The distribution of the participants in the study by occupation and gender is presented in Table 1. The age of participants varied between 26 and 64 years and the experience of work in interventional cardiology – between 1 and 25 years.
Table 1. Distribution of participants in the study by occupation and gender
Occupation | Phase 1 (July 2009) | Phase 2 (October 2009 |
Interventional cardiologist | 4 (4 men and 0 women) | 14 (9 men and 5 women) |
Nurse in interventional cardiology | 16 (1 men and 15 women) | 3 (0 men and 3 women) |
Radiographer in interventional cardiology | 5 (1 men and 4 women) | - |
Total staff working with FG procedures | 25 (6 men and 19 women) | 17 (9 men and 8 women) |
Control group | 20 (6 men and 14 women) | 4 (4 men and 0 women) |
In the Phase 1 of the study identical scores were given by both ophthalmologists and this good agreement let the further study in October to be performed by only one of the ophthalmologist from this team.
The positive cases found in Phase 1, Phase 2 and pooled data of the study are presented on Fig. 1. Eye opacities were found in 4 of 18 (22 %) of interventional cardiologists, 10 of 24 (42 %) of paramedical staff, or in total 14 of 42 (33 %) of the staff and only 2 of 24 persons (8 %) in the control group. Of total 16 positive cases, 6 (43 %) are with bilateral changes, 4 cases are with opacities in only left eye and 4 ‑ in only right eye.
Our results support the preliminary conclusion from the RELID testing exercise held in Colombia, Malaysia and Uruguay [20] demonstrated an increased incidence rate of eye opacities in medical staff working in interventional cardiology. The results are consistent with the overall picture from the RELID study in Bogota [20, 23] showing that 21 of 76 (28%) persons working in interventional cardiology rooms had posterior subcapsular lens changes in one or both eyes consistent with radiation exposure and similar eye opacities in only 4 of the 42 in the control group (9.5 %). The difference in findings between both studies is in the distribution of positive cases among the cardiologists and paramedical staff – 22 % for the cardiologist and 42 % for the paramedical staff in our study against 43 % and 9 % respectively in the Bogota study.
It was found difficult to reconstruct the eye doses because of the practice in the country of using only one dosemeter worn under the lead apron at the chest level. That why the analysis of the questionnaires was used to explain the results from the study.
Only one of the cardiologists with posterior lens changes never in 22 years practice used protective screen, while other three were with shorter work experience (2 – 7 years) declared using protective screen in 30 – 70 % of cases, but only in last two years. All of them never or rarely use eye glasses.
Both of the radiographers with eye opacities have been working more than 20 years with FG procedures. One of them works in non-cardiac interventional room and most often on the left side of the patient. Both have family history of cataract.
From nurses with eye opacities one has been working more that 20 years with FG procedures, 2 have between 5 and 10 years and other 4 – less than 5 years professional experience.
Typical position of nurse is on the right side of the patient, next to the cardiologist (Fig. 2), but most of participants indicated 20 % of time working on the left side of the patient and two of them ‑ 100 % of time in this position. Our measurements showed that scatter dose in this position commensurate that in the typical position of cardiologist.
Most of the paramedical staff do not use eye glass wear and only few declared to use it but irregularly. One of the nurses with eye opacities declared a family history of cataract and two have had head CT scans in last years. Nine of 14 (64 %) of persons with opacities are smokers.
Among cardiologists without opacities only 2 rarely use protective screen and all others use it in 50 – 100 % of time. During the discussion with participants it was recognized that even when used, protective screen sometimes is not positioned properly between the patient and operator, which increases the scatter dose rate to the head of the cardiologist and other staff.
Eye glass wear were used in more that 50 % of time by 40 % of participating cardiologist. Contrary, only 12 % of the paramedical staff uses regularly eye glasses and 63 % never wear them.