radhydРадиационная гигиенаRadiatsionnaya Gygiena = Radiation Hygiene1998-426X2409-9082NIIRG10.21514/1998-426X-2021-14-4-76-84radhyd-836Research ArticleОбзорыReviewsОсобенности применения средств радиационной защиты для персонала рентгенохирургических операционныхFeatures of radiation protection equipment for the staff of X-ray operating roomsСарычеваС. С.SarychevaS. S.

Сарычева Светлана Сергеевна – кандидат биологических наук, старший научный сотрудник

197101, Санкт-Петербург, ул. Мира, д. 8

Svetlana S. Sarycheva Saint-Petersburg Research Institute of Radiation Hygiene after Professor P.V. Ramzaev

Mira Str., 8, Saint-Petersburg, 197101

Svetlana2003@mail.ruСанкт-Петербургский научно-исследовательский институт радиационной гигиены имени профессора П.В. Рамзаева, Федеральная служба по надзору в сфере защиты прав потребителей и благополучия человекаРоссияSaint-Petersburg Research Institute of Radiation Hygiene after Professor P.V. Ramzaev, Federal Service for Surveillance on Consumer Rights Protection and Human Well-BeingRussian Federation2021261220211447684Copyright © Сарычева С.С., 20212021Сарычева С.С.Sarycheva S.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.radhyg.ru/jour/article/view/836

Обзорная работа посвящена вопросу радиационной защиты персонала рентгенохирургических операционных. Для безопасной работы персоналу необходимо регулярно и правильно использовать средства защиты, что, в свою очередь, должно обеспечиваться их доступностью, удобством и маневренностью при выполнении процедур. Стремительное развитие рентген-хирургических методов диагностики и лечения привело к тому, что персонал рентген-операционных имеет один из самых высоких уровней профессионального облучения, однако отечественная система обеспечения радиационной безопасности не успевает за столь бурным развитием данного направления медицины. В статье показаны основные закономерности распределения рассеянного излучения вокруг пациента в процессе проведения исследований и связанного с ним профессионального облучения. Показано распределение излучения при разных режимах работы ангиографического аппарата типа С-дуга и даны наглядные примеры распределения рассеянного излучения в рентген-операционных. Подробно рассмотрены коллективные и индивидуальные средства защиты, разработанные специально для радиационной защиты персонала рентген-операционных. Представлены обобщенные данные по степени защиты и особенностям использования наиболее перспективных средств защиты персонала. Большинство из рассмотренных средств защиты являются обязательными для использования в рентген-операционных ряда европейских стран, однако в отечественных нормативных документах пока не упомянуты. В работе внесены предложения по модернизации отечественной системы радиационной защиты персонала рентген-операционных, включая защиту хрусталика глаза, в части обеспечения рентген-операционной актуальными средствами радиационной защиты, согласно накопленному мировому опыту в данной области и опубликованным международным рекомендациям.

 

This survey is devoted to the staff radiation protection in X-ray operating rooms. For self-safety staff must regularly and correctly use the protective equipment, which is ensured by their availability, convenience and manoeuvrability during procedures performing. The rapid development of interventional radiology led to the fact that the staff work in this area have one of the highest levels of occupational exposure. Unfortunately, domestic radiation protection system does not keep pace with such a rapid development of this branch of medicine. The article shows the basic principles of the distribution of scattered radiation in the X-ray operating room during the procedures performing. The distribution of scattered radiation around the patient for various modes of C-arm angiographic systems is shown. Graphical examples of scattered radiation distribution in X-ray operating rooms are given. Collective and individual protective equipment specifically designed for staff radiation protection in X-ray operating room are considered in detail. The common data on the protection features of the recommended staff protection equipment are presented. Most of the considered protection equipment is mandatory in many European countries, but not mentioned in domestic regulatory documents yet. The proposals for the modernization of the domestic radiation protection system for staff of X-ray operating rooms have been made. These recommendations focused on providing X-ray operating rooms with relevant radiation protection equipment, including eye protection, following the accumulated world experience and international regulations.

