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Submitted by Augusto Giussani, BfS - Bundesamt für Strahlenschutz
   Commenting on behalf of the organisation
Document Occupational Radiological Protection in Interventional Procedures
 

The ICRP draft on "Occupational radiological protection in interventional radiology" is an interesting and very useful document. Some editorial comments are reported below, as well as some general and technical comments on single issues that require to be better specified.



Page #

Line #

Type*

Comment

Proposed change

 

 

Ge

The document contains many useful pieces of information about protection methods and devices, but practically no illustrations or pictures. Figures can provide visual details which can be very helpful for the wider reader audience for which this document is targeted, including professionals who have no direct experience with these devices and methods.

Insert figure and/or illustrations depicting the protection devices and methods and their applications.

9

225

Ed

Typo (missing o)

occupational

10

274

Ed

Parentheses after RELID is not needed

delete parentheses

14

459-ff

Ge/Te

The definition of effective dose given in the glossary (and also in Annex B, Paragraph B9) does not correspond to the effective dose as defined in ICRP Publication 103 (according to which the equivalent doses to organs are calculated separately for male and female and then averaged).

Insert correct definition of effective dose

19

614

Ed

Missing space

insert space between "assurance" and "for"

21

689

Ed

Missing space

insert space between "assurance" and "for"

21

692

Ed

Useless comma

delete comma after "and"

24

832

Ed

Missing space

Insert space between "PET" and "imaging"

24

833

Ed

The last sentence of the paragraph ("Occupation exposures from interventional procedures") is only the short title of the document

Delete the sentence

25

856

Te

A multicentric study in Germany evaluated radiation exposure of medical staff
from interventional x-ray procedures and could be added to the list of references:
Häusler, U., Czarwinski, R., Brix, G., 2009. Radiation exposure of medical staff from interventional x-ray procedures: a multicentre study. Eur. Radiol. 19, 2000-2008

 

25-ff

858-ff

Te/Ed

Different notations are used to indicate the position of the dosimeter on the apron: "over apron", "over-apron", "outside apron"…

Use a unique notation

25-26

886-887

Ed

Sentence is ambiguous. Move "in a national survey" earlier in the sentence.

"Sanchez et al. (2017) found in a national survey monthly median…"

27

936

Te

The symbol PKA for Kerma-area product has not yet been defined

Define PKA

27

944-947

Ed

Sentence is hard to follow

Reformulate

27

950

Ed

 

Introduce here the acronym ORAMED

28

970-978

Te

Fig. 2.1 is not cited in the text. Additionally in the upper panel of the figure the value of average E is missing

Modify the figure accordingly and insert in the main text a reference to the figure.

29

987-ff

Te/Ed

Values are expressed sometimes in mGy and sometimes in µGy, and this may induce misunderstandings.

Use the same units throughout the paragraph

29

996

Te/Ed

The acronyms for TAVI and TAVR have already been defined previously (line 915)

Just use the acronyms

29ff

1030-ff

Ge/Te

The case of SIRT is a very special case. In my opinion only the scenario related to the trans-catheter delivery of the microspheres is of pertinence to this chapter, the other scenarios (preparation and calibration of the microspheres and exposures of nurses and care personnel) are common to every nuclear medicine procedure (specifically, radiotherapy applications) and should not be dealt with here.

Restrict the discussion to the trans-catheter delivery

30

1041

Ed

missing space

insert space between "rates" and "if"

30

1059

Ed

missing space

insert space between "purposes." and "Lower"

31

1098

Ed

Typo

Delete "." after "2004"

32

1104

Ed

Typo (missing s)

possible

32

1147-ff

Ge/Te

Section 2.5.2 deals actually with an incident related to a radioimmunotherapy treatment. Again, this has less to do with interventional procedures, rather with good practices in nuclear medicine therapy applications

 

33

1174

Ed

Typo

Correct "infection"

33

1175-1177

Ge/Te

Functioning commercial systems are available for eye-lens dosimetry, this should be acknowledged.

 

34

1244

Ed

Typo

Check the sentence

37

1332-1334

Ed

The text on "Lens of the eye" is differently structured as the corresponding text on "Whole Body"

Change the text accordingly: Lens of the eye: an equivalent dose to the lens of the eye of 20 mSv per year, averaged over defined periods of five years, provided that the equivalent dose to the lens of the eye does not exceed 50 mSv in any single year.

42

1552

Te

It is not clear, from a practical point of view, ho to define in advance which is going to be the "finger nearest the patient".

 

46

1725-1728

Ed

Font size: The sentence beginning with "This assessment" is formatted differently than the rest of the paragraph.

