RADIATION PROTECTION: A TRAINEE'S PERSPECTIVE

If finding a lead apron that fits properly is a weekly, if not daily, struggle - you're not alone. This isn't just an inconvenience—it's a health risk. According to our survey, 58% of trainees have difficulty finding appropriately sized lead aprons at least once a week. The implications are severe, with 56% of trainees reporting back pain from ill-fitting personal protective equipment (PPE).

The survey highlighted health concerns among trainees who are only just starting out in what is hopefully a long career. Musculoskeletal pain, including back and neck pain, is alarmingly common. Specifically:

• 56% of trainees reported back pain

• 23% experienced neck pain

• 11% had hip pain

• 6% dealt with knee pain

• 6% reported foot or ankle pain

Eye Protection: A Critical Concern

The provision of appropriate eye protection is mandated by the Ionising Radiations Regulations 2017 and is the responsibility of the employer. However, nearly a quarter of those trainees wearing personal eye protection had still been required to fund acquisition of lead goggles at a significant cost of around £300-£500. For trainees requiring prescription glasses, a staggering 77% felt that overfit goggles compromised their ability to perform procedures.

IR trainees have encountered difficulties with funding, as some trusts are reluctant to pay for prescription glasses for trainees who will inevitably rotate placements. It is essential that local training schemes work with individual NHS trusts and Health Education England (HEE) to provide the appropriate PPE for trainees to ensure their work, training, and health are not compromised.

Dosimetry: Inconsistent Practices

While compliance with body dosimetry is high, with 99% of trainees using it regularly, the use of eye dosimeters is inconsistent. Only 50% of trainees reported using eye dosimeters, exposing them to unnecessary risks. Given the well-documented risks of radiation to the eyes, including the potential for cataracts, this gap in monitoring needs to be addressed urgently.

Gender-Specific Concerns

As the number of female trainees entering IR increases, it is essential we consider the link between exposure to ionising radiation at work and breast cancer Alarmingly, a study in the USA by Chou et al. showed that female orthopaedic surgeons were four times more likely to develop breast cancer due to inadequate shielding of the axillary tail. Furthermore, no occupational dose limits exist for breast tissue despite it being highly radiation sensitive

Use of axillary coverage or sleeves has been shown to decrease intra-procedural irradiation to the upper outer quadrant by 99%, and the European Society for Vascular Surgery has already recommended female operators consider adopting this extra protection.

Recommendations for Improvement

The results of this survey are concerning and highlight the variation in trainee radiation protection across the UK. It is essential for training schemes across the UK to address these radiation concerns and ensure current and future IR trainees are properly protected. Here are some recommendations:

• Personalised PPE: All IR trainees should feel empowered to advocate for themselves regarding radiation protection by familiarising themselves with the relevant legislation. On commencing IR training, an assessment of eye protection, lead apron, and thyroid shield availability should be performed at induction, with a dedicated set of leads and eye protection assigned to each IR trainee. If there is no suitably fitting lead, a new personalised lead should be purchased by the employer. This should also include specialised prescription goggles.

• Routine Assessments: Implement regular assessments of PPE fit and condition, as well as periodic reviews of dosimetry results. This could include annual fit checks and quarterly reviews of dosimeter readings to identify any trends or concerns early.

• Standardized Monitoring Protocols: Establish consistent protocols for radiation monitoring across all training sites. This should include the use of body, eye, and finger dosimeters for all trainees, regardless of their rotation site.

• Education and Training: Provide comprehensive radiation safety training at the start of IR rotations and offer refresher courses annually. This should cover proper use of PPE, understanding dosimetry reports, and strategies for minimising radiation exposure.

• Gender-Specific Considerations: Implement additional protective measures for female trainees, such as providing axillary shields and considering breast-specific dosimetry.

The radiation protection supervisors in your department are likely to be responsible for ensuring appropriate PPE is available and are usually in charge of the provision and collection of dosimetry badges for assessment. In addition to body dosimetry, all IR trainees should be provided with eye and finger dose monitors to assess exposure levels and ensure they remain within safe limits. Without this, it's difficult to identify whether additional protective measures are required.

Conclusion

Radiation protection in interventional radiology is essential to safeguard not only patients but also staff from the harmful effects of ionising radiation. Improving radiation protection for our trainees isn't just about meeting regulatory requirements it's about protecting the safety of our trainees and the interventionalists of the future. By addressing these concerns, we can ensure a safer, more sustainable future for the field of interventional radiology.

Read the full article: https://issuu.com/bsir/docs/2024_autumn_newsletter_3_