Use of medical imaging continues to increase, making the largest contribution to the exposure of populations from artificial sources of radiation worldwide. The principle of optimisation of protection is that \'the likelihood of incurring exposures, the number of people exposed, and the magnitude of their individual doses should all be kept as low as reasonably achievable (ALARA), taking into account economic and societal factors\'. Optimisation for medical imaging involves more than ALARA - it requires keeping individual patient exposures to the minimum necessary to achieve the required medical objectives. In other words, the type, number, and quality of images must be adequate to obtain the information needed for diagnosis or intervention. Dose reductions for imaging or x-ray-image-guided procedures should not be used if they degrade image quality to the point where the images are inadequate for the clinical purpose. The move to digital imaging has provided versatile acquisition, post-processing, and presentation options, and enabled wide and often immediate availability of image information. However, because images are adjusted for optimal viewing, the appearance may not give any indication if the dose is higher than necessary. Nevertheless, digital images provide opportunities for further optimisation, and allow the application of artificial intelligence methods.Optimisation of radiological protection for digital radiology (radiography, fluoroscopy, and computed tomography) involves selection and installation of equipment, design and construction of facilities, choice of optimal equipment settings, day-to-day methods of operation, quality control programmes, and ensuring that all personnel receive proper initial and career-long training. The radiation dose levels that patients receive also have implications for doses to staff. As new imaging equipment incorporates more options to improve performance, it becomes more complex and less easily understood, so operators have to be given more extensive training. Ongoing monitoring, review, and analysis of performance is required that feeds back into the improvement and development of imaging protocols. Several different aspects relating to optimisation of protection that need to be developed are set out in this publication. The first is collaboration between radiologists/other radiological medical practitioners, radiographers/medical radiation technologists, and medical physicists, each of whom have key skills that can only contribute to the process effectively when individuals work together as a core team. The second is appropriate methodology and technology, with the knowledge and expertise required to use each effectively. The third relates to organisational processes which ensure that required tasks, such as equipment performance tests, patient dose surveys, and review of protocols, are carried out. There is wide variation in equipment, funding, and expertise around the world, and the majority of facilities do not have all the tools, professional teams, and expertise to fully embrace all the possibilities for optimisation. Therefore, this publication sets out broad levels for aspects of optimisation that different facilities might achieve, and through which they can progress incrementally: Level D - preliminary; Level C - basic; Level B - intermediate; and Level A - advanced. Guidance from professional societies can be invaluable in helping users to evaluate systems and aid in adoption of best practice. Examples of systems and activities that should be in place to achieve the different levels are set out. Imaging facilities can then evaluate the arrangements they already have, and use this publication to guide decisions about the next actions to be taken in optimising their imaging services.

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BACKGROUND: The establishment of diagnostic reference levels (DRLs) is challenge for interventional neuroradiology (INR) due to the complexity and variability of its procedures.
OBJECTIVE: The main objective of this systematic review is to analyse and compare DRLs in fluoroscopy-guided procedures in INR.
METHODS: An observational study reporting DRLs in INR procedures, specifically cerebral arteriography, cerebral aneurysm embolisation, cerebral thrombectomy, embolisation of arteriovenous malformations (AVM), arteriovenous fistulas (AVF), retinoblastoma embolisation, and spinal cord arteriography. Comprehensive literature searches for relevant studies published between 2017 and 2023 were conducted using the Scopus, PubMed, and Web of Science databases.
RESULTS: A total of 303 articles were identified through an extensive literature search, with 159 removed due to duplication. The title and abstract of 144 studies were assessed and excluded if they did not meet the inclusion criteria. Thirty-one out of the 144 articles were selected for a thorough full-text screening. Twenty-one articles were included in the review after the complete text screening.
CONCLUSIONS: The different conditions of patients undergoing INR procedures pose a barrier to the standardization of DRLs; nevertheless, they are extremely important for monitoring and optimising radiological practices.

To ensure the safety of medical personnel in healthcare organizations, radiation-shielding materials like protective clothing are used to protect against low-dose radiation, such as scattered rays. The extremities, particularly the hands, are the most exposed to radiation. New materials that can be directly coated onto the skin would be more cost-effective, efficient, and convenient than gloves. We developed protective creams using eco-friendly shielding materials, including barium sulfate, bismuth oxide, and ytterbium oxide, to avoid harmful effects of heavy metals like lead, and tested their skin-protective effects. Particularly, the radiation-shielding effect of ytterbium oxide was compared with that of the other materials. As shielding material dispersion and layer thickness greatly affect the efficacy of radiation-shielding creams, we assessed dispersion in terms of the weight percentage (wt%). The effective radiation energy was reduced by 20% with a 1.0-mm increase in cream thickness. Ytterbium oxide had a higher radiation-shielding rate than the other two materials. A 28% difference in protective effect was observed with varying wt%, and the 45 wt% cream at 63.4 keV radiation achieved a 61.3% reduction rate. Higher content led to a more stable incident energy-reducing effect. In conclusion, ytterbium oxide shows potential as a radiation-shielding material for creams.

The review provides an extensive study of regulations and recommendations set forth by organizations worldwide in the domain of high-dose rate (HDR) brachytherapy for the prevention and mitigation of radiation hazards. The relevant reports and publications by the International Commission on Radiological Protection (ICRP), International Atomic Energy Agency (IAEA), American Association of Physicists in Medicine (AAPM), United States (US) Nuclear Regulatory Commission (NRC), and Atomic Energy Regulatory Board (AERB) were accessed, and necessary information was compiled to clarify and understand concepts, similarities, and differences in safety standards concerning to the topic. The regulations and guidance are categorized under three major components of safety, namely layout, equipment, and source. Layout category accesses structure, design, layout, and survey. The equipment category summarizes the requirements of equipment, installation, commissioning, quality assurance (QA) and performance, safety precautions and preparedness, safety procedures, and instructions. The source category includes requirements for sealed source possession and use, calibration, categorization, certification, licensing, QA tests, and security. IAEA gives inclusive guidance on radiation protection and regulatory requirements, forming the basis of reference for other organizations worldwide. AERB regulates the radiation facilities in India; therefore, most set-ups follow their safety standards and instructions.

