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Article

Development of a New Radiation Shield for the Face and Neck of IVR Physicians

by
Toshimitsu Sato
1,
Yoichi Eguchi
2,
Chika Yamazaki
1,
Takanobu Hino
1,
Toshikazu Saida
3 and
Koichi Chida
2,4,*
1
Department of Radiology, Yamagata University Hospital, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
2
Course of Radiological Technology, Health Sciences, Graduate School of Medicine, Tohoku University, 2-1 Seiryo, Sendai 980-8575, Japan
3
Department of Central Radiology, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro, Nara 636-0802, Japan
4
Department of Radiation Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, 468-1 Aramaki Aza-Aoba, Sendai 980-0845, Japan
*
Author to whom correspondence should be addressed.
Bioengineering 2022, 9(8), 354; https://doi.org/10.3390/bioengineering9080354
Submission received: 29 May 2022 / Revised: 20 July 2022 / Accepted: 23 July 2022 / Published: 29 July 2022
(This article belongs to the Special Issue Recent Advances of Medical Devices)
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Abstract

:
Interventional radiology (IVR) procedures are associated with increased radiation exposure and injury risk. Furthermore, radiation eye injury (i.e., cataract) in IVR staff have also been reported. It is crucial to protect the eyes of IVR physicians from X-ray radiation exposure. Many IVR physicians use protective Pb eyeglasses to reduce occupational eye exposure. However, the shielding effects of Pb eyeglasses are inadequate. We developed a novel shield for the face (including eyes) of IVR physicians. The novel shield consists of a neck and face guard (0.25 mm Pb-equivalent rubber sheet, nonlead protective sheet). The face shield is positioned on the left side of the IVR physician. We assessed the shielding effects of the novel shield using a phantom in the IVR X-ray system; a radiophotoluminescence dosimeter was used to measure the radiation exposure. In this phantom study, the effectiveness of the novel device for protecting against radiation was greater than 80% in almost all measurement situations, including in terms of eye lens exposure. A large amount of scattered radiation reaches the left side of IVR physicians. The novel radiation shield effectively protects the left side of the physician from this scattered radiation. Thus, the device can be used to protect the face and eyes of IVR physicians from occupational radiation exposure. The novel device will be useful for protecting the face (including eyes) of IVR physicians from radiation, and thus could reduce the rate of radiation injury. Based on the positive results of this phantom study, we plan to perform a clinical experiment to further test the utility of this novel radiation shield for IVR physicians.

1. Introduction

Interventional radiology (IVR) procedures are increasingly being performed because of the significant advantages for patients [1,2,3,4,5,6]. However, IVR procedures are associated with increased radiation exposure and injury risk in both patients and IVR staff [7,8,9,10]. Many studies have evaluated the radiation dose to patients and IVR staff, and methods to reduce exposure [11,12,13,14,15,16,17,18]. We also previously evaluated exposure of patients and staff to radiation in our IVR laboratory [19,20,21,22,23,24,25,26].
In 2011, the International Commission on Radiological Protection significantly reduced the limit of occupational exposure of the eyes to radiation, from 150 to 100 mSv/5 years (i.e., 20 mSv/year) [27]. Furthermore, radiation eye injury (i.e., cataract) in IVR staff has also been reported [28,29]. It is crucial to protect the eyes of IVR physicians from X-ray radiation exposure [30,31,32,33,34,35]. Therefore, evaluation of the exposure of the eyes of IVR physicians to occupational radiation, and related protection, is important [36,37,38,39,40].
Lead (Pb) eyeglasses are useful for shielding the eyes against radiation [41,42,43]. Many IVR physicians use protective Pb eyeglasses to reduce occupational eye exposure. Despite the diversity in the thickness and shape of Pb eyeglasses, none offer complete protection against radiation exposure to the eyes of IVR physicians [44,45,46]. Therefore, we developed a unique face radiation shield that also protects the eyes. The device was designed to protect the neck and the left side of the face, including the left eye, of IVR physicians.
The purpose of this phantom study was to evaluate the radiation-protective effects of the novel shield in an IVR X-ray system.

