CIRSE and the Society of Interventional Radiology (SIR) have released an updated joint guidelines document on radiation protection. To learn about key features of the guidelines, CIRSE Insider spoke with the authors: Dr. Donald Miller and Prof. Peter Reimer.
CIRSE Insider: What was the motivation behind publishing this joint CIRSE-SIR guidelines document on radiation protection?
Miller: A previous version of the document was published in 2010. We wanted to provide an update based on recent science and observations and to include additional topics that were not covered in the previous version.
CIRSE Insider: The last joint CIRSE-SIR guidelines on radiation protection were published in 2010. What do the current guidelines address that the previous guidelines did not?
Miller: The previous guidelines addressed only radiation protection in fluoroscopically guided interventions. In the new guidelines, we also address occupational protection issues related to computed tomography (CT) guided interventions and radioembolization. There is also a new section that addresses musculoskeletal risks.
CIRSE Insider: Why did CIRSE and SIR collaborate with one another on these guidelines? What was the experience like?
Miller: It was a natural collaboration between two major interventional radiology societies. The topics are of interest on both sides of the Atlantic Ocean. Together, we were able to identify and address topics where the approach is identical and those where national or international regulations and guidance vary.
Reimer: On a broader level, the updated guidelines embody both societies’ commitment to advancing clinical excellence in interventional radiology through the provision of robust, contemporary scientific evidence.
CIRSE Insider: The new guidelines also contain a section about radiation protection during pregnancy. What is one of the key takeaways that you can share from that section?
Reimer: The section helps pregnant staff in interventional radiology better understand that they can maintain their professional roles safely if they adhere to established radiation protection protocols. The guidelines also clarify that excessive protective measures may not improve foetal safety.
Miller: To that last point, wearing protective garments with greater than 0.5 mm lead equivalent thickness provides no meaningful advantage for foetal radiation protection and increases the risk of musculoskeletal injury to the pregnant staff member.
CIRSE Insider: Implementing new procedures and practices across diverse healthcare settings can be difficult. What challenges do you foresee medical professionals involved in interventional radiology will face when implementing the guidelines?
Miller: Personal protective equipment (e.g., aprons, vests, skirts, thyroid shields, eyewear) needs to be chosen carefully and must fit each individual properly. One size or style does not fit all. Interventional fluoroscopy facilities should be designed (or modified), so that ergonomic hazards are managed adequately. Addressing these concerns can be expensive.
CIRSE Insider: The joint guidelines reference data from governments, radiation protection organizations such as the International Atomic Energy Agency, and professional associations. What was the data collection process like? Was it difficult to synthesize a wide range of data?
Miller: The members of the writing panel were chosen because of their expertise, including familiarity with relevant government regulations, guidance from radiation protection organizations and professional organizations, and relevant scientific publications. It was therefore less challenging to identify and review relevant publications than it might otherwise have been.
CIRSE Insider: Were you surprised by any of the information you collected to write the joint guidelines? If so, which?
Miller: I was surprised that the same musculoskeletal issues relevant to interventionalists are also a recognized hazard for surgeons. Available information and advice on ergonomics from surgical organizations were helpful in making recommendations for interventionalists.
CIRSE Insider: You have included a section on musculoskeletal injuries among interventional radiologists (IRs) with elaboration in the annex. How aware is the IR community about MSK injuries? What are the risks for IRs, and how can they be better prevented?
Reimer: The awareness is growing, however, there is still limited understanding regarding effective prevention strategies. Surveys indicate that a significant number of interventional radiologists report neck, thoracic, or back pain, highlighting the prevalence of these injuries within the field.
Miller: It’s also important to note that some measures to prevent injury do not require any additional resources. For example, table height should be adjusted, so that the operator does not need to bend over and so that the elbows can be held in a neutral position. Even taking one-to-two minute “microbreaks” every 20 to 60 minutes during a case can improve mental focus and physical performance.
CIRSE Insider: The joint guidelines are directed not only at physicians but also all other staff involved in interventional radiology procedures. How important is it for you that the guidelines encompass all staff in the interventional suite and reach a broader audience within the medical community?
Reimer: The members of the writing panel agreed unanimously to ensure the document would be a resource for all staff in the interventional suite, including radiographers and nurses as well as physicians. Occupational radiation exposure and hazards affect every team member, so teams must work together to reduce these risks in order to perform at their best.
