Interventional Procedure and Cataract Risk

Interventional procedures are actions carried out with fluoroscopy guidance where radiological images are displayed in real time and are generally used for diagnostic and therapeutic purposes. This type of procedure is commonly used for heart, blood vessel, digestive, bladder and kidney disorders. Flouroscopy itself is an imaging technique that uses X-rays to produce moving images in real time.

Increasing use of fluoroscopy for integrated diagnosis and procedures has resulted in the need for high awareness in the application of radiation exposure. The international commission for radiation protection (ICRP) has issued three main recommendations, namely justification, optimization and dose limitation to reduce unnecessary radiation exposure.

Epidemiological studies of victims of hirosima, nagasaki and chernobyl provide an overview of the relationship between exposure to low radiation doses with cataract formation. Based on research conducted by Klein, it is also known that diagnostic X-ray exposure results in an increased incidence of opacification in the lens of the eye. Vano also mentioned in his research that there was an eye lens injury to interventionists and medical staff if the radiation protection system was not implemented properly.

The eye lens is the part of the eye structure that is most sensitive to radiation. Damage to the lens of the eye due to radiation is characterized by the appearance of clouding points or loss of transparency of the lens cell properties called cataracts. Turbidity on the lens occurs due to the breakdown of proteins or other materials due to oxidation and photo-oxidation processes. Cataracts appear without symptoms and are generally detected by eye examination.

According to ICRP records, workers in the cardiology laboratory section experienced many cases of eye lens clouding as a result of radiation exposure during the intervention procedure. Workers who experience lens exposure are workers in the field of cardiology catheters who receive doses close to the threshold value of 150 mSv for several years. It also reported that on average 10% of interventional cardiology samples that reached 200 people received doses on the eye lens that exceeded the new dose threshold of 20 mSv, based on the dosimeters they were wearing behind the apron or dosemeter of the eye. Therefore it is necessary for medical worker in this field to use scatter radiation shields and radiation monitoring devices such as eye lens dosimeter to monitor the radiation dose received by the eye and to avoid injury of eye lens or cataracts.

Reference

Vano, Eliseo et al. 2013. Radiation-associated Lens Opacities in Catheterization Personnel: Results of a Survey and Direct Assessments. J Vasc Interv Radiol 2013; 24:197–204

Klein, Barbara E. 1993. Diagnostic X-ray Exposure andLens Opacities: The Beaver Dam Eye Study. American Journal of Public Health April 1993, Vol. 83, No. 4

ICRP Publication 113. Education and Training in Radiological Protection for Diagnostic and Interventional Procedures

Tana, Lusiana. 2006 Faktor Risiko dan Upaya Pencegahan Katarak Pada Kelompok Pekerja. Puslitbang Pemberantasan Penyakit, Badan Litbangkes Depkesd RI.

SKK. 2009. Radiation-Induced Cataracts. Recommendation by the German Commission on Radiological Protection with Scientific Reasoning