2. Materials and Methods

2.1. Development of the Novel Radiation Shield

Figure 1 shows the novel radiation shield for IVR physicians. The device consists of a neck guard and face shield designed using a 0.25 mm Pb-equivalent rubber sheet (nonlead protective sheet, Figure 2). Pb-equivalent rubber sheeting is easy to handle and often used in personal protective aprons. The device is lightweight (0.65 kg). The neck guard and face shield are firmly connected and have adequate stability. The face shield was designed to mainly protect the left side of IVR physicians from scattered radiation.

2.2. Phantom Study

We conducted a phantom study at Yamagata University Hospital, Japan. Figure 3 displays the experimental setup used to simulate the typical settings for IVR procedures.
A digital cine angiography X-ray unit (an “under-tube” X-ray tube system) with a 16-in mode flat-panel detector (FPD) was used. Digital cine acquisitions were performed at 30 frames/s with a total duration of 150 s (30 s × 5). An automatic control system was used to set the X-ray exposure settings (i.e., kilovoltage and milliamperage) (Table 1).
We set the focus-to-image receptor (i.e., FPD) distance to 120 cm, and the height of the patient table to 92 cm. Five standard tube-viewing angles were used to simulate the typical settings for percutaneous coronary intervention (PCI) and cardiac catheterization: posteroanterior (PA), 60° left anterior oblique (LAO), 30° right anterior oblique (RAO), 30° RAO + 30° caudocranial (cranial), and 60° LAO + 30° craniocaudal (caudal).
A trunk phantom (PBU-60) was used to simulate the patient (Figure 3). A head phantom (THRA1) was used to simulate the IVR physician (Figure 3); it was placed 70 cm horizontally and 40 cm vertically from the central radiation beam on the patient table. This position is similar to that used by physicians during PCI at our hospital. The height of the head phantom was 165 cm; therefore, the eye of the phantom was approximately 150 cm above the floor. We did not use a ceiling-protecting Pb plate.

2.3. Dosimetry

Scattered radiation from the trunk phantom representing the patient was measured using radiophotoluminescence dosimeters (RPLDs; GD-302M), with and without the novel radiation shield. Dose Ace FGD-1000 was used as the measurement/readout system. RPLDs were placed on the surface of the head phantom representing the physician at 24 locations, including the left (No. ③) and right (No. ㉑) eyes (Figure 4).
The background radiation dose was subtracted from the measurements, and the doses were calibrated. The average of three measurements was recorded for each X-ray viewing angle. Based on the doses measured with (Dwith) and without (Dwithout) the novel radiation shield, we calculated the effectiveness of the radiation protection of the shield as: (Dwithout − Dwith)/Dwithout × 100%.

3. Results

Table 2 summarizes the results of our phantom study of the novel radiation shield. The scattered radiation doses were highest and lowest for the LAO views (LAO 60° and LAO 60° + CAU 30°) and RAO views (RAO 30° and RAO 30° + CRA 30°), respectively, for all measurements acquired without the novel radiation shield.
The scattered radiation doses were higher for the left side (No. ①–⑮) compared to the right side (No. ⑲–㉔) of the face.
Figure 5 depicts the protective effect of the novel radiation shield. The radiation protection effectiveness of the novel radiation shield was greater than 80% at almost all measurement points, except RAO 30°, at which the effectiveness was slightly lower. The average radiation protection effectiveness of the novel device for the five viewing angles were 87.5% and 83.6% for the left (No. ③) and right (No. ㉑) eyes, respectively.