This paper describes the development of the Safety Performance Indicators (SPIs), the methodology for assessment of the safety culture of radiotherapy institutions using SPIs and common strengths and common areas for improvement. SPIs were categorized into eight sections which all together contain 23 attributes and each attribute has scoring criteria from 0 to 2 (in steps of 0.5). The maximum absolute cumulative score of SPIs was 46. A relative cumulative SPIs score of >80% indicates an institution strong commitment towards safety while score <50% indicates need for additional guidance to enhance safety culture. The assessment using SPIs was conducted for 17 radiotherapy institutions. The methodology of assessment includes interactive discussion, direct observations and document analysis. The relative cumulative SPIs score of seven institutions was found to be >80% while it was found in the range of 67.0% to 80% for the remaining ten institutions. Institutions were communicated about the cumulative SPIs score, areas of strengths, and areas for improvement. SPIs were found to be a good tool for safety culture assessment and can be utilized by the radiotherapy institutes for self-assessment to identify the areas of improvement. Based on SPIs score, regulatory body can grade the institutions from a radiation safety compliance point of view.

BACKGROUND: To retrospectively investigate scatter radiation (SCR) exposure among staff in the endourology operating theatre.
METHODS: During surgeries under fluoroscopic guidance, five professional groups (urological surgeon [US], surgical nurse [SN], assistant surgical nurse [ASN], anaesthetist [A], and anaesthesia care [AC]) wore real-time dosimeters (Philips DoseAware System) on their head and chest over lead aprons between July 2023 and February 2024. The SCR data were analysed and correlated with procedural and patient factors.
RESULTS: In total, 249 procedures were performed, including 86 retrograde intrarenal surgeries and 10 percutaneous nephrolithotomies. Median SCR exposure was 38.81, 17.20, 7.71, 11.58, 0.63, 0.23, 0.12, and 0.15 Microsievert (µSv) for US chest (USC), US head (USH), SN chest (SNC), SN head (SNH), A chest (AC), AC chest (ACC), ASN chest (ASNC), and ASN head (ASNH), respectively. There was a significant correlation between DAP and SCR doses detected by USC, USH, SNC, SNH, AC, and ACC dosimeters (p < 0.05). The median chest-to-eye conversion factor (CECF) was 2.11 for the US and 0.71 for the SN.
CONCLUSIONS: This study, using real-time dosimetry, is among the first to assess staff occupational SCR exposure in endourology. It highlights a substantial SCR exposure, indicating an occupational health hazard that warrants further investigation.

Dose optimization in computed tomography (CT) is crucial, especially in CT fluoroscopy (fluoro-CT) used for real-time navigation, affecting both patient and operator safety. This study evaluated the impact of spectral X-ray filtering using a tin filter (Sn filter), and a method called partial-angle computed tomography (PACT), which involves segmentally switching off the X-ray tube current at the ambient dose rate H˙*(10) at the interventional radiologist\'s (IR) position. Measurements were taken at two body regions (upper body: head/neck; lower body: lower legs/feet) using a 120 kV X-ray tube voltage, 3 × 5.0 mm CT collimation, 0.5 s rotation speed, and X-ray tube currents of 43 Eff.mAs (without Sn filter) and 165 Eff.mAs (with Sn filter). The study found significant dose reductions in both body regions when using the Sn filter and PACT together. For instance, in the upper body region, the combination protocol reduced H˙*(10) from 11.8 µSv/s to 6.1 µSv/s (p < 0.0001) compared to the protocol without using these features. Around 8% of the reduction (about 0.5 µSv/s) is attributed to the Sn filter (p = 0.0005). This approach demonstrates that using the Sn filter along with PACT effectively minimizes radiation exposure for the IR, particularly protecting areas like the head/neck, which can only be insufficiently covered by (standard) radiation protection material.

The advent of robotic systems in interventional radiology marks a significant evolution in minimally invasive medical procedures, offering enhanced precision, safety, and efficiency. This review comprehensively analyzes the current state and applications of robotic system usage in interventional radiology, which can be particularly helpful for complex procedures and in challenging anatomical regions. Robotic systems can improve the accuracy of interventions like microwave ablation, radiofrequency ablation, and irreversible electroporation. Indeed, studies have shown a notable decrease of an average 30% in the mean deviation of probes, and a 40% lesser need for adjustments during interventions carried out with robotic assistance. Moreover, this review highlights a 35% reduction in radiation dose and a stable-to-30% reduction in operating time associated with robot-assisted procedures compared to manual methods. Additionally, the potential of robotic systems to standardize procedures and minimize complications is discussed, along with the challenges they pose, such as setup duration, organ movement, and a lack of tactile feedback. Despite these advancements, the field still grapples with a dearth of randomized controlled trials, which underscores the need for more robust evidence to validate the efficacy and safety of robotic system usage in interventional radiology.

Since 2013, the adoption of Directive 2013/59/EURATOM in the European Union has mandated emergency plans for facilities housing radiology equipment, including radiology and dental clinics, and required periodical testing of these plans. However, the testing procedures have sparked widespread confusion regarding the definition of radiological emergencies in clinical settings. A potential solution lies in broadening the scope to include \'radiological events\', covering accidents, incidents or other type of unjustified exposures. Utilizing realistic scenarios can enhance the radiological protection system within institutions, specifically addressing situations that might lead to unwanted patient exposure.