Keywords:
Interventional vascular, Vascular, Percutaneous
Authors:
J. Vassileva1, I. Stankova1, R. Borisova1, N. Kleiman2, E. Vano3, M. Rehani4; 1Sofia/BG, 2New York, NY/US, 3Madrid/ES, 4Vienna/AT
DOI:
10.1594/ecr2010/C-2100
Methods and Materials
Methodology developed by the IAEA for its RELID (Retrospective Evaluation of Lens Injuries and Dose) project [20] was used.
Every participant in the study signed an informed consent form, describing:
- The purpose of the study
- The study procedure
- The study risks
- The study benefits
- Confidentiality statement and
- Principle of voluntary participation.
Every participant filled in a detailed questionnaire having information on:
- Profession and personal demographic data
- Models of the X-ray systems used in the past and at present
- Short description of the work inside the interventional room, location in the room and percentage of time inside the catheterization lab during a typical procedure
- Pattern of practice – use of ceiling suspended screen, led glass eye wear
- Personal dosemetry – use of dosemeter, number and location of dosemeters
- Typical workload currently and in the past
- Relevant medical history – diabetes, heart disease, cancer / chemotherapy, MRI, nuclear medicine procedures, phototherapy, skin disease, use of drugs; history of autoimmune disease or use of systemic corticosteroids, etc.
- Radiation examination of head as a patient (head CT, skull X ray)
- Ocular history – personal and family history of eye diseases, previous examinations for lens opacity for eye/cataract, surgery for cataract, etc.
- Other factors – work with radiation, exposure to the sun, smoking, alcohol
Comprehensive slit lamp examination of both eye lenses was performed by experience ophthalmologists after a papillary dilation (Fig. 1).
Each eye was tested separately for posterior subcapsular opacities, known to be the sign of radiation induced opacities [17, 21, 22]. The found opacities were scored using Merriam-Focht scale (Fig. 2), assuming that the radiation cataracts develop sequentially with the earliest lens changes consisting of development of an opalescent sheen to the posterior capsule followed by the appearance of dots, vacuoles or diffuse opacities centered around the posterior lens suture. Continued cataract development leads to progression of these posterior changes, the involvement of the anterior subcapsular region and, ultimately, total lens opacification [21, 22].
A total 66 voluntaries were included in this study – 18 cardiologists, 24 paramedical staff (19 nurses and 5 radiographers) and a control group of 24 non-radiation workers (Fig. 3).
The study was performed in two phases. The first was performed in July 2009 in two cities by an international team of two ophthalmologists and three medical physics experts. Each ophthalmologist scored the opacities staging independently. A total of 25 people working in interventional rooms and a control group of 20 people not working with radiation were tested. The control group consisted of cardiologist, not involved in FG procedures and other voluntaries of different non-radiation professions.
The second round of eye testing was performed during the Annual Symposium on the Bulgarian Society of Interventional Cardiology when 17 radiation workers and 4 cardiologists not working with radiation were tested. The same methodology was applied but the eye testing was performed by only one local ophthalmologist, who participated in the first phase of the study.