4. Discussion

It is crucial to evaluate exposure of patients and healthcare workers to radiation during radiological examinations, especially IVR [47,48,49,50,51,52]. Despite the importance of protecting IVR physicians from occupational radiation exposure, no ideal radiation shield exists [53,54,55,56]. Although many devices protecting against radiation are available, none offer complete protection, especially for IVR physicians [54,57,58].
We developed a novel radiation shield to protect the face of IVR physicians (Figure 1 and Figure 2). This device is lightweight and comfortable to wear and has a unique design that protects the face (including the eyes) of IVR physicians. To provide stability and prevent misalignment, the face shield is firmly connected to the neck guard as a single component (Figure 1 and Figure 2). The device also allows IVR physicians to have a full field of vision. The face shield is connected to the left side of the face because most occupational radiation exposure to IVR physicians occurs from that side.
At almost all measurement points, the radiation protection of the shield was greater than 80%, which confirms its usefulness for IVR physicians. However, slightly lower effectiveness (<80%) was observed for the RAO view and No. ㉒. Thus, the protective effects of the device were slightly reduced in the RAO view compared to the other views. However, compared to the left side of the face, the doses of radiation delivered to the right side are nonetheless small, such that the device would still be effective for protecting IVR physicians from occupational radiation exposure. Similarly, the protection at No. ㉑ (right eye) was relatively low (i.e., 70.5%) at RAO30; however, this is unlikely to be a problem because the radiation doses delivered to this area are also small.
Radiation exposure to physicians is greater in the LAO compared to the RAO view because of the higher levels of scattered radiation (from the patient to the physician) in the former view. Occupational radiation protection of the eyes is crucial for IVR physicians, and Pb eyeglasses are often used for this purpose. Lightweight and comfortable Pb eyeglasses (0.07 mm Pb-equivalent) are often preferred by IVR physicians because of the prolonged duration of IVR procedures. However, the radiation-shielding effect of 0.07 mm Pb-equivalent eyeglasses is inadequate (45–60%). Although the radiation-shielding effect of 0.75 mm Pb-equivalent eyeglasses (~80%) is superior to that of 0.07 mm Pb-equivalent eyeglasses, the latter glasses are heavy and uncomfortable, which makes them unsuitable for use by IVR physicians.
Our novel shield provides eye radiation protection of above 80% on average (left eye, ③: 87.5%, right eye, ㉑: 83.6%), which is superior to that of Pb eyeglasses.
Generally, the distance between the left side of the IVR physician and the scattered radiation source (i.e., the patient) is small, such that more scattered radiation is received by the left than the right side of the physician [42,43,59]. Therefore, our novel radiation shield was developed to protect the left side of the IVR physician’s head.
IVR physicians are also potentially at higher risk of radiation-induced brain tumors compared to the general population [60,61,62]. Roguin et al. reported a higher rate of tumors on the left compared to the right side of the brain in IVR physicians, which they attributed to the higher radiation dose to the left side of the head (because it is nearer to the primary X-ray beam and exposed to more scattered radiation) [63]. The novel shield was designed to protect particularly the left side of the head of IVR physicians, and thus may reduce the risk of radiation-induced brain tumors.
Currently, the novel shield is available only in a single size; small and large sizes may also be needed. The novel shield protects only the face and neck of IVR physicians. Therefore, other radiation shields (e.g., a protective apron) are also required.
Further studies comparing the eye-protective effect of our novel radiation shield with that of protective Pb glasses (using the same radioactive source in the same environment) may be needed. This study using phantoms introduces our novel shield for the face and neck of IVR physicians, but further investigation is required in clinical settings to fully test the shield.

5. Conclusions

We performed a phantom study to investigate the protective effects against radiation of a novel shield for the face and eyes of IVR physicians and found it to be highly effective (>80% protection) under almost all measurement conditions. The novel shield can reduce the radiation dose by more than 80% without the use of Pb eyeglasses and offers equivalent or superior protection compared to Pb eyeglasses.
A large amount of scattered radiation reaches the left side of IVR physicians. The novel radiation shield effectively protects the left side of the physician from this scattered radiation. Thus, the device can be used to protect the face and eyes of IVR physicians from occupational radiation exposure. The novel device will be useful for protecting the face (including eyes) of IVR physicians from radiation, and thus could reduce the rate of radiation injury. Based on the positive results of this phantom study, we plan to perform a clinical experiment to further test the utility of this novel radiation shield for IVR physicians.

Author Contributions

Conceptualization, Y.E., T.S. (Toshimitsu Sato) and T.S. (Toshikazu Saida); methodology, Y.E., T.S. (Toshimitsu Sato) and K.C.; software, C.Y. and T.H.; validation, T.S. (Toshimitsu Sato), C.Y., T.H. and K.C.; formal analysis, T.S. (Toshimitsu Sato), C.Y. and T.H.; investigation, Y.E., T.S. (Toshimitsu Sato), T.S. (Toshikazu Saida) and K.C.; resources, T.S. (Toshimitsu Sato) and K.C.; data curation, T.S. (Toshimitsu Sato), C.Y. and T.H.; writing—original draft preparation, K.C.; writing—review and editing, T.S. (Toshimitsu Sato), C.Y. and T.H.; visualization, T.S. (Toshimitsu Sato), C.Y., T.H. and K.C.; supervision, Y.E., T.S. (Toshikazu Saida) and K.C.; project administration, T.S. (Toshimitsu Sato) and K.C.; funding acquisition, K.C. All authors have read and agreed to the published version of the manuscript.

