Radiation induced lens changes and development of a radiation safety framework for interventionalists
Background: Ionising radiation (IR) is a modality that is increasingly being used in diagnostic, prognostic, therapeutic and interventional procedures. The health effects due to IR exposure can be deterministic or stochastic. Deterministic effects refer to effects that are seen at a minimal threshold level. These effects include skin burns and cytopaenia. Stochastic effects refer to effects where a minimum threshold is not evident. These include carcinomas and recently cataracts are thought to fall into this group. Interventionalists are at increased risk of developing cataracts due to IR exposure. The use of personal protective equipment (PPE) is essential to mitigate against the effects of IR on the eyes. Lead glasses, lead visors and ceiling suspended screens are essential for protecting the eyes of radiation healthcare workers (HCWs) in the catheterisation laboratory. PPE is often not readily available and interventionalists are notoriously non-compliant with donning PPE, especially lead glasses. They do not consistently wear their dosimeters either. Essential to reducing the risk of cataracts associated with IR is to ensure that education and training on radiation safety is formalised in the training of interventionalists and that there is ongoing reinforcement of this training. Creating and sustaining a culture of radiation protection (CRP) is essential to changing attitudes and behaviour towards radiation safety practices. A CRP ensures better patient safety and improves quality of care. Methods: This was a cross sectional prospective study that used multiple methods to address the research question. There was a qualitative and quantitative component. The qualitative component used individual interviews and group interviews to understand interventionalists’ perceptions about radiation and its effects on their health; to garner insight to their training in radiation safety; and to make meaning of how they understood what a CRP was. The quantitative components included a slit lamp examination and the completion of a survey. We compared a group of doctors not routinely occupationally exposed to IR to a group of interventionalists that are occupationally exposed to IR. There was no randomisation. Participation was voluntary and participants granted informed consent. The study was approved by an ethics committee. Results: The prevalence of cataracts possibly associated with IR exposure was 18.8% in the exposed group and the prevalence of posterior sub-capsular (PSC) cataracts in this group was 5.9%. PSC cataracts were 2.2 times more likely to occur in the exposed compared to the unexposed group. Lead glasses were consistently used by 10.2% of the interventionalists. Females were 4.3 times more likely to report that PPE was not available. Qualitative data showed that interventionalists had a culture where PPE such as lead aprons were consistently used but lead glasses were not a priority. Participants had poor knowledge of the dose limits and they did not consistently use dosimeters. There was a dearth of radiation protection training for interventionalists in South Africa. Radiologists received dedicated teaching on radiation safety while cardiologists did not always receive teaching on the topic. This was especially true for cardiologists. Participants generally agreed that there was a gap in their education and training in radiation safety training. Only 44.1% of participants thought their training was adequate. The majority of participants (95.4%) indicated that they wanted radiation safety training as part of their curriculum. A CRP was a strong theme that emerged as a conduit to creating a culture of radiation safety and participants supported the notion of developing a better CRP to promote radiation safety. Conclusion: IR exposure remains a high risk in the cath. lab exposing interventionalists to the risk of developing cataracts. This can be mitigated by improving training radiation safety and encouraging utilisation of PPE. Developing and sustaining a CRP is essential to improving radiation safety in the cath. lab.