cardiology. 2015 Mar 3; 65(8):820-6.
Occupational health hazards in the interventional laboratory: progress report of the Multispecialty Occupational Health Group. Miller DL, Klein LW, Balter S, Norbash A, Haines D, Fairobent L, Goldstein JA; Multispecialty Occupational Health Group. Journal of Vascular and Interventional Radiology (JVIR). 2010 Sep; 21(9):1338-41.
Occupational health hazards in the interventional laboratory: time for a safer environment. Klein LW, Miller DL, Balter S, Laskey W, Haines D, Norbash A, Mauro MA, Goldstein JA. Radiology. 2009 Feb; 250(2):538-44. doi: 10.1148/radiol.2502082558.
The occupational effects of interventional cardiology: results from the WIN for Safety survey. Buchanan GL, Chieffo A, Mehilli J, Mikhail GW, Mauri F, Presbitero P, Grinfeld L, Petronio AS, Skelding KA, Hoye A, Mehran R, Morice MC; Women In Innovation Group. EuroIntervention. 2012 Oct; 8(6):658-63.

Prevalence of spinal disc disease among interventional cardiologists. Ross AM, Segal J, Borenstein D, Jenkins E, Cho S. American Journal of Cardiology. 1997 Jan 1;79(1):68-70.

Pain prevention for interventional radiologists. Healy JF. American Journal of Neuroradiology (AJNR). 2001;22(1):225.

Low back pain, lead aprons, and the angiographer. Pelz DM. American Journal of Neuroradiology (AJNR). 2000;21(7):1364.
A set of patient and staff dose data for validation of Monte Carlo calculations in interventional cardiology. Vano E, Sanchez RM, Fernandez JM, Bartal G, Canevaro L, Lykawka R, Melo C. Radiation Protection Dosimetry. 2015 Jul;165(1-4):235-9.
Prevalence and risk factors for cervical and lumbar spondylosis in interventional electrophysiologists. Birnie D, Healey JS, Krahn AD, Ahmad K, Crystal E, Khaykin Y, et al.  J Cardiovasc Electrophysiol. 2011;22(9):957-60.

II. Eye Lens Dose and Radiation-Induced Cataracts

Eye dose assessment and management: overview. Rehani MM. Radiation Protection Dosimetry. 2015 Jul;165(1-4):276-8.
Eye dosimetry in interventional radiology and cardiology: current challenges and practical considerations. Ciraj-Bjelac O, Rehani MM. Radiation Protection Dosimetry. 2014 Dec;162(3):329-37.
Eye Lens Dosimetry in Interventional Cardiology: Results of Staff Dose Measurements and Link to Patient Dose Levels. V. Antic, O. Ciraj-Bjelac, M. Rehani, S. Aleksandric, D. Arandjic and M. Ostojic. Radiat Prot Dosimetry. 2013;154(3):276-84.
Occupational radiation doses to the extremities and the eyes in interventional radiology and cardiology procedures. Efstathopoulos EP, Pantos I, Andreou M, Gkatzis A, Carinou E, Koukorava C, Kelekis NL, Brountzos E. British Journal of Radiology. 2011 Jan;84(997):70-7.
Radiation-associated lens opacities in catheterization personnel: results of a survey and direct assessments. E. Vano, NJ. Kleiman, A.Duran, M. Romano-Miller, M. Rehani. J Vasc Interv Radiol. 2013 Feb;24(2):197-204.
Radiation and cataract. M. Rehani, E. Vano, O. Ciraj-Bjelac, N.J. Kleiman. Radiat Prot Dosimetry. 2011 Sep;147(1-2):300-4.
Radiation Cataract Risk in Interventional Cardiology Personnel. E. Vano, N.J. Kleiman, A. Duran, M. Rehani, D. Echeverri, M. Cabrera. Radiat Res. 2010 Oct;174(4):490-5.
Risk for Radiation-Induced Cataract for Staff in Interventional Cardiology: Is There Reason for Concern? P. Ciraj-Bjelac, M. Rehani, K. Hian Sim, H. Bang Liew, E. Vano, N.J. Kleiman. Catheter Cardiovasc Interv. 2010 Nov 15;76(6):826-34.
Radiation-Induced Eye Lens Changes and Risk for Cataract in Interventional Cardiology. O. Ciraj-Bjelac, M. Rehani, A. Minamoto, K.H. Sim, H.B. Liew, E. Vano. Cardiology 2012; 123:168-171.
Exposition of the Operator’s Eye Lens and Efficacy of Radiation Shielding in Fluoroscopically Guided Interventions. M. Galster, C. Guhl, M. Uder, R. Adamus. 2012,  Fortschr Röntgenstr 2013; 185: 474–481. (Article in German)

III. Efficacy of Radiation Protection Equipment

Efficacy of radiation safety glasses in interventional radiology. Van Rooijen BD, de Haan MW, Das M, Arnoldussen CWKP, de Graaf R, van Zwam WH, Backes WH, Jeukens CRLPN. CardioVascular and Interventional Radiology (CVIR), October 2014, Volume 37, Issue 5, pp 1149-1155.
Comparison of the zerogravity radiation protection system vs. standard lead apron plus ancillary shielding during clinical interventional procedures (Abstract No. 251). Shaw C, Rees CR, Bruner A, Savage CM. Journal of Vascular and Interventional Radiology (JVIR). March 2011Volume 22, Issue 3, Supplement, Page S108.
Comparison of a suspended radiation protection system versus standard lead apron for radiation exposure of a simulated interventionalist. Marichal DA, Anwar T, Kirsch D, Clements J, Carlson L, Savage C, Rees CR. Journal of Vascular and Interventional Radiology (JVIR) 2011 Apr;22(4):437-42.

