Can leaded glasses protect the eye lens in patients undergoing neck computed tomography?
Background and aims: Computed tomography (CT) is one of the main sources using ionizing radiation. Considering the toxicity from this radiation, any technique that could reduce the radiosensitive organs’ doses without affecting the image diagnostic quality must be considered in routine practice. In this study, the amount of eye lens dose reduction in the presence of radioprotective glasses was evaluated in neck CT examinations.
Methods: Thirty adult patients (15 men and 15 women) with a mean age of 44.6 years undergoing neck CT examination participated in this study. For each patient, six thermoluminescent dosimeters (TLDs-100) were attached above the eye lens glasses surface, and another six under the glasses to assess the radioprotective effect of the glasses. The TLDs were readout and converted to Hp (3) as an indicator of eye lens dose. The obtained results from the TLD readouts as eye lens dose were compared using a paired t-test.
Results: The TLD measurements showed the mean ± standard deviation values of 2.97 ± 0.61 mGy and 1.04 ± 0.16 mGy for TLDs above and under the radioprotective glasses, respectively. The radioprotective glasses significantly decreased the eye lens dose by about 64.9% (P-value=0.001).
Conclusions: Owing to the results, wearing radioprotective glasses for patients during neck CT scans, could significantly reduce the eye lens doses.
Relevance for patients: The outcome of this research shows that leaded glasses can decrease the received dose significantly in patient during neck CT scans.
[1] Hess EP, Haas LR, Shah ND, Stroebel RJ, Denham CR, Swensen SJ. Trends in Computed Tomography Utilization Rates: A Longitudinal Practice-Based Study. J Patient Saf 2014;10:52-8.
[2] Mettler FA Jr., Huda W, Yoshizumi TT, Mahesh M. Effective Doses in Radiology and Diagnostic Nuclear Medicine: A Catalog. Radiology 2008;248:254-63.
[3] Davoudi M, Khoramian D, Abedi-Firouzjah R, Ataei G. Strategy of Computed Tomography Image Optimisation in Cervical Vertebrae and Neck Soft Tissue in Emergency Patients. Radiat Prot Dosimetry 2019;187:98-102.
[4] Khoramian D, Sistani S, Firouzjah RA. Assessment and Comparison of Radiation Dose and Image Quality in Multi-Detector CT Scanners in Non-Contrast Head and Neck Examinations. Pol J Radiol 2019;84:e61-7.
[5] Mettler FA Jr., Thomadsen BR, Bhargavan M, Gilley DB, Gray JE, Lipoti JA, et al. Medical Radiation Exposure in the US in 2006: Preliminary Results. Health Phys 2008;95:502-7.
[6] Khorramian D, Sistani S, Banaei A, Bijari S. Estimation and Assessment of the Effective doses for Radiosensitive Organs in Women Undergoing Chest CT Scans with or without Automatic Exposure Control System. Tehran Univ Med J TUMS Publ 2017;75:496-503.
[7] Dougeni E, Faulkner K, Panayiotakis G. A Review of Patient Dose and Optimisation Methods in Adult and Paediatric CT Scanning. Eur J Radiol 2012;81:e665-83.
[8] Badshah M, Soames R, Ibrahim M, Khan MJ, Khan A. Surface Anatomy of Major Anatomical Landmarks of the Neck in an Adult Population: A CT Evaluation of Vertebral Level. Clin Anat 2017;30:781-7.
[9] Iball GR, Brettle DS. Organ and Effective Dose Reduction in Adult Chest CT using Abdominal Lead Shielding. Br J Radiol 2011;84:1020-6.
[10] Martin CJ. A 20 mSv Dose Limit for the Eye: Sense or no Sense? J Radiol Prot 2011;31:385-7.
[11] ICRP. ICRP Publication 60: 1990 Recommendations of the International Commission on Radiological Protection. Amsterdam, Netherlands: Elsevier Health Sciences; 1991.
[12] Charles MW. ICRP Publication 103: Recommendations of the ICRP. Oxford: Oxford University Press; 2008.
[13] Stewart FA, Akleyev AV, Hauer-Jensen M. Early and Late Effects of Radiation in Normal Tissues and OrgansThreshold Doses for Tissue Reactions in a Radiation Protection Context. ICRP Publ 2012;118:322.
[14] Rehani MM, Vano E, Ciraj-Bjelac O, Kleiman NJ. Radiation and Cataract. Radiat Prot Dosimetry 2011;147:300-4.
[15] Chodick G, Bekiroglu N, Hauptmann M, Alexander BH, Freedman DM, Doody MM, et al. Risk of Cataract after Exposure to Low Doses of Ionizing Radiation: A 20- Year Prospective Cohort Study among US Radiologic Technologists. Am J Epidemiol 2008;168:620-31.
[16] Khaleghi Fard A, Alian AH, Pourafkari L, Ghojazadeh M, Tarighatnia A, Farajollahi A. Impact of Pelvic and RadBoard Lead Shields on Operator and Patient Radiation Dose in Trans-Radial Coronary Procedures. Radiat Prot Dosimetry 2019;187:108-14.
