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Radiation Exposure to Patients During Interventional Procedures in 20 Countries: Initial IAEA Project Results

¹ Konstantopoulio Hospital, Attiki, Greece.
² Sudan Atomic Energy Commission,Khartoum, Sudan.
³ Dubai Hospital, Dubai, United Arab Emirates.
⁴ University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
⁵ Centre National de Radioprotection, Ministère de la Santé Rabat, Agdal, Morocco.
⁶ Centre National de Radioprotection (CNRP), Ministère de la Santé Publique, Tunis, Tunisia.
⁷ National Centre of Radiobiology and Radiation Protection (NCRRP), Ministry of Health, Sofia, Bulgaria.
⁸ Greek Atomic Energy Commission, Athens, Greece.
⁹ Lebanese Atomic Energy Commission, Beirut, Lebanon.
¹⁰ University Hospital of Osijek, Osijek, Croatia.
¹¹ Research Institute of Cardiology, CSC, Yerevan, Armenia.
¹² Syrian Atomic Energy Commission, Damascus, Syria.
¹³ Centre de Recherche Nucléaire d'Alger, Commissariat à l'Énergie Atomique, Alger Gare, Algeria.
¹⁴ Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.
¹⁵ Radiation Safety Agency (State Regulatory Authority), Dushanbe, Republic of Tajikistan.
¹⁶ Al-Sabah Hospital, Shuwaikh, Kuwait.
¹⁷ National Scientific Practical Center of Applied Preventive Medicine, Chisinau, Republic of Moldova.
¹⁸ Kenyatta National Hospital, Nairobi, Kenya.
¹⁹ Institute of Nuclear Medicine and Oncology, Pakistan Atomic Energy Commission, Lahore, Pakistan.
²⁰ Radiation Protection Centre, Ministry of Health, Vilnius, Lithuania.
²¹ Slovenian Radiation Protection Administration, Ljubljana, Slovenia.
²² International Atomic Energy Agency, Wagramer Strasse 5, PO Box 100, A-1400, Vienna, Austria.

OBJECTIVE. The purpose of our study was to investigate the level of radiation protection of patients and staff during interventional procedures in 20 countries of Africa, Asia, and Europe.

SUBJECTS AND METHODS. In a multinational prospective study, information on radiation protection tools, peak skin dose (PSD), and kerma-area product (KAP) was provided by 55 hospitals in 20 mainly developing countries (nine mostly in Eastern Europe, five in Africa, and six in Asia).

RESULTS. Nearly 40% of the interventional rooms had an annual workload of more than 2,000 patients. It is remarkable that the workload of pediatric interventional procedures can reach the levels of adult procedures even in developing countries. About 30% of participating countries have shown a 100% increase in workload in 3 years. Lead aprons are used in all participating rooms. Even though KAP was available in almost half of the facilities, none had experience in its use. One hundred of 505 patients monitored for PSD (20%) were above the 2-Gy threshold for deterministic effects.

CONCLUSION. Interventional procedures are increasing in developing countries, not only for adults but also for pediatric patients. The situation with respect to staff protection is considered generally acceptable, but this is not the case for patient protection. Many patients exceeded the dose threshold for erythema. A substantial number (62%) of percutaneous transluminal coronary angioplasty procedures performed in developing countries in this study are above the currently known dose reference level and thus could be optimized. Therefore, this study has significance in introducing the concept of patient dose estimation and dose management.

Keywords: developing countries • IAEA activities • interventional procedures • patient safety • percutaneous transluminal coronary angioplasty (PTCA) • radiation exposure • radiation safety • staff safety

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