IV. Radiation Protection of Patients

Radiation Exposure to Patients During Interventional Procedures in 20 Countries: Initial IAEA Project Results. V. Tsapaki, NA. Ahmed, JS. AlSuwaidi, A. Beganovic, A. Benider, L. BenOmrane, R. Borisova, S. Economides, L. El-Nachef, D. Faj, A. Hovhannesyan, MH. Kharita, N. Khelassi-Toutaoui, N. Manatrakul, I. Mirsaidov, M. Shaaban, I. Ursulean, JS. Wambani, A. Zaman, J. Ziliukas, D. Zontar, M. Rehani. AJR Am J Roentgenol. 2009 Aug;193(2):559-69.
Radiation skin injury caused by percutaneous coronary intervention, report of 3 cases. Srimahachota S, Udayachalerm W, Kupharang T, Sukwijit K, Krisanachinda A, Rehani M. International Journal of Cardiology. Volume 154, Issue 2, Pages e31–e33, January 26, 2012.
Skin injuries in interventional procedures. Rehani MM, Srimahachota S. Radiation Protection Dosimetry. 2011 Sep;147(1-2):8-12.
Radiation effects in fluoroscopically guided cardiac interventions - keeping them under control.  Rehani MM, Ortiz-Lopez P. International Journal of Cardiology. 2006 May 10;109(2):147-51. Epub 2005 Jul 19.
I perform more than 100 interventional procedures every year but have never seen radiation-induced skin injury: am I missing something? Tsapaki V, Rehani MM. American Journal of Roentgenology (AJR). 2014 Nov; 203(5):W462-3.

V. Recommended ICRP Publications

Avoidance of Radiation Injuries from Medical Interventional Procedures. ICRP Publication 85. Ann. ICRP 30 (2), 2000.
Education and Training in Radiological Protection for Diagnostic and Interventional Procedures. E. Vaño, M. Rosenstein, J. Liniecki, M. Rehani, C.J. Martin, R.J. Vetter. ICRP Publication 113. Ann. ICRP 39 (5), 2009.
Radiological Protection in Fluoroscopically Guided Procedures outside the Imaging Department. M.M. Rehani, O. Ciraj-Bjelac, E. Vaño, D.L. Miller, S. Walsh, B.D. Giordano, J. Persliden. ICRP Publication 117. Ann. ICRP 40(6), 2010ICRP Statement on Tissue Reactions

ICRP Statement on Tissue Reactions: Early and Late Effects of Radiation in Normal Tissues and Organs – Threshold Doses for Tissue Reactions in a Radiation Protection Context. F.A. Stewart, A.V. Akleyev, M. Hauer-Jensen, J.H. Hendry, N.J. Kleiman, T.J. MacVittie, B.M. Aleman, A.B. Edgar, K. Mabuchi, C.R. Muirhead, R.E. Shore, W.H. Wallace. ICRP Publication 118. Ann. ICRP 41(1/2), 2012.

Radiological Protection in Paediatric Diagnostic and Interventional Radiology. P-L. Khong, H. Ringertz, V. Donoghue, D. Frush, M. Rehani, K. Appelgate, R. Sanchez. ICRP Publication 121. Ann. ICRP 42(2), 2013.


VI. Practical Tips

  IAEA 10 pearls on radiation protection of staff in fluoroscopy (available in several languages)
  IAEA 10 pearls on radiation protection of patients in fluoroscopy (available in several languages)
  IAEA 10 pearls on radiation protection for children in interventional procedures (available in several languages)
  Protection for occupational x-ray exposures especially in TIPS. R. Adamus, R. Loose, M. Galster.
  Management of patient and staff radiation dose in interventional radiology: current concepts. G.Bartal, E. Vano, G.Paulo, DL.Miller. CVIR, 2014 Apr;37(2):289-98.
  Improving protocols and procedures for strengthened radiation protection in interventional procedures. R. Loose.
  Eye Dose Assessment & Management: Overview. M. Rehani (RPM 2014)
  Eye dose assessment and management in diagnostic and interventional radiology. O. Ciraj-Bjelac (RPM 2014)


VII. CIRSE & European Partnerships

CIRSE sees its role as representing IR in these European radiation protection partnerships, offering interventional expertise where required and making sure that the interests of interventional radiologists are adequately represented at European level. Over the years, the Radiation Protection Subcommittee has been mandated to participate in several European Commission-funded research tenders, the scientific and legislative output of which can be accessed here: 

Medical Radiation Protection Training and Education                 Referral Guidelines for Medical Imaging                       

VIII. European and International Guidelines and related information material

European Basic Safety Standards Directive, 2013, officially: EU Council Directive 2013/59/EURATOM of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation.
  European survey on imaging referral guidelines. D.Remedios, M.Hierath, N.Ashford, P.Cavanagh, P.A.Grenier, C.M.Lloyd, G.Simeonov, J.A.Simonnet, V.Vilgrain. Insights into Imaging, February 2014, Volume 5, Issue 1, pp 15-23.
  European Basic Safety Standards Directive 2013/59/Euratom and Activities in Radiation Protection in Medicine. G.Simeonov (RPM 2014).
  Education and training in radiation protection in the European Basic Safety Standards. G.Simeonov
  Transposing and implementing Council Directive 2013/59/Euratom. Steve Ebdon-Jackson (RPM 2014)
  European Diagnostic Reference Levels for Paediatric Imaging.
Occupational Radiation Protection in Interventional Radiology: A Joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology
 EuroSafe Imaging
 HERCA Information Poster

For any questions regarding the Radiation Protection Pavilion or CIRSE's radiation protection efforts, please contact the Research & Analytics Department at tkalec@cirse.org