Funding

This study was supported in part by the Industrial Disease Clinical Research Grants (200701-1), Japan.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Acknowledgments

We thank Yuuki Murabayashi, Tohoku university, Japan, and Akihiro Shinobu of the Yamagata university Hospital, Japan for their invaluable assistance.

Conflicts of Interest

The authors declare no conflict of interest.

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Bioengineering 09 00354 g001 550
Figure 1. Photograph of the novel shield: (a) frontal view; (b) lateral view. The neck guard and face shield are fastened together to create a single device, which cannot be disassembled. The face shield is attached to the left side of the neck guard and protects the left side of the physicians’ neck and face from radiation. The novel shield was designed so that it does not obstruct IVR physicians’ field of vision.
Figure 1. Photograph of the novel shield: (a) frontal view; (b) lateral view. The neck guard and face shield are fastened together to create a single device, which cannot be disassembled. The face shield is attached to the left side of the neck guard and protects the left side of the physicians’ neck and face from radiation. The novel shield was designed so that it does not obstruct IVR physicians’ field of vision.
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Bioengineering 09 00354 g002 550
Figure 2. Schematic of the novel shield: (a) frontal view; (b) lateral view. The novel shield consists of a neck guard and face shield, which together comprise a single unit to promote stability and prevent misalignment. The shield is firmly attached behind the neck of the IVR physicians using Velcro to protect them from scattered radiation from the left side. The device consists of a neck guard and face shield designed using a 0.25 mm Pb-equivalent rubber sheet (nonlead protective sheet).
Figure 2. Schematic of the novel shield: (a) frontal view; (b) lateral view. The novel shield consists of a neck guard and face shield, which together comprise a single unit to promote stability and prevent misalignment. The shield is firmly attached behind the neck of the IVR physicians using Velcro to protect them from scattered radiation from the left side. The device consists of a neck guard and face shield designed using a 0.25 mm Pb-equivalent rubber sheet (nonlead protective sheet).
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Bioengineering 09 00354 g003 550
Figure 3. Experimental setup used for our phantom study (e.g., LAO60): (a) without novel shielding device; (b) with novel shielding device.
Figure 3. Experimental setup used for our phantom study (e.g., LAO60): (a) without novel shielding device; (b) with novel shielding device.
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Bioengineering 09 00354 g004a 550Bioengineering 09 00354 g004b 550
Figure 4. The 24 measurement points on the head of the phantom simulating the physician: (a) frontal view; (b) left lateral view; (c) right lateral view. Twenty-four dosimeters were attached to the points marked on the phantom’s surface (left eye: No. ③, right eye: No. ㉑). The distance between the measurement points was 3 cm.
Figure 4. The 24 measurement points on the head of the phantom simulating the physician: (a) frontal view; (b) left lateral view; (c) right lateral view. Twenty-four dosimeters were attached to the points marked on the phantom’s surface (left eye: No. ③, right eye: No. ㉑). The distance between the measurement points was 3 cm.
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Figure 5. Protective effect of the novel radiation shield in the phantom study. Measurement point: Twenty-four dosimeters were attached to the points marked on the phantom’s surface (left eye: No. ③, right eye: No. ㉑) (See Figure 4). PA: posteroanterior, LAO60: 60° left anterior oblique, RAO30: 30° right anterior oblique, LAO60+CAU30: 60° left anterior oblique + 30° craniocaudal (caudal), RAO30+CRA30: 30° right anterior oblique + 30° caudocranial (cranial).