интервенционная радиологиярадиационная защита персоналасредства радиационной защитыinterventional radiologystaff protectionradiation protection equipmentReferencesICRP Publication 139. Occupational radiological protection in interventional procedures ICRP Publication 139 // Ann ICRP. 2018. Vol. 47, No 2. P. 1–112.ICRP Publication 139. Occupational radiological protection in interventional procedures ICRP Publication 139. Ann ICRP. 2018;47(2): 1–112.Miller D.L., 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 // CardioVascular and Interventional Radiology. 2010. Vol. 33, No 2. P. 230–239.Miller DL, Vano E, Bartal G, Balter S, Dixon R, Padovani R, 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. CardioVascular and Interventional Radiology. 2010;33(2): 230–239.Форма федерального статистического наблюдения N 30 «Сведения о медицинской организации» за 2018 год (приказ Росстата об утверждении формы № 483 от 03.08.2018). 2018. 13 с.Federal statistic form N 30 “Information about the medical organization” for 2018. (Order No. 483 on the approval of Form by Rosstat dated 03.08.2018). 2018. 13 p. (in Russian).Международная Комиссия по Радиационной Защите (ICRP). 2007 Рекомендации Международной Комиссии по Радиационной Защите (ICRP 103) // Ann ICRP. 2007. Vol. 37, No 2–4. P. 1–332.ICRP, 2007. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann. ICRP. 2007;37 (2-4). (In Russian).ICRP publication 118. ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs – Threshold doses for tissue reactions in a radiation protection context // Ann ICRP. 2012. Vol. 41. P. 1–322.ICRP publication 118. ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs – Threshold doses for tissue reactions in a radiation protection context. Ann ICRP. 2012;41: 1–322.Implications for Occupational Radiation Protection of the New Dose Limit for the Lens of the Eye /TecDoc-1731 // Vienna: International Atomic Energy Agency. 2013. P. 1-44.Implications for Occupational Radiation Protection of the New Dose Limit for the Lens of the Eye /TecDoc-1731. Vienna: International Atomic Energy Agency; 2013. 1-44NCRP Report 168. Radiation dose management for fluoroscopically-guided interventional procedures // National Council on Radiological Protection. 2010. 314 p.NCRP Report 168. Radiation dose management for fluoroscopically-guided interventional procedures // National Council on Radiological Protection, 2010. 314 p.Behrman R.H., Rees C.R. Radiation safety and protection systems. Vascular Imaging and Intervention. Jaypee Bros: New Delhi; 2020. Vol 1, Second Edition. P. 81-123.Behrman RH, Rees CR. Radiation safety and protection systems. Vascular Imaging and Intervention. Jaypee Bros: New Delhi; 2020. Vol 1, Second Edition. P. 81-123.Hirshfeld Jr.J.W., Ferrari V.A., Bengel F.M., et al. 2018 ACC/ HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness. A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways // Journal of the American College of Cardiology. 2018. Vol. 71, No. 24. P. 283-351.Hirshfeld Jr. JW, Ferrari VA, Bengel FM, Bergersen L, Chambers CE, Einstein AJ, et al. 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness. A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Journal of the American College of Cardiology. 2018;71(24): 283-351.Vano E., Gonzalez L., Fernández J.M., et al. Eye lens exposure to radiation in interventional suites: caution is warranted // Radiology. 2008 Sep. Vol. 248, No 3. P. 945-953.Vano E, Gonzalez L, Fernández JM, Haskal ZJ. Eye lens exposure to radiation in interventional suites: caution is warranted. Radiology. 2008 Sep;248(3): 945-953.Haqqani O.P., Agarwal P.K., Halin N.M., Iafrati M.D. Defining the radiation “scatter cloud” in the interventional suite // Journal of Vascular Surgery. 