Ocular Radiation Exposure and Shielding Practices During Complex Fluoroscopic Guided Interventions: An Exploratory Multicenter Observational Study.

Background/

Objectives

Lead acrylic shields (LASs) enhance radiation protection, with variation of their usage among different specialties. This prospective multicentric observational study aimed to explore patterns of ocular radiation exposure and LAS usage among interventionalists from different disciplines and to assess behavioral dose changes in a longitudinally monitored subgroup.

Methods

From July 2019 to July 2020, ocular doses (protected and unprotected) were measured in 15 interventionalists from four specialties (radiology, neuroradiology, cardiology and vascular surgery) across 2286 procedures using thermoluminescent dosimeters. Procedure type, operator position, total body dose, fluoroscopy time, dose area product, LAS usage and dose exceedances were documented. Ocular doses of five interventionalists, who participated in our previous study, allowed a longitudinal comparison of radiation doses and protective behavior.

Results

Cumulative annual unprotected ocular doses ranged from 0 to 59 mSv, with five participants exceeding the annual limit of 20 mSv, whereas protected doses (0 to 18 mSv) remained within the limits. Procedural LAS usage was seen in 89% of radiologists and 82% of vascular surgeons. Participants with 100% LAS usage recorded minimal measurable ocular doses, whereas lower LAS compliance resulted in higher ocular doses. Longitudinal subgroup data analyses showed a decrease in ocular dose per procedure in all five participants, suggesting a potential learning effect, without statistical significance.

Conclusions

Unprotected ocular doses exceeded the annual occupational eye lens dose limit in several participants, whereas protected doses remained within recommended limits in all participants. No specialty demonstrated universally lower ocular doses, while consistent LAS use proved highly effective in reducing the dose in all groups. Longitudinal findings suggest that structured dose monitoring and repeated training may support behavioral improvements in radiation protection over time.