Figure 5. Protective effect of the novel radiation shield in the phantom study. Measurement point: Twenty-four dosimeters were attached to the points marked on the phantom’s surface (left eye: No. ③, right eye: No. ㉑) (See Figure 4). PA: posteroanterior, LAO60: 60° left anterior oblique, RAO30: 30° right anterior oblique, LAO60+CAU30: 60° left anterior oblique + 30° craniocaudal (caudal), RAO30+CRA30: 30° right anterior oblique + 30° caudocranial (cranial).
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Table
Table 1. X-ray exposure setup used in our study.
Table 1. X-ray exposure setup used in our study.
Tube-Viewing AnglesTube Kilovoltage
(kV)		Tube Milliamperage (mA)Additional Copper Filter (mm)
60° left anterior oblique743200.3
30° right anterior oblique833200.3
Posteroanterior743200.3
60° left anterior oblique
+30° craniocaudal		744000.3
30° right anterior oblique
+30° caudocranial		793200.3
Table
Table 2. Summary of the phantom study.
Table 2. Summary of the phantom study.
Posteroanterior60° Left Anterior Oblique30° Right Anterior Oblique60° Left Anterior Oblique
+30° Craniocaudal		30° Right Anterior Oblique
+30° Caudocranial
1 MP2 Without3 With4PE2 Without3 With4PE2 Without3 With4PE2 Without3 With4PE2 Without3 With4PE
(μGy)(μGy)(%)(μGy)(μGy)(%)(μGy)(μGy)(%)(μGy)(μGy)(%)(μGy)(μGy)(%)
①691867190.312,600176486.0305878674.315,512125091.9414767383.8
②767371690.713,451189485.9320780974.816,460135291.8428959186.2
③806563992.114,470186187.1344278577.217,585131992.5449550888.7
④782170691.013,510183986.4330477076.715,799128391.9449165385.5
⑤832071891.414,175186786.8349077877.716,614128492.3456858787.1
⑥847364092.415,145191787.3364576079.217,821130492.7478648489.9
⑦836865892.113,796164088.1334267579.816,185121592.5484063686.9
⑧868662092.914,510159689.0363765781.917,103116193.2486551689.4
⑨909658893.516,667178989.3403867483.319,216128193.3516842191.9
⑩807459292.713,757155888.7316756682.115,833115992.7462157487.6
⑪853359093.114,800156989.4362060983.217,066108893.6492449090.1
⑫953457394.016,966177789.5408069982.919,278121693.7531944991.6
⑬773156992.613,258208084.3287956180.514,937181987.8450956387.5
⑭840658193.114,764247783.2327462081.115,837177188.8466454788.3
⑮877253094.015,916305980.8373062983.117,348186989.2496845090.9
⑯635362790.111,267155586.2271484768.813,699113091.7373568081.8
⑰666961890.712,338163486.8287575773.714,677115392.1376555385.3
⑱628360790.312,998173386.7282276972.815,090122891.9389150487.0
⑲565261089.29515139285.4247096860.812,094102591.5338072678.5
⑳553655889.910,010138586.2258576370.511,75897191.7338755683.6
㉑356339389.0602694084.4190556870.2654864090.2249340084.0
㉒149829880.1169363162.7105061041.9182743976.0134645865.9
㉓318336988.4407175481.5178260566.0414651087.7215543479.8
㉔411840590.2674293586.1229861173.4614461690.0277843884.2
1 MP: Measurement point. 2 Without: Doses measured without the novel radiation shield (The average of three measurements was recorded). 3 With: Doses measured with the novel radiation shield (The average of three measurements was recorded). 4 PE: Protective effect, (Dwithout − Dwith)/Dwithout × 100%.
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Sato, T.; Eguchi, Y.; Yamazaki, C.; Hino, T.; Saida, T.; Chida, K. Development of a New Radiation Shield for the Face and Neck of IVR Physicians. Bioengineering 2022, 9, 354. https://doi.org/10.3390/bioengineering9080354

AMA Style

Sato T, Eguchi Y, Yamazaki C, Hino T, Saida T, Chida K. Development of a New Radiation Shield for the Face and Neck of IVR Physicians. Bioengineering. 2022; 9(8):354. https://doi.org/10.3390/bioengineering9080354

Chicago/Turabian Style

Sato, Toshimitsu, Yoichi Eguchi, Chika Yamazaki, Takanobu Hino, Toshikazu Saida, and Koichi Chida. 2022. "Development of a New Radiation Shield for the Face and Neck of IVR Physicians" Bioengineering 9, no. 8: 354. https://doi.org/10.3390/bioengineering9080354

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