2013 Nov. Vol. 58, No 5. P. 1339-1345.Haqqani OP, Agarwal PK, Halin NM, Iafrati MD. Defining the radiation “scatter cloud” in the interventional suite. Journal of Vascular Surgery. 2013 Nov;58(5): 1339-1345.Vano E., Gonzalez L., Fernandez J.M., et al. Influence of patient thickness and operation modes on occupational and patient radiation doses in interventional cardiology // Radiation Protection Dosimetry. 2006. Vol. 118, No 3. P. 325-330.Vano E, Gonzalez L, Fernandez JM, Prieto C, Guibelalde E. Influence of patient thickness and operation modes on occupational and patient radiation doses in interventional cardiology. Radiation Protection Dosimetry. 2006;118(3): 325-330.Balter S. Stray radiation in the cardiac catheterisation laboratory // Radiation Protection Dosimetry. 2001. Vol. 94, No 1-2. P. 183-188.Balter S. Stray radiation in the cardiac catheterisation laboratory. Radiation Protection Dosimetry. 2001;94(1-2): 183-188.Schueler B.A., Vrieze T.J., Bjarnason H., et al. An investigation of operator exposure in interventional radiology // Radiographics. 2006 Sep-Oct. Vol. 26, No 5. P. 1533-1541.Schueler BA, Vrieze TJ, Bjarnason H, Stanson AW. An investigation of operator exposure in interventional radiology. Radiographics. 2006 Sep-Oct;26(5): 1533-1541Gonzales J.P., Moran C., Silberzweig J.E. Reduction of operator radiation dose by an extended lower body shield // Journal of Vascular and Interventional Radiology. 2014 Mar. Vol. 25, No 3. P. 462-468.Gonzales JP, Moran C, Silberzweig JE. Reduction of operator radiation dose by an extended lower body shield. Journal of Vascular and Interventional Radiology. 2014 Mar;25(3): 462-468Vanhavere F., Carinou E., Gualdrini G., et al. ORAMED: Optimization of Radiation Protection for Medical Staff. 7th EURADOS Report. EURADOS. 2012.Vanhavere F, Carinou E, Gualdrini G, Clairand I, Sans Merce M, Ginjaume M, et al., ORAMED: Optimisation of Radiation Protection for Medical Staff. 7th EURADOS Report. EURADOS; 2012.Whitby M., Martin C.J. Radiation doses to the legs of radiologists performing interventional procedures: are they a cause for concern? // British Journal of Radiology. 2003. Vol. 76. P. 321–327.Whitby M, Martin CJ. Radiation doses to the legs of radiologists performing interventional procedures: are they a cause for concern? British Journal of Radiology. 2003;76: 321–327.Martin C.J. Eye lens dosimetry for fluoroscopically guided clinical procedures: practical approaches to protection and dose monitoring // Radiation Protection Dosimetry. 2016 Jun. Vol. 169, No 1-4. P. 286–291.Martin CJ. Eye lens dosimetry for fluoroscopically guided clinical procedures: practical approaches to protection and dose monitoring. Radiation Protection Dosimetry. 2016 Jun;169(1- 4):2 86–291.Koukorava C., Carinou E., Simantirakis G., et al. Doses to operators during interventional radiology procedures: focus on eye lens and extremity dosimetry // Radiation Protection Dosimetry. 2011 Mar. Vol. 144, No 1-4. P. 482-486.Koukorava C, Carinou E, Simantirakis G, Vrachliotis TG, Archontakis E, Tierris C, et al. Doses to operators during interventional radiology procedures: focus on eye lens and extremity dosimetry. Radiation Protection Dosimetry. 2011 Mar;144(1-4): 482-486.Kuon E., Schmitt M., Dahm J.B. Significant reduction of radiation exposure to operator and staff during cardiac interventions by analysis of radiation leakage and improved lead shielding // American Journal of Cardiology. 2002 Jan 1. Vol. 89, No 1. P. 44-49.Kuon E, Schmitt M, Dahm JB. Significant reduction of radiation exposure to operator and staff during cardiac interventions by analysis of radiation leakage and improved lead shielding. American Journal of Cardiology. 