 

49

1880

Ed

Typo

Change "gradiants" into "gradients"

50

1933

Ed

Missing space

Add space between "Ho" and "where"

50

1935-1938

Te/Ge

The sentence does not make much sense. It seems you have to check constantly your collar dosimeter and then use an eye dosimeter if you see that the dose exceeds 10 mSv. Additionally, this sentence is not consistent with paragraph (52), which states that there are no measurement techniques available for routine use for assessing eye lens doses.

Change "When the collar dosimeter reading exceeds…" into "When the collar dosimeter reading is expected to exceed" or, alternatively, "If experience has shown that the collar dosimeter reading…"

52

1994

Ed

Missing text between "20 cm2-sized lead" and "ranging"

Check sentence

52

2029-2036

Ge/Te

This sentence refers to therapy with beta emitters and has little to do with interventional procedure.

Remove or better specify the relevance for interventional procedures

54

2079

Ed

 

Remove "be" between "can" and "benefit"

57

2181

Ed

The formatting of the legend of Fig. 5.2 (text in parentheses) is different from the one in Fig. 5.1

Use the same formatting

57

2189-2191

Ge

The sentence "Occupational exposures.." is out of context here and has no link with the rest of the section (dealing with scattered radiation).

Remove

57-58

2197-2256

Ge

The whole section 5.4.1 is practically dedicated to lead apron, subtitles may be removed (at least subtile 5.4.1)

Remove or rearrange subtitles

58

2208-ff

Te/Ed

Different notations are used to indicate light aprons: "lighter weight aprons", "lighter-weight aprons", "lightweight aprons"…

Use a unique notation

58

2238

Ed

A reference "Johns et al." is indicated, however no year is associated to this reference and no related item is present in the list of references at the end of the document

Add details as appropriate (see also comment below)

58

2238-2243

Te

The reference to the work of Wagner and Mulhem (1996) does not seem to be the proper reference for this text. More appropriate references are:

A.K.Jones and L.K.Wagner, Med. Phys. 2013, 40:063902

A.S.Pasciak, A.K.Jones and L.K.Wagner, Med. Phys. 2015, 42:653-662

A.K.Jones, A.S.Pasciak and L.K.Wagner, Med. Phys. 2016, 43:4133

Include the new references

58

2250-ff

Ge

The text in paragraph (157) is not pertinent with the title of the subsection 5.4.3.

Remove or rearrange subtitles (see also previous comment)

59

2261

Ed

Typo (missing i)

Siiskonen et al.

59

2264

Ed

"for males" repeated twice

Remove "for males" after "of age"

60

2322

Ed

Missing space

Add space between "drapes" and "were"

61

2348

Ed

Text is not consistent, either you say that simulations that provide higher values or that the DRFs derived from simulations assume higher values.

Remove "DRFs derived from"

61

2370

Ed

Incomplete reference, the list of references reports three articles by Vano et al. issued in 2015. I assume that the authors wanted to quote the one labelled 2015c.

(2015c)

63

2470-ff

Ge/Te

Paragraph (184) seems to be a kind of summary of the previous paragraphs. However it quotes the paper of Sandblom et al. (2012) which never appears in the preceding text.

 

64

2508

Ed

"would give a dose to 100 to 300 µGy" - Wrong preposition

"a dose from 100 to.."

66

2572

Ed

The whole paragraph is dealing with hands, therefore the expression "On the other hand" might be confusing

Replace it with "Moreover"

67

2607-2609

Ge/Te

The sentence "The types of.." contains general considerations and is out of context here.

Remove

68

2657-ff

Ge/Te

Paragraph (206) contains general considerations relevant for every therapy with beta emitters (or for every nuclear medicine procedure, actually) and has little to do with interventional procedure.

Remove or better specify the relevance for interventional procedures

69

2683

Ed

Text is incomplete: "…x-ray spectra that used…"

Check the sentence

69

2700

Ed

Typo, missing "t"

equipment

70

2702

Ed

Typo, wrong spelling

strategies (delete a)

70

2704

Ed

Typo, missing "s"

specialists

70

2722

Ed

Typo, missing "s"

exposures

71

2747

Te

The text refers to the information to be recorded, so I assume that the authors wanted to say that one has to record the actions that have been taken in response to an unusual event, and not the actions that should be taken (it doesn't seem very logical to record something that has not been done)

Remove "to be" between "measures" and "taken".

81

3199

Ge

Missing reference details: only the document title is given, without any further bibliographic information (is it a printed document, an online resource,…?)

Add details as appropriate


 * Type: Ge = general, Ed = editorial, Te = technical