[17] Banaei A, Dadashi A, Zakariaee SS, Saba V. Assessing the Image Quality and Eye Lens Dose Reduction Using Bismuth Shielding in Computed Tomography of Brain. J Kerman Univ Med Sci 2018;25:471-82.
[18] Wang J, Duan X, Christner JA, Leng S, Grant KL, McCollough CH. Bismuth Shielding, Organ-Based Tube Current Modulation, and Global Reduction of Tube Current for Dose Reduction to the Eye at Head CT. Radiology 2012;262:191-8.
[19] Saba V, Keshtkar M. Targeted Radiation Energy Modulation using Saba Shielding Reduces Breast Dose without Degrading Image Quality during Thoracic CT Examinations. Phys Med 2019;65:238-46.
[20] Prins R, Dauer LT, Colosi DC, Quinn B, Kleiman NJ, Bohle GC, et al. Significant Reduction in Dental Cone Beam Computed Tomography (CBCT) Eye Dose through the Use of Leaded Glasses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:502-7.
[21] Weiss J, Maurer M, Ketelsen D, Notohamiprodjo M, Zinsser D, Wichmann JL, et al. Effect of Reduced Z-Axis Scan Coverage on Diagnostic Performance and Radiation Dose of Neck Computed Tomography in Patients with Suspected Cervical Abscess. PLoS One 2017;12:e0180671.
[22] Suzuki S, Furui S, Ishitake T, Abe T, Machida H, Takei R, et al. Lens Exposure During Brain Scans using Multidetector Row CT Scanners: Methods for Estimation of Lens Dose. AJR Am J Neuroradiol 2010;31:822-6.
[23] Nikupaavo U, Kaasalainen T, Reijonen V, Ahonen SM, Kortesniemi M. Lens Dose in Routine Head CT: Comparison of Different Optimization Methods with Anthropomorphic Phantoms. AJR Am J Roentgenol 2015;204:117-23.
[24] Silva AC, Lawder HJ, Hara A, Kujak J, Pavlicek W. Innovations in CT Dose Reduction Strategy: Application of the Adaptive Statistical Iterative Reconstruction Algorithm. AJR Am J Roentgenol 2010;194:191-9.
[25] Hoang JK, Yoshizumi TT, Choudhury KR, Nguyen GB, Toncheva G, Gafton AR, et al. Organ-Based Dose Current Modulation and Thyroid Shields: Techniques of Radiation Dose Reduction for Neck CT. AJR Am J Roentgenol 2012;198:1132-8.
[26] Hopper KD, Neuman JD, King SH, Kunselman AR. Radioprotection to the Eye during CT Scanning. AJNR Am J Neuroradiol 2001;22:1194-8.
[27] ICRU. Determination of Dose Equivalents Resulting from External Radiation Sources, ICRU Report No. 39; 1985.
[28] Units IC on R. Quantities and Units in Radiation Protection Dosimetry. International Commission on Radiation; 1993.
[29] Gualdrini G, Mariotti F, Wach S, Bilski P, Denoziere M, Daures J, et al. A New Cylindrical Phantom for Eye Lens Dosimetry Development. Radiat Meas 2011;46:1231-4.
[30] Behrens R. Air Kerma to H p (3) Conversion Coefficients for a New Cylinder Phantom for Photon Reference Radiation Qualities. Radiat Prot Dosimetry 2012;151:450-5.
[31] Gaudreau K, Thome C, Weaver B, Boreham DR. Cataract Formation and Low-Dose Radiation Exposure from Head Computed Tomography (CT) Scans in Ontario, Canada, 1994-2015. Radiat Res 2020;193:322-30.
[32] Alkhorayef M, Sulieman A, Alonazi B, Alnaaimi M, Alduaij M, Bradley D. Estimation of Radiation-Induced Cataract and Cancer Risks during Routine CT Head Procedures. Radiat Phys Chem 2019;155:65-8.
[33] Thorne MC. Regulating Exposure of the Lens of the Eye to Ionising Radiations. J Radiol Prot 2012;32:147-54.
[34] Newman B, Callahan MJ. ALARA (as Low as Reasonably Achievable) CT 2011-Executive Summary. Pediatr Radiol 2011;41:453-5.
[35] Griffiths HJ. Radiation Protection for Medical and Allied Health Personnel. NCRP Report No. 105. Radiology 1990;176:702.
[36] Neriishi K, Nakashima E, Minamoto A, Fujiwara S, Akahoshi M, Mishima HK, et al. Postoperative Cataract Cases among Atomic Bomb Survivors: Radiation Dose Response and Threshold. Radiat Res 2007;168:404-8.
[37] Ainsbury EA, Bouffler SD, Dörr W, Graw J, Muirhead CR, Edwards AA, et al. Radiation Cataractogenesis: A Review of Recent Studies. Radiat Res 2009;172:1-9.