2002 Jan 1;89(1): 44-49.Galster M., Guhl C., Uder M., et al. Exposition of the operator’s eye lens and efficacy of radiation shielding in fluoroscopically guided intervention // RöFo. 2013 May. Vol. 185, No 5. P. 474- 481. (In German).Galster M, Guhl C, Uder M, Adamus R. Exposition of the operator’s eye lens and efficacy of radiation shielding in fluoroscopically guided interventions. R Fo. 2013 May;185(5): 474-481. (In German).Fetterly K.A., Magnuson D.J., Tannahill G.M., et al. Effective use of radiation shields to minimize operator dose during invasive cardiology procedures // JACC: Cardiovascular Interventions. 2011 Oct. Vol. 4, No 10. P. 1133-1139.Fetterly KA, Magnuson DJ, Tannahill GM, Hindal MD, Mathew V. Effective use of radiation shields to minimize operator dose during invasive cardiology procedures. JACC: Cardiovascular Interventions. 2011 Oct;4(10): 1133-1139.Von Boetticher H., Lachmund J., Hoffmann W. Cardiac catheterization: impact of face and neck shielding on new estimates of effective dose // Health Physics. 2009 Dec. Vol. 97, No 6. P. 622-627.Von Boetticher H, Lachmund J, Hoffmann W. Cardiac catheterization: impact of face and neck shielding on new estimates of effective dose. Health Physics. 2009 Dec;97(6): 622-627.Maeder M., Brunner-La Rocca H.P., Wolber T., et al. Impact of a lead glass screen on scatter radiation to eyes and hands in interventional cardiologists // Catheterization and Cardiovascular Interventions. 2006 Jan. Vol. 67, No 1. P. 18-23.Maeder M, Brunner-La Rocca HP, Wolber T, Ammann P, Roelli H, Rohner F, et al. Impact of a lead glass screen on scatter radiation to eyes and hands in interventional cardiologists. Catheterization and Cardiovascular Interventions. 2006 Jan;67(1): 18-23.Van Rooijen B.D., de Haan M.W., Das M., et al. Efficacy of radiation safety glasses in interventional radiology // CardioVascular and Interventional Radiology. 2014 Oct. Vol. 37, No 5. P. 1149-1155.Van Rooijen BD, de Haan MW, Das M, Arnoldussen CW, de Graaf R, van Zwam WH, et al. Efficacy of radiation safety glasses in interventional radiology. CardioVascular and Interventional Radiology. 2014 Oct;37(5): 1149-1155.Magee J.S., Martin C.J., Sandblom V., et al. Derivation and application of dose reduction factors for protective eyewear worn in interventional radiology and cardiology // Journal of Radiological Protection. 2014 Dec. Vol. 34, No 4. P. 811-823.Magee JS, Martin CJ, Sandblom V, Carter MJ, Almén A, Cederblad Å, et al. Derivation and application of dose reduction factors for protective eyewear worn in interventional radiology and cardiology. Journal of Radiological Protection. 2014 Dec;34(4): 811-823.Jacob S., Donadille L., Maccia C., et al. Eye lens radiation exposure to interventional cardiologists: a retrospective assessment of cumulative doses // Radiation Protection Dosimetry. 2013 Mar. Vol. 153, No 3. P. 282-293.Jacob S, Donadille L, Maccia C, Bar O, Boveda S, Laurier D, et al. Eye lens radiation exposure to interventional cardiologists: a retrospective assessment of cumulative doses. Radiation Protection Dosimetry. 2013 Mar;153(3): 282-293.IAEA, “Training Material on Radiation Protection in Cardiology: Occupational exposure and protective devices.” URL: https://rpop.iaea.org/RPOP/RPoP/Content/Documents/TrainingCardiology/Lectures/CARD_L07_OccupationalExposure_and_ProtectiveDevices_WEB.ppt. (Дата обращения 09.08.2021).IAEA, “Training Material on Radiation Protection in Cardiology: Occupational exposure and protective devices.” [Available on: https://rpop.iaea.org/RPOP/RPoP/Content/Documents/TrainingCardiology/Lectures/CARD_L07_OccupationalExposure_and_ProtectiveDevices_WEB.ppt (Accessed August 09, 2021).ICRP, 2012. Radiological protection in Cardiology. ICRP Publication 120 // Ann. ICRP. 2012. Vol. 42, No 1.ICRP, 2012. Radiological protection in Cardiology. ICRP Publication 120. Ann. ICRP. 2012; 42(1).Goldstein J.A., Balter S., Cowley M., et al., Occupational hazards of interventional cardiologists: prevalence of orthopedic health problems in contemporary practice // Catheterization and Cardiovascular Interventions. 