Radiation Protection Dosimetry (2019), Vol. 185, No. 3, pp. 351–354 doi:10.1093/rpd/ncz021
Advance Access publication 28 February 2019
PRELIMINARY STAFF DOSE ASSESSMENT FOR COMMON
FLUOROSCOPY GUIDED PROCEDURES AT KORLE-BU
TEACHING HOSPITAL, ACCRA, GHANA
R. N. Nana1,2,*, M. Boadu1,3, M. N. Moyo2,4, P. K. Gyekye5 and B. O. Botwe1,6
1School of Nuclear and Allied Sciences, University of Ghana, PO Box AE 1, Atomic, Accra, Ghana
2Department of Physics, Faculty of Science, University of Douala, PO Box 24157, Douala, Cameroon
3Radiological and Medical Science Research Institute, Ghana Atomic Energy Commission, PO Box LG80,
Legon, Accra, Ghana
4National Radiation Protection Agency (NRPA), PO Box 33732, Yaoundé, Cameroon
5Nuclear Regulatory Authority, PO Box AE 50 Atomic Energy, Kwabenya, Accra, Ghana
6Department of Radiography, School of Biomedical & Allied Health Sciences, University of Ghana, PO Box
KB 143, Korle-Bu campus, Accra, Ghana
*Corresponding author: nruth13@yahoo.fr
Received 13 November 2018; revised 23 January 2019; editorial decision 29 January 2019;
accepted 1 February 2019
Preliminary studies on effective and eye lens doses of six Radiologists, four Cardiologists have been conducted for a period of
3 months. Electronic dosemeters positioned under and over lead apron of staff were used for the dosimetry. The estimated
effective dose per month to Cardiologist and Radiologist were 0.01–0.07 mSv and 0.03–0.14 mSv, respectively. The estimated
eye lens doses per month to Cardiologists and Radiologists were also 0.15–0.30 mSv and 0.53–3.39 mSv, respectively. The
effective doses per month to staff were below the ICRP acceptable limit of 1.67 mSv/month but the upper limit of the range of
estimated eye lens dose exceeded the ICRP acceptable limit by a factor of 2. Regular use of protective goggles and consistent
eye lens dose monitoring is encouraged at the hospital for dose optimization.
INTRODUCTION unsatisfactory radiation monitoring of staff at Korle-Bu
Staff performing uoroscopically guided procedures Teaching Hospital (KBTH). Also, procedure statisticsfl
is likely exposed to high radiation exposure among from the Cathlab at KBTH indicates an increase from
all medical occupational staff. Due to the nature (i.e. 15 to 20 procedures per year to 22–24 procedures per
real time viewing) of procedures, long exposure times month.
are recorded and the presence of the staff in the room Therefore, this study aimed to estimate effective
is required(1, 2). The continuous and systematic use of and eye lens dose to staff performing common fluor-
adequate protective equipment such as protective oscopy guided procedure for a duration of 3 months.
apron, thyroid shield can significantly reduce expos- The knowledge of staff dose level and factors in this
ure to the workers directly involved in interventional preliminary study is important requirement for opti-
procedures. The eye lens (when not shielded) could mization of radiological protection.
result in high radiation exposure leading to lens
opacities and cataracts(3–5). Therefore, International
Commission on Radiological Protection (ICRP) MATERIAL AND METHODS
reduced the recommended eye lens dose limit from A Shimadzu/Flexavision (Model: Collimator type R-
150 to 20mSv per year(6). Additionally, ICRP has 30H and serial number 3Z0FF7D22045) over-couch
recommend the use of two dosemeters for fluoros- and Siemens (model no. 10144181 and serial no.
copy staff (one dosemeter placed inside lead at waist 640041673) under-couch fluoroscopy machines in
level and another outside lead at neck level) in order different rooms were considered for the study. The
to consider the unshielded parts of the body(7). study focused on the radiation monitoring of six
Some studies on occupational exposure in fluoros- Radiologists performing retrograde urethrogram,
copy guided procedures have been done in Europe and hysterosalpingogram, fistulogram, barium meal, and
America(8–10) and none published to give the perspec- myelogram, biliary drainage, biliary stenting; and
tive of Ghana practices. Currently, studies performed in four Cardiologists performing coronary angiogram
the country have focussed largely on patient dosim- (CA), percutaneous coronary intervention (PCI) and
etry(11, 12) and a study by Botwe et al.(13) suggested an right heart catheterization (RHC) for a period of 3
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R. N. NANA ET AL.
Table 1. Cumulative effective dose and eye lens dose to Radiologist and number of procedures per month for the considered
procedures.
Type of procedures No. of procedures per month Effective dose (mSv) Eye lens dose (mGy)
Rad 1 Retrograde uretrogram 32 0.03 0.55
Rad 2 Hysterosalpingogram 69 0.03 0.57
Rad 3 Hysterosalpingogram 69 0.03 0.53
Rad 4 Fistulogram, barium meal, myelogram 8 0.14 3.39
Table 2. Cumulative effective dose and eye lens dose to Cardiologist and number of procedures per month for the considered
procedures.
