The Institute of Physics and Engineering in Medicine (IPEM) welcomes this report and the opportunity to comment on the draft.
We would recommend that the involvement of both the Radiation Protection Adviser and Medical Physics Expert is highlighted throughout the report as a step toward ensuring staff safety and optimizing patient dose.
The report frequently associates long fluoroscopy times with increased patient doses. This may not necessarily be the case as using low dose fluoroscopy as opposed to acquisition may be a lower dose method.
The glossary (p11-18) could be moved to the end of the document.
The document appears to use the terms ‘deterministic effects’ and ‘tissue reactions’ where just one should be used.
IPEM has the following specific comments:
Executive summary
Line 171 – seems to imply that only children undergoing cardiology procedures have an increased cancer risk. This is misleading. Whilst the cancer risk may be of more concern for younger patients, the risk should obviously be considered for all patients.
Lines 347-348 – implies that only nuclear cardiology and CT examinations should be optimized – should cover any work with ionizing radiation.
Chapter 5 – managing patient dose in fluoroscopically guided interventions
It is worth mentioning in this section the difference between fluoroscopy and acquisition dose rates. Users should be aware that the majority of dose to both patient and staff comes from acquisition and as such consideration should be given to the use of acquisition runs and optimizing exposure factors for acquisition settings.
The involvement of a Medical Physics Expert in optimizing patient doses should be emphasized.
Table 5.1 could include the removal of anti-scatter grids if appropriate and the use of additional x-ray filtration.
Chapter 6 – radiation doses and protection of staff during interventional fluoroscopy
Paragraph 113 – it is not normal practice to consider the staff members age when considering the use of a thyroid shield. The need should be based on a risk assessment and for practical purposes be applied to all staff working in that area. Most cardiology labs require all staff to wear thyroid shields.
Paragraph 124 – could mention that failure to wear monitoring equipment could be in breech of the radiation employer’s procedures and/or local legislative requirements.
Paragraph125 – need to emphasize that the collar badge gives only a broad indication of dose to the eye and that the advice of a Radiation Protection Adviser should be sought to interpret monitoring results.
Chapter 8 – radiological protection for cardiac CT
Section 8.6.2 – need to mention that a Medical Physics Expert should be involved in optimization.
Chapter 10 – quality assurance programmes
Section 10.3 – the description of tests could include the test of the radiation safety aspects of the facility (e.g. the critical examination required by UK law).