2004. No 63. P. 407–411.Goldstein JA. Balter S, Cowley M, et al. Occupational hazards of interventional cardiologists: prevalence of orthopedic health problems in contemporary practice. Catheterization and Cardiovascular Interventions. 2004;63: 407–411.Dixon R.G., Khiatani V., Statler J.D., et al. Society of interventional radiology: occupational back and neck pain and the interventional radiologist // Journal of Vascular and Interventional Radiology. 2017. Vol. 28, No 2. P. 195–9.Dixon RG, Khiatani V, Statler JD, et al. Society of interventional radiology: occupational back and neck pain and the interventional radiologist. Journal of Vascular and Interventional Radiology. 2017;28(2): 195–9.ICRP, 2010. Radiological Protection in Fluoroscopically Guided Procedures outside the Imaging Department. ICRP Publication 117 // Ann. ICRP. 2010. Vol. 40, No 6.ICRP, 2010. Radiological Protection in Fluoroscopically Guided Procedures outside the Imaging Department. ICRP Publication 117. Ann. ICRP. 2010; 40(6).Klein L.W., Tra Y., Garratt K.N., et al., Occupational health hazards of interventional cardiologists in the current decade: results of the 2014 SCAI membership survey // Catheterization and Cardiovascular Interventions. 2015. No 86. P. 913–924.Klein LW, Tra Y, Garratt KN, et al. Occupational health hazards of interventional cardiologists in the current decade: results of the 2014 SCAI membership survey. Catheterization and Cardiovascular Interventions. 2015;86: 913–924.ICRP Publication 85. Avoidance of radiation injuries from medical interventional procedures // Ann ICRP. 2000. Vol. 30, No 2. P. 7–67.ICRP Publication 85. Avoidance of radiation injuries from medical interventional procedures. Ann ICRP. 2000;30(2): 7–67.Detorie N., Mahesh M., Schueler B.A., Reducing occupational exposure from Fuoroscopy // Journal of the American College of Radiology. 2007. No. 4. P. 335–337.Detorie N, Mahesh M, Schueler BA. Reducing occupational exposure from Fuoroscopy. Journal of the American College of Radiology. 2007;4: 335–337.Franken Y. Guidance on the use of protective lead aprons in medical radiology protection efficiency and correction factors for personal dosimetry. Proc. 6th European ALARA Network Workshop on Occupational Exposure Optimisation in the Medical Field and Radiopharmaceutical Industry, 23–25 October 2002, Madrid: Spain; 2002. P. 135–139.Franken Y. Guidance on the use of protective lead aprons in medical radiology protection efficiency and correction factors for personal dosimetry. Proc. 6th European ALARA Network Workshop on Occupational Exposure Optimisation in the Medical Field and Radiopharmaceutical Industry, 23–25 October 2002, Madrid: Spain; 2002. P. 135–139.Christodoulou E.G., Goodsitt M.M., Larson S.C., et al. Evaluation of the transmitted exposure through lead equivalent aprons used in a radiology department, including the contribution from backscatter // Medical Physics. 2003 Jun. Vol. 30, No 6. P. 1033-1038.Christodoulou EG, Goodsitt MM, Larson SC, Darner KL, Satti J, Chan HP. Evaluation of the transmitted exposure through lead equivalent aprons used in a radiology department, including the contribution from backscatter. Medical Physics. 2003 Jun;30(6): 1033-1038.Finnerty M., Brennan P.C. Protective aprons in imaging departments: manufacturer stated lead equivalence values require validation // European Journal of Radiology. 