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Shafiee M. et al., 2020: Chromosomal aberrations in C-arm fluoroscopy, CT-scan, lithotripsy, and digital radiology staff

Shafiee M, Borzoueisileh S, Rashidfar R, Dehghan M, Jaafarian Sisakht Z.
Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.
Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran.

Abstract

We have assessed chromosome-type aberrations and micronuclei in the peripheral lymphocytes of personnel working with C-arm fluoroscopy, multi-slice CT-scan, lithotripsy, and digital radiology medical procedures. The study population comprised of 46 exposed workers and 35 controls matched for age, gender, and other confounding factors. Chromosome-type aberrations and micronuclei were analyzed and compared with occupational dosimetry data. The highest frequency of both chromosome aberrations (1.62 CA/100 cells) and MN (MN = 7.47 ± 2.55) was observed in the operating room group. According to occupational dosimetry, surgeons and medical staff received 0-2.99 mSv over the previous year, well below the limit established by the International Committee on Radiation Protection. An increased level of chromosomal aberrations was observed among workers exposed in the operating rooms. We recommend that operating room radiation safety programs be improved and better supervised, in particular for orthopedic surgeons and personnel performing fluoroscopically guided procedures.
Mutat Res. 2020 Jan;849:503131. doi: 10.1016/j.mrgentox.2020.503131. Epub 2020 Jan 7. PMID: 32087852

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Comments 1

Hans-Göran Tiselius on Thursday, May 14 2020 08:15

The effect and risk of radiation exposure is an important issue in urological intervention, and it can be assumed that insufficient attention is paid to this problem.

The authors of this report studied radiation effects on a molecular level by measuring chromosome-type aberrations and micronuclei in controls, persons involved in lithotripsy, digital radiology as well as in those working in operating rooms where fluoroscopy is used.
Dosimeter data were analysed, and the highest readings were recorded for persons working in operating rooms (1.05±0.83 mSv; range 0-2.99). The corresponding measurements for lithotripsy staff were much lower: 0.07±0.11 mSv; range 0-0.34.

Micronuclei were significantly more common for operating room staff and the same was found for chromosome aberrations. Although the measurements were well below established risk levels the observations require careful and serious considerations.

It is of note that these data were recorded in persons who most certainly were aware of the conditions and most certainly also paid extra attention to radiation protection and to the need of maintaining as short fluoroscopy times as possible.

During lithotripsy, control of the procedure is carried out either close to the C-arm or in a radiation protected cabin. But although the operator in the latter case is well protected this is not necessarily so for the assisting personal who occasionally may be close to the radiation source during fluoroscopy.

A similar problem, with both urologists and assistants being close to the C-arm, occurs when endourological procedures are necessary before or after SWL; for instance, when stents are inserted or when complex stent problems need to be handled.

The golden rule is always to have the x-ray tube beneath the table, but scattered radiation might nevertheless be a problem. It is also mentioned in the report that a lead curtain significantly can reduce that kind of radiation. I am, however, not certain that lead curtains commonly are used.

Another point too frequently ignored is the need to decrease radiation by reducing the aperture with the collimators as soon as the situation allows.
The observations in this report are probably of limited clinical significance but they should result in consideration regarding the use of fluoroscopy. I have a feeling that too many urologists and assistants who work with lithotripsy and endourology have insufficient knowledge of radiation protection and how to work with the fluoroscopy equipment. Inexperienced nurses and young residents with minimal education in this regard may be exposed to more radiation than necessary.

Of course, replacing fluoroscopy by ultrasound is the best solution to avoid radiation, but ultrasound is more difficult to learn and master than fluoroscopy.

Hans-Göran Tiselius

The effect and risk of radiation exposure is an important issue in urological intervention, and it can be assumed that insufficient attention is paid to this problem. The authors of this report studied radiation effects on a molecular level by measuring chromosome-type aberrations and micronuclei in controls, persons involved in lithotripsy, digital radiology as well as in those working in operating rooms where fluoroscopy is used. Dosimeter data were analysed, and the highest readings were recorded for persons working in operating rooms (1.05±0.83 mSv; range 0-2.99). The corresponding measurements for lithotripsy staff were much lower: 0.07±0.11 mSv; range 0-0.34. Micronuclei were significantly more common for operating room staff and the same was found for chromosome aberrations. Although the measurements were well below established risk levels the observations require careful and serious considerations. It is of note that these data were recorded in persons who most certainly were aware of the conditions and most certainly also paid extra attention to radiation protection and to the need of maintaining as short fluoroscopy times as possible. During lithotripsy, control of the procedure is carried out either close to the C-arm or in a radiation protected cabin. But although the operator in the latter case is well protected this is not necessarily so for the assisting personal who occasionally may be close to the radiation source during fluoroscopy. A similar problem, with both urologists and assistants being close to the C-arm, occurs when endourological procedures are necessary before or after SWL; for instance, when stents are inserted or when complex stent problems need to be handled. The golden rule is always to have the x-ray tube beneath the table, but scattered radiation might nevertheless be a problem. It is also mentioned in the report that a lead curtain significantly can reduce that kind of radiation. I am, however, not certain that lead curtains commonly are used. Another point too frequently ignored is the need to decrease radiation by reducing the aperture with the collimators as soon as the situation allows. The observations in this report are probably of limited clinical significance but they should result in consideration regarding the use of fluoroscopy. I have a feeling that too many urologists and assistants who work with lithotripsy and endourology have insufficient knowledge of radiation protection and how to work with the fluoroscopy equipment. Inexperienced nurses and young residents with minimal education in this regard may be exposed to more radiation than necessary. Of course, replacing fluoroscopy by ultrasound is the best solution to avoid radiation, but ultrasound is more difficult to learn and master than fluoroscopy. Hans-Göran Tiselius
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