Radiation induced lens changes and development of a radiation safety framework for interventionalists

[摘要] Background: Ionising radiation (IR) is a modality that is increasingly being used in diagnostic,prognostic, therapeutic and interventional procedures. The health effects due to IR exposurecan be deterministic or stochastic. Deterministic effects refer to effects that are seen at aminimal threshold level. These effects include skin burns and cytopaenia. Stochastic effectsrefer to effects where a minimum threshold is not evident. These include carcinomas andrecently cataracts are thought to fall into this group. Interventionalists are at increased riskof developing cataracts due to IR exposure.The use of personal protective equipment (PPE) is essential to mitigate against the effects ofIR on the eyes. Lead glasses, lead visors and ceiling suspended screens are essential forprotecting the eyes of radiation healthcare workers (HCWs) in the catheterisation laboratory.PPE is often not readily available and interventionalists are notoriously non-compliant withdonning PPE, especially lead glasses. They do not consistently wear their dosimeters either.Essential to reducing the risk of cataracts associated with IR is to ensure that education andtraining on radiation safety is formalised in the training of interventionalists and that there isongoing reinforcement of this training.Creating and sustaining a culture of radiation protection (CRP) is essential to changingattitudes and behaviour towards radiation safety practices. A CRP ensures better patientsafety and improves quality of care.Methods: This was a cross sectional prospective study that used multiple methods toaddress the research question. There was a qualitative and quantitative component. Thequalitative component used individual interviews and group interviews to understandinterventionalists' perceptions about radiation and its effects on their health; to garnerinsight to their training in radiation safety; and to make meaning of how they understoodwhat a CRP was. The quantitative components included a slit lamp examination and thecompletion of a survey. We compared a group of doctors not routinely occupationally exposed to IR to a group of interventionalists that are occupationally exposed to IR. Therewas no randomisation. Participation was voluntary and participants granted informedconsent. The study was approved by an ethics committee.Results: The prevalence of cataracts possibly associated with IR exposure was 18.8% in theexposed group and the prevalence of posterior sub-capsular (PSC) cataracts in this group was5.9%. PSC cataracts were 2.2 times more likely to occur in the exposed compared to theunexposed group.Lead glasses were consistently used by 10.2% of the interventionalists. Females were 4.3times more likely to report that PPE was not available. Qualitative data showed thatinterventionalists had a culture where PPE such as lead aprons were consistently used butlead glasses were not a priority. Participants had poor knowledge of the dose limits and theydid not consistently use dosimeters.There was a dearth of radiation protection training for interventionalists in South Africa.Radiologists received dedicated teaching on radiation safety while cardiologists did notalways receive teaching on the topic. This was especially true for cardiologists. Participantsgenerally agreed that there was a gap in their education and training in radiation safetytraining. Only 44.1% of participants thought their training was adequate. The majority ofparticipants (95.4%) indicated that they wanted radiation safety training as part of theircurriculum.A CRP was a strong theme that emerged as a conduit to creating a culture of radiation safetyand participants supported the notion of developing a better CRP to promote radiationsafety.Conclusion: IR exposure remains a high risk in the cath. lab exposing interventionalists to therisk of developing cataracts. This can be mitigated by improving training radiation safety andencouraging utilisation of PPE. Developing and sustaining a CRP is essential to improvingradiation safety in the cath. lab.

[发布机构] University of the Free State