2005 Jul. Vol. 15, No 7. P. 1477-84.Finnerty M, Brennan PC. Protective aprons in imaging departments: manufacturer stated lead equivalence values require validation. European Journal of Radiology. 2005 Jul;15(7): 1477-84.Schlattl H., Zankl M., Eder H., et al. Shielding properties of lead-free protective clothing and their impact on radiation doses // Medical Physics. 2007 Nov. Vol. 34, No 11. P. 4270-80.Schlattl H, Zankl M, Eder H, Hoeschen C. Shielding properties of lead-free protective clothing and their impact on radiation doses. Medical Physics. 2007 Nov;34(11): 4270-80.Eder H., Schlattl H., Hoeschen C. X-Ray protective clothing: does DIN 6857-1 allow an objective comparison between lead-free and lead-composite materials? // RöFo. 2010 May. Vol. 182, No 5. P. 422-428.Eder H, Schlattl H, Hoeschen C. X-Ray protective clothing: does DIN 6857-1 allow an objective comparison between lead-free and lead-composite materials? RöFo. 2010 May;182(5): 422-428.Marshall N.W., Faulkner K., Clarke P. An investigation into the effect of protective devices on the dose to radiosensitive organs in the head and neck // British Journal of Radiology. 1992 Sep. Vol. 65, No 777. P. 799-802.Marshall NW, Faulkner K, Clarke P. An investigation into the effect of protective devices on the dose to radiosensitive organs in the head and neck. British Journal of Radiology. 1992 Sep;65(777): 799-802.Kicken P.J.H., Kemerink G.J., Schultz F.W., et al. Dosimetry of occupationally exposed persons in diagnostic and interventional arteriography. Part II: Assessment of effective dose // Radiation Protection Dosimetry. 1999. Vol. 82. P. 105–114.Kicken PJH, Kemerink GJ, Schultz FW, Zoetelief J, Broerse JJ, van Engelshoven JMA. Dosimetry of occupationally exposed persons in diagnostic and interventional arteriography. Part II: Assessment of effective dose. Radiation Protection Dosimetry. 1999;82: 105–114.Moore W.E., Ferguson G., Rohrmann C., Physical factors determining the utility of radiation safety glasses // Medical Physics. 1980. No 7. P. 8–12.Moore WE, Ferguson G, Rohrmann. Physical factors determining the utility of radiation safety glasses. Medical Physics. 1980;7: 8–12.Thornton R.H., Dauer L.T., Altamirano J.P., et al., Comparing strategies for operator eye protection in the interventional radiology suite // Journal of Vascular and Interventional Radiology. 2010. No 21. P. 1703–1707.Thornton RH, Dauer LT, Altamirano JP, et al. Comparing strategies for operator eye protection in the interventional radiology suite. Journal of Vascular and Interventional Radiology. 2010;21: 1703–1707.Limacher M.C., Douglas P.S., Germano G., et al. ACC expert consensus document. Radiation safety in the practice of cardiology // Journal of the American College of Cardiology. 1998 Mar 15. Vol. 31, No 4. P. 892-913.Limacher MC, Douglas PS, Germano G, Laskey WK, Lindsay BD, McKetty MH, et al. ACC expert consensus document. Radiation safety in the practice of cardiology. American College of Cardiology. Journal of the American College of Cardiology. 1998 Mar 15;31(4): 892-913.Wagner L.K., Mulhern O.R. Radiation-attenuating surgical gloves: Effects of scatter and secondary electron production // Radiology. 1996. No 200. P. 45–48.Wagner LK, Mulhern OR. Radiation-attenuating surgical gloves: Effects of scatter and secondary electron production. Radiology. 1996;200: 45–48.Adamus R., Loose R., Wucherer M., Uder M., et al. Strahlenschutz in der interventionellen Radiologie // Radiologe. 2016 Mar. Vol. 56, No 3. P. 275-81. (In German).Adamus R, Loose R, Wucherer M, Uder M, Galster M. Strahlenschutz in der interventionellen Radiologie. Radiologe. 2016 Mar;56(3): 275-81. (in German). Recei

The authors declare that there are no conflicts of interest present.