Introduction

Article Outline

• Appendix
• Copyright

Radiation safety is a hot topic in both the lay press and the medical literature. Within the last couple of years, reports of unrecognized, high radiation doses during brain perfusion studies, accidental exposures of pregnant patients, and high doses delivered to children have made headlines, while articles on the increased contribution to the population's medical radiation exposure and estimations of the cancer risk of computed tomography (CT) have recently been reported in the medical literature. Both patients and health care providers are keenly aware of this issue. Interventional radiology, as a contributor to the collective dose of the US population, comes in third behind CT and nuclear medicine. Nonetheless, for any given complex procedure, the dose to an individual patient has the potential to be quite high. While the actual risks continue to be debated, the machines that we use continue to increase in their sophistication. It makes sense that we master the technology (rather than have the technology master us) so that we can maximize the benefit:risk ratio and avoid making the 6:00 PM Nightly News. This will require a continued effort by every practicing interventionalist.

To help achieve this goal of maximizing the benefit/risk ratio so that it is “As High As Reasonably Achievable” (AHARA), an outstanding group of physicians and medical physicists has been recruited for this issue of Techniques in Vascular and Interventional Radiology. While I hope this issue will be read from cover to cover, topics are presented that will allow readers to focus on the various facets of radiation safety in the interventional arena that may be of particular interest to them.

Drs Spies and Tse have provided an in-depth look at what the risk is and how to reduce that risk during 1 specific procedure: uterine artery embolization. Dr Marx has provided an insightful review of a situation that scares us all: the management of the pregnant patient in the interventional radiology setting. Dr Sidhu and her “Step Lightly” dream team have delivered a superb piece from the pediatric interventional radiology perspective. For those of us who really want to know about the “how and why” of operator shielding, Dr Schueler has created a concise examination of what we all should be doing and why. For those of you who are interested in creating a Practice Quality Improvement project (and need to understand the metrics involved and the record keeping required), the articles by Drs Glaiberman, Miller, and Jaco will allow you to get the job done.

To help the reader better understand how to manage radiation dose, the topic has been broken down into 3 areas. Dr Stecker has focused on the importance of preprocedure planning and consent, while Drs Wagner and Ogden have assisted me in creating a guide to managing dose in both the angiography suite and the CT scanner.

Perhaps the most provocative piece is Dr Vano's European perspective on mandatory radiation safety training for interventionalists. My hope is that this article, as well as all the others in this issue, will stimulate discussion regarding the level of training for practicing interventionalists. Should we in the US adopt a similar model? As controversial as this may be, it should at least encourage interventionalists to more closely investigate the various topics that are discussed in this issue and continually replenish their fund of knowledge in the field of radiation protection. The technology truly is becoming sophisticated, and we are going to have to work at keeping up with it.

I would like to thank each contributing author for all the hard work required to bring these outstanding and timely contributions to this issue. While this issue is not a comprehensive review of every component of radiation safety, I hope that the readers find it to be a very practical, concise resource for the practicing interventionalist as well as for residents and fellows. For motivated individuals who want to further explore topics of interest, I would recommend the on-line and written resources listed in the appendix, as well as the list of references following each piece.

I want to thank Dr Kaufman for the opportunity to head up this project and Herb Niemerow and David Newcombe at Elsevier for providing the vehicle to deliver it (and for their patience while it was created). In addition, I want to thank my colleagues at the University of North Carolina; without their support I could not be involved in projects such as this. Most importantly, I want to thank my wife Eileen for her incredible patience and for understanding that I'll be late for dinner … again.

Be safe out there.

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Appendix 

Available On-Line Resources and Suggested Readings
1. http://www.sirweb.org/. Information available on MOC and PQI projects
2. http://www.imagegently.org. Resource for medical providers and parents with information on the “step lightly” program
3. http://rpop.iaea.org. Training material freely available from the International Atomic Energy Agency (IAEA)
4. http://www.rsna.org/Education/physics.cfm. A growing collection of physics modules created as a joint project by the RSNA and the AAPM. RSNA or AAPM membership required; however, RSNA membership is free to residents and fellows
5. European Commission. MARTIR (Multimedia and Audiovisual Radiation Protection Training in Interventional Radiology): CD-ROM. Luxembourg. 2002. Available at http://ec.europa.eu/energy/nuclear/radiation-protection/publications_en.htm (go to publication 119). This resource contains 80 lessons with their texts, 350 images, 30 videos, and 25 PowerPoint slide presentations. This material can be downloaded free of charge
6. http://rpop.iaea.org/RPOP/RPoP/Content/News/relid-cataract-study.htm. Information on the IAEA Retrospective Evaluation of Lens Injuries
7. International Commission on Radiological Protection, Pregnancy, and Medical Radiation. Annals of the ICRP, publication 84, Pergamon Press, Oxford (2000). This is available in an abstracted PowerPoint presentation at: http://www.icrp.org/educational_area.asp
8. Stecker MS, Balter S, Towbin RB, et al. Guidelines for patient radiation dose management. J Vasc Interv Radiology. 2009;20:S263–S273
9. Miller DL, Vano E, Bartal G, et al. Occupational radiation protection in interventional radiology A joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. Cadiovasc Intervent Radiol. 2010;33:230–239J Vasc Interv Radiology. 2010;21:607–615
10. Wagner LK, Archer BR, Cohen AM. Management of patient skin dose in fluoroscopically guided interventional procedures. J Vasc Interv Radiology. 2000;11:25–33
11. Miller DL, Balter S, Noonan PT, et al. Minimizing radiation-induced skin injury in interventional radiology procedures. Radiology. 2002;225:329–336
12. Nikolic B, Spies JB, Campbell L, et al. Uterine artery embolization: Reduced radiation with refined technique. J Vasc Interv Radiology. 2001;12:39–44
13. Miller DL, Balter S, Cole PE, et al. Radiation doses in interventional radiology procedures: The RAD-IR study (Part II. Skin dose). J Vasc Interv Radiology. 2003;14:977–990
14. Vano E, Gonzalez L, Fernandez JM, et al. Eye lens exposure to radiation in interventional suites: Caution is warranted. Radiology. 2008;248:945–953
15. Schueler BA, Vrieze TJ, Bjarnason H, et al. An investigation of operator exposure in interventional radiology. RadioGraphics. 2006;26:1533–1541
16. Mettler FA, Huda W, Yoshizumi TT, et al. Effective doses in radiology and diagnostic nuclear medicine: A catalog. Radiology. 2008;248:254–263