Rehani MM, et al. ICRP Publication 117. Radiological Protection In Fluoroscopically Guided Procedures Performed Outside The Imaging Department. Ann ICRP. 2010 Dec;40(6):1-102.

A brief account of the health effects of ionising radiation and protection principles is presented in Section 2. Section 3 deals with general aspects of the protection of workers and patients that are common to all, whereas specific aspects are covered in Section 4 for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology, gastroenterology and hepatobiliary system, and anaesthetics and pain management.

Rehani MM, et al. ICRP Publication 117. Radiological Protection In Fluoroscopically Guided Procedures Performed Outside The Imaging Department. Ann ICRP. 2010 Dec;40(6):1-102.

A brief account of the health effects of ionising radiation and protection principles is presented in Section 2. Section 3 deals with general aspects of the protection of workers and patients that are common to all, whereas specific aspects are covered in Section 4 for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology, gastroenterology and hepatobiliary system, and anaesthetics and pain management.

Stewart FA, Akleyev AV, Hauer-Jensen M, et al. 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 Feb;41(1-2):1–322.

This report provides a review of early and late effects in normal tissue and organs with respect to radiation protection. The organ systems comprise the haematopoietic, immune, reproductive, circulatory, respiratory, musculoskeletal, endocrine, and nervous systems; the digestive and urinary tracts; the skin;and the eye.

Simson N, Stonier T, Suleyman N, et al. Defining a national reference level for intraoperative radiation exposure in urological procedures: FLASH, a retrospective multicentre UK study. BJU Int. 2020;125:292-298.

To define reference levels for intraoperative radiation during stent insertion, ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL); to identify variation in radiation exposure between individual hospitals across the UK, between low- and high-volume PCNL centres, and between grade of lead surgeon.

Schernthaner RE, Haroun RR, Nguyen S, et al. Characteristics of a New X-Ray Imaging System for Interventional Procedures: Improved Image Quality and Reduced Radiation Dose. Cardiovasc Intervent Radiol. 2018;41:502–508.

To compare image quality and radiation exposure between a new angiographic imaging system and the preceding generation system during uterine artery embolization (UAE). There was no significant difference between the patients treated on the new (n = 36) and the old system (n = 18) regarding age (p = 0.10), BMI (p = 0.18), DF time (p = 0.35) and DSA time (p = 0.17). The new system significantly reduced the cumulative AK and DAP by 64 and 72%, respectively (median 0.58 Gy and 145.9 Gy*cm2 vs. 1.62 Gy and 526.8 Gy*cm2, p < 0.01 for both). Specifically, DAP for DF and DSA decreased by 59% (75.3 vs. 181.9 Gy*cm2, p < 0.01) and 78% (67.6 vs. 312.2 Gy*cm2, p < 0.01), respectively. The new system achieved a significant decrease in DF image noise (p < 0.01) and a significantly better DSA image quality (p < 0.01).

Sarti G, Busca F, Carpano L, et al. DOSE MEASUREMENTS TO THE LENS IN NUCLEAR MEDICINE AND IN FLUOROSCOPY-GUIDED INTERVENTIONAL PROCEDURES: ANALYSIS OF THE RESULTS AND ASSESSMENT OF THE EFFECTIVENESS OF PROTECTIVE EYEWEAR ANTI-X. Radiat Prot Dosimetry. 2016 Sep;170(1-4):181-6.

The new limit of 20 mSv to the lens raises the need for further assessment of the equivalent dose to the lens for nuclear medicine and interventional radiology operators. (a) A measurement campaign was performed in nuclear medicine, (b) a routine monitoring was organised in interventional procedures and (c) the effectiveness of protective eyewear was assessed. In nuclear medicine, for photon fields, the adequacy of Hp(0.07) of dosemeter worn on the trunk is confirmed; with (90)Y, the annual values of Hp(3) measured in therapeutic session are <5 mSv. In interventional procedures, routine monitoring of the dose to the lens must be maintained where the values of Hp(0.07) dosemeter worn on the trunk are higher than one-third of the new limits. The measures carried out have shown that the attenuation factor mean of the protective glasses is equal to ∼4 (range 1.7-11.4).

Lee YS, Lee HK, Cho JH, Kim HG. Analysis of radiation risk to patients from intra-operative use of the mobile X-ray system (C-arm). J Res Med Sci. 2015 Jan;20(1):7-12.

The aim of this study was to investigate clinical applications of mobile C-arms and consequent radiation risk, to increase medical attention on radiation protection, and to provide basic data for safe radiation use in the operating room. Orthopedic surgery was the most frequent with 165 cases (44.1%). The highest DAP value and effective dose were found in liver transplant among surgical specialty fields. The highest DAP value and effective dose were observed in intra-operative mesenteric portography among types of surgery.

Khoury H, Garzon W, Andrade G, et al. Radiation exposure to patients and medical staff in hepatic chemoembolisation interventional procedures in Recife, Brazil. Radiat Protect Dosimetry. 2015 Jul;165(1-4):263-267.

The purpose of this study was to evaluate patient and medical staff absorbed doses received from transarterial chemoembolisation of hepatocellularcarcinoma, which is the most common primary liver tumour worldwide. The results showed that the mean value of the total PKA was 267.49, 403.83 and 479.74 Gycm2 for Hospitals A, B and C, respectively. With regard to the physicians, the average effective dose per procedurewas 17 mSv, and the minimum and maximum values recorded were 1 and 41 mSy, respectively. The results showed that the feet received the highest doses followed by the hands and lens of the eye, since the physicians did not use leaded glasses and the equipment had no lead curtain.

Isoardi P, D’Ercole L, Vavallari M, et al. Patient Dose in Angiographic Interventional Procedures: A Multicentre Study in Italy. Physica Medica. 2019 Aug;64:273–292.

This work reports the early experience of managing dose data from patients under going angiography in a multicentre study. The duration and dose values of fluoroscopic exposure for each procedure is strongly dependent on individual clinical circumstances including the complexity of the procedure; the observed distribution of patient doses was very wide, even for a specified protocol.The median values of the parameters were compared with the diagnostic reference levels (DRL) proposed for some procedures in Italy (ISTISAN) or internationally. This work proposes local DRL values for three procedures.

Hsi RS, Harper JD. Fluoroless ureteroscopy: zero-dose fluoroscopy during ureteroscopic treatment of urinary-tract calculi. J Endourol. 2013 Apr;27(4):432-7.

Fluoroscopy usage during endoscopic procedures exposes the patient and operating room staff to ionizing radiation. Pooled mean fluoroscopy usage time during ureteroscopy reported from recent literature is 144 seconds per case. The purpose of this study was to evaluate radiation exposure using a minimal-use fluoroscopy protocol during ureteroscopic treatment of urinary-tract calculi and determine patient and perioperative factors associated with increased fluoroscopy time.