Type of procedure Fluoroscopy time No. of procedures Effective dose Eye lens dose
(min) per month (mSv) (mGy)
Card 1 CA, PCI 177.0 10 0.03 0.30
Card 2 CA, PCI, RHC 129.0 12 0.02 0.25
Card 3 CA, PCI, RHC 77.1 7 0.01 0.15
Card 4 CA, PCI, RHC 109.2 12 0.02 0.20
months. The fluoroscopy time for each procedure Table 3. Comparison of effective dose per procedure of
and the number of procedures were recorded. The Cardiologists with other studies.
required ethical clearance was sought for this study.
Effective dose (μSv)
Personnel dose measurements CA PCI RHC
Four calibrated electronic personal dosemeters of type This study 0.05–21.1 0.8–57.6 0.1–2.8
EPD MK 2.3 manufactured by Thermo Electron Morrish and Golstone17 0.02–30.2 0.17–31.2 —
Corporation with corresponding serial numbers Fardid et al.18 0.3–14.3 1.3–27.5 —
00179975, 00178174, 00070491, 00179958 were used in
this study. Two were issued to each staff to be used at
the neck on the thyroid collar (surface dose) and one at
the waist level inside the lead apron (deep dose) accord- Eye lens dose = 1.46 × Hp (0.07)over (3)
ing to ICRP recommendation(14). The deep dose
equivalent at a depth of 10mm [Hp(10)] and 0.07mm
[Hp(0.07)] were recorded after each procedure.
Dose estimation algorithms proposed by Carinou
(14) RESULTS AND DISCUSSIONet al. and Swiss ordinance(15) were used to esti-
mate eye lens and effective dose, respectively. The Table 1 illustrates the number of procedures, cumula-
chosen algorithms meet ICRP(16) criteria of no tive effective doses and eye lens doses received by
underestimation and minimum overestimation of each Radiologist (rad) monthly. Rad 1, 2 and 3
dose. Equation 1 is the effective dose estimation received comparable effective and eye lens doses
algorithm proposed by Swiss ordinance(15). although the number of procedures and type of pro-
cedure are different. Rad 1 performed approximately
E = Hp (10)under + 0.05Hp (10)over (1) half of the procedures of Rad 2 and 3 but their
cumulative effective and eye lens doses are compar-
able. This could be attributed to the difference in the
Equations 2 and 3 are the eye lens dose estimation procedures and hence examination protocol. Rad 4
for under-couch and over-couch fluoroscopy tube
(14) received doses in excess of a factor of 4.6 and 6.2 forrespectively proposed by Carinou et al. . effective and eye lens dose respectively. It could be
Under-couch fluoroscopy tube: seen that Rad 4 performed the least number of pro-
cedures but recorded the highest effective dose and
Eye lens dose = 0.75 × Hp (0.07)over (2) dose to the eye lens. Again, this could be attributed
to difference in the procedures performed and hence
Over couch fluoroscopy tube: different examination protocols (i.e. staff position,
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PRELIMINARY STAFF DOSE ASSESSMENT FOR COMMON FLUOROSCOPY GUIDED PROCEDURES
Table 4. Dose records of interventional radiology procedures using different configuration of the x-ray tube.
Procedures Fluoroscopy time (min) Equipment Effective dose Eye lens dose
(mSv) (mSv)
IR Ass. IR IR Ass. IR
Biliary drainage 14.3 Over couch 0.04 0.02 0.53 0.22
Biliary stenting 76.4 Under couch 0.05 0.01 0.67 0.11
use of protective devices, fluoroscopy time, radio- protocols. Fluoroscopy time of Cardiologist has
graphs taken) engaged. strong influence on staff doses irrespective of the
Effective dose, eye lens dose, number of proce- number of procedures performed. Cardiologist and
dures and fluoroscopy time for each Cardiologist Radiologist cumulative doses per month compared
performing CA, PCI and RHC is illustrated in well with other studies except one staff with eye lens
Table 2. It could be seen that Card 1 recorded a high dose greater than ICRP recommended dose limit by
fluoroscopy time and hence high effective and eye a factor of 2. Under-couch tube orientation for pro-
lens dose comparatively. Cardiologist doses are not cedures is recommended due to low dose delivery to
dependent on the number of procedures performed staff.
but rather on the fluoroscopy time. Comparison of
Cardiologist effective dose per procedure has been
done with other studies in Table 3. The range of ACKNOWLEDGEMENTS
effective dose to Cardiologist published by Morrish The authorship of this article acknowledges with
and Goldstone(17) had an upper limit more than that gratitude the support of the radiologists and cardiol-
of this study by a a factor of 1.4 for CA procedures ogists for agreeing to participate in the study.
but less by a factor of 1.84 for PCI procedures and
those published by Fardid et al.(18) was within the
range of this study for both CA and PCI procedures. FUNDING
The cumulative effective dose and eye lens dose This work was supported by the International
to Radiologists and Cardiologists per month were Atomic Energy Agency (CMR/16019) in collabor-
all below the ICRP recommended dose limit of ation with the University of Ghana.
1.67 mSv/month except Rad 4 whose eye lens dose
was more by a factor of ~2. It must be mentioned
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