[38] Blakely EA, Kleiman NJ, Neriishi K, Chodick G, ChylackLT, Cucinotta FA, et al. Radiation Cataractogenesis: Epidemiology and Biology. Radiat Res 2010;173:709-17.
[39] Shore RE, Neriishi K, Nakashima E. Epidemiological Studies of Cataract Risk at Low to Moderate Radiation Doses: (Not) Seeing is Believing. Radiat Res 2010;174:889-94.
[40] Hsieh WA, Lin IF, Chang WP, Chen WL, Hsu YH, Chen MS. Lens Opacities in Young Individuals Long after Exposure to Protracted Low-Dose-Rate γ Radiation in 60Co-Contaminated Buildings in Taiwan. Radiat Res 2010;173:197-204.
[41] Dauer LT, Thornton RH, Solomon SB, Germain JS. Unprotected Operator Eye Lens Doses in Oncologic Interventional Radiology are Clinically Significant: Estimation from Patient Kerma-Area-Product Data. J Vasc Interv Radiol 2010;21:1859-61.
[42] Hall EJ, Brenner DJ, Worgul B, Smilenov L. Genetic Susceptibility to Radiation. Adv Space Res 2005;35:249-53.
[43] Kleiman NJ, David J, Elliston CD, Hopkins KM, Smilenov LB, Brenner DJ, et al. Mrad9 and atm Haploinsufficiency Enhance Spontaneous and X-RayInduced Cataractogenesis in Mice. Radiat Res 2007;168:567-73.
[44] Vafaei A, Khosravi N, Barjouei NS, Sendani NG, Sadeghi AO, Akhtari AS. Radiation Organ Dose Measurement and Cancer Risk Estimation in CT Examination on Trauma Patients. Middle East J Cancer 2019;10:206-13.
[45] Asgari A, Parach AA, Sharafi AA, Nazarparvar B, Parvizi S. Thyroid, Parathyroid and Eye Dose Evaluation in Head and Neck Computed Tomography Examinations, Phantom and Clinical Study. West Indian Med J 2016;65:538-42.
[46] Medicine AA of P. AAPM Position Statement on the use of Bismuth Shielding for the Purpose of dose Reduction in CT Scanning, AAPM Website; 2012.
[47] Mehnati P, Malekzadeh R, Divband B, Sooteh MY. Assessment of the Effect of Nano-Composite Shield on Radiation Risk Prevention to Breast during Computed Tomography. Iran J Radiol 2020;17:e96002.
[48] Mehnati P, Malekzadeh R, Sooteh MY. New Bismuth Composite Shield for Radiation Protection of Breast during Coronary CT Angiography. Iran J Radiol 2019;16:e84763.
[49] Malekzadeh R, Zali VS, Jahanbakhsh O, Okutan M, Mesbahi A. The Preparation and Characterization of Silicon-Based Composites Doped with BaSO4, WO3, and PbO Nanoparticles for Shielding Applications in PET and Nuclear Medicine Facilities. Nanomed J 2020;7:324-34.
[50] Taylor S, Litmanovich DE, Shahrzad M, Bankier AA, Gevenois PA, Tack D. Organ-Based Tube Current Modulation: Are Women’s Breasts Positioned in the Reduced-Dose Zone? Radiology 2015;274:260-6.
[51] Toossi MT, Zare H, Eslami Z, Roodi SB, Daneshdoust M, Saeed Z, et al. Assessment of Radiation dose to the Lens of the Eye and Thyroid of Patients Undergoing Head and Neck Computed Tomography at Five Hospitals in Mashhad, Iran. Iran J Med Phys 2018;15:226-30.
[52] Chan PN, Antonio GE, Griffith JF, Yu KW, Rainer TH, Ahuja AT. Computed Tomography for Cervical Spine Trauma. The Impact of MDCT on Fracture Detection and Dose Deposition. Emerg Radiol 2005;11:286-90.
[53] Abdeen N, Chakraborty S, Nguyen T, dos Santos MP, Donaldson M, Heddon G, et al. Comparison of Image Quality and Lens Dose in Helical and Sequentially Acquired Head CT. Clin Radiol 2010;65:868-73.
[54] Niu Y, Wang Z, Liu Y, Liu Z, Yao V. Radiation Dose to the Lens Using Different Temporal Bone CT Scanning Protocols. AJNR Am J Neuroradiol 2010;31:226-9.
[55] Korn A, Fenchel M, Bender B, Danz S, Hauser TK, Ketelsen D, et al. Iterative Reconstruction in Head CT: Image Quality of Routine and Low-Dose Protocols in Comparison with Standard Filtered Back-Projection. AJNR Am J Neuroradiol 2012;33:218-24.
[56] Hakim A, Pastore-Wapp M, Vulcu S, Dobrocky T, Z’Graggen WJ, Wagner F. Efficiency of Iterative Metal Artifact Reduction Algorithm (iMAR) Applied to Brain Volume Perfusion CT in the Follow-up of Patients after Coiling or Clipping of Ruptured Brain Aneurysms. Sci Rep 2019;9:1-10.