Evidence of radiation induced cataracts and brain tumors · Comparison of Operator Eye Exposures...

Evidence of radiation inducedcataracts and brain tumors

Dittmar BöcklerDepartment of Vascular and Endovascular Surgery

University Hospital Heidelberg

University Hospital Heidelberg | 8th MAC 2018 | Prof. Dr. Dittmar Böckler

Disclosures• Consultant

– Cook, Endologix, Gore, Medtronic

• Research Grant

– Gore, Maquet, Medtronic, Siemens

• Advisory Board

– Endologix, Gore, Maquet, Medtronic, Siemens

• Paid Speaker

– Endologix, Gore, Maquet, Medtronic, Siemens

• Major Stokeholder

– noneUniversity Hospital Heidelberg | 8th MAC 2018 | Prof. Dr. Dittmar Böckler

NONE

Radiation Protection becomes more important…

Patients, OR-Team, Anesthesiology, Scrub Nurses, Students, Visitors


More Endovascular > Increased Exposure


?Skin Eye lens Brain cancer


Potential Harms of Radiation

Treshold Values – Occupational Exposure

http://m.welt.de/gesundheit/article137871513/Grafik-Strahlenbelastung-Deutschland-DW-Wissenschaft-Berlin-jpg.html

Effective Dose < 20 mSv / year

Occuptaional life dose < 400 mSv

Treshold values for organ dosages (§ 55 StrlSchV) Eye lense >20 mSv

Skin, hands, forarm, feet, ankle

Gonads

Thyroid gland, bones

Colon, stomach, lungs, liver

Brain : unknown, not given


Evidence is increasing


Radiation induces Cataract

lens changes 5 x higher in interventional cardiologist compared to controls

Cumulative effect > injuries results afer years of practice

Radiation exposure to eye lens in Hybrid - OR


Prospective non-randomized trial

171 endovascular procedures

Heidelberg & Nuremberg

DAP, fluoro time, OR-time

Radiation exposure to eye lens &hand



Estimated fluoroscopy time to reach

20 mSV/y = 1404 minutes

Estimated DAP to reach treshold of

20 mSv/y. = 932.000 mGy/m2

Operator Eye Exposure depends on Working Positionfemoral region, side, or head of patient1

M.J. Ray, W.B. Taylor III, J.T. Weber, C.M. Savage. Comparison of Operator Eye Exposures When Working from Femoral Region, Side or Head of Patient, Journal of Vascular Interventional Radiology, Volume 23, Issue 3, Supplement, Page S127, March 2012

Radiation Eye Exposure increases with Angulation

A

B

C

Haqqani J Vasc Surg 2012

When LAO/RAO angle are >30°,patient & operator dose rate increases

exponentially.Same with CRA/CAU >15°

Operator Eye Exposure – working position

Contrary to instincts, workcloser to the side of the imageintensifier rather than x-tube

✔

✗


Protect your Eye Lenses

Differences between Lead Glasses

Radiation Exposure to eye lenses /Head


Attention and Awareness


Cancer Risk for Aircrew- Natural Radiation Exposure

Systematic review (n= 65 publications) Increased incidence for breat cancer in women Increased risk for melanoma (ultraviolet rays) 50% eleveated risc for prostatic cancer &brain tumors in pilots Overall low evidence and low corrleation


DNA Changes in OperatorsAberrant cells and chromosome breaks

Individual Radiation Sensitivity


Circulation 2017

Radiation Induced Cancer = Latency of 10 years


Angulation of C-ARM Increaseas Readiation Exposure

Hirntumore & Strahlenexposition , 6. Frühjahrestagung der DGG, Berlin April 2018

Radiation Head Exposure


Is there are association ? Brain cancer & radiation exposed staff performing interventions

?


Seelected Literature


Retrospective Study

110.297 MTRA

Mean cumulative brain dose 12 mGy

Mean follow up: 26.7. years

193 developed brain tumors (0.17%)

Conclusion: no association

Kitahara et al. AJR 2017; 208:1278-84


Case control study

31 cases 23 intervent. cardiologists 6 intervent. radiologists 2 electro-physiologists

Tumor 55 % Gliobastoma multiforme 16% Meningeoma 7% Astrozytome

85 % left sided „possibility of causal relation“ raises concern

Roguin et al, Am J Cardiol 2013


Nationale US- Survey

84.966 MTRA (radiological technologists)

Increased incindence for melanoma (OR 1,3)

Breats cancer (OR 1,16)

No data on brain tumors

2x increased mortality risk (OR 2,55)

Limitation: pot. Non radiogenic factors

„future epidemiological studies needed“

Rajaraman et al AJR 2016;206:1101-09


Rajaraman et al AJR 2016;206:1101-09


6,95 mSv 0,0017 mSv

Factor 4000

0,08 mSv

Chohan et al J Neurinterv Surg 2014:6:633-6Effect of cealing mounted shields


Reeves et al., JACC 2015;8:1197-1201

Prospektive Single Center Study N= 11 cardiologists carried lead caps

Interv. cardiologists are exposed to greater left sided radiation

5 x greater left > right sided radiation exposure

16 x higher radiation outside the cap than inside


Benefit of lead caps ?

0,005 mSv

factor 16

0,08 mSv


Reeves et al., JACC 2015;8:1197-1201

Benefit of lead caps ?

Summary Evidence for radiation induced cataracts is relatively high (2a and b)

Evidence for radiation induced brain tumors is low (3b)


Conclusion

Radiation protection of thyroid, eyes & head makes sense

2010- 2016 Since 2017 ?

Evidence of radiation induced cataracts and brain tumors · Comparison of Operator Eye Exposures...

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