Occupational Exposure Clinical Trial
Official title:
Radiation Exposure Affecting Anaesthesia Personnel During Endoscopic Retrograde Cholangiopancreatography
Radiation now becomes a dreadful effect as its outcomes are tremendous to be expected. As a
result, anesthetists become an inevitable target to the radiation exposure since they have
to monitor patients closely during the operation. Unfortunately, radiation may not have an
immediate sequelae, but an accumulation of adverse effects.
These sequelae happen by means of direct exposure and reflection. The reflected rays is
inversely proportional to the distance between the origin and the target. Practically, the
radiation source can be protected by individual cover and glass shield.
Siriraj hospital is a tertiary, general university hospital with 2,200 beds. Annually, an
Endoscopy centre has over 700 patients undergoing endoscopic retrograde cholangio
pancreaticography (ERCP). Normally, fluoroscopy for pancreatic and biliary ducts
visualisation is needed under anesthesia. Though the procedure is operated in a
well-equipped, radiating-protection room; many medical personnel including 1-2 endoscopists,
2 scrub nurses, 1-2 anesthetists and 1 x-ray man, still have a chance of irradiation.
During ERCP, all medical personnel particularly anesthetists are rinsed by radiation from
here and there. Though they always wear lead aprons and collar shields to protect themselves
from the rays, they are normally in the position - less than 1 meter - close to the
fluoroscopy.
Due to the advancement in technology, anesthetists can remotely monitor patients during the
surgical procedure. This might cause a lesser effect of ray upon them. As a result, whether
or not the positioning of anesthesia personnel relating to the distance of x-ray source
would help to alleviate the effect of radiation exposure.
This study has been approved by Siriraj IRB. Inclusion criteria were the patient who
underwent ERCP procedure. Exclusion criteria were none. The project was terminated when 19
August 2016 A total of 222 cases was included without the need of informed consent.
At the Endoscopic unit A nurse anesthetist performed venous cannulation on the right forearm
and transfused with 5% dextrose in half-strength normal saline. Then the patient was
transferred to the ERCP theatre.
The patient was monitored with non-invasive blood pressure (NIBP), percutaneous arterial
oxygen saturation (SpO2), and electrocardiogram (EKG) and administered with oxygen 3LPM via
nasal cannula.
A co-researcher reset and prepared 4 pocket dosimeters (PDS) and labelled as PDSa1, PDSa2,
PDSb1 and PDSb2.
The PDSa1 and PDSa2 were placed on the outside and inside of a lead shirt respectively. The
shirt-covered box was close to an anesthetic machine. This box would represent anesthetic
personnel on duty and marked as position A.
The PDSb1 and PDSb2 were placed on the outside and inside of the glass shield of control
room respectively. This glass shield would represent all personnel working in the operating
theatre and marked as position B.
Both position A and B were 160 cm. above the floor. After an anesthesiologist administered a
narcotic and an induction agent to a patient (total intravenous anaesthesia, TIVA), an
endoscopist commenced the procedure. A co-researcher turned on all PDS devices as soon as
the surgeon started a fluoroscopy, and turned it off whenever the use of radiative source
was over. When the study was completed, the PDA devices was kept in a solid and dry place.
The lead apron was hanged in the specific area and covered by a bag.
The devices
A lead apron was 0.5 mm. and 0.25 mm. in thickness on the front and back (BT medical)
respectively. A thyroid shield was 0.5 mm. in thickness. A paper box was 30x1510 cm. in
dimension. A radiative dosimeter (Ludlum model 25-IS &25-IS-1 Personal Radiation Monitor,
501 Oak street, Sweetwater, Texas, USA) had characteristic details as follow:
Ludlum model 25-IS & Model 25-IS-1 Radiation detected Gamma (X ray) typically < 18 count per
minute per milliroentgen/hr.
Beta response typically < 0.10 milliroentgen/hr Display range For 25-IS: 0.01
milliroentgen/hr to 10 sievert/hr For 25-IS-1: 0.01 millisievert/hr to 10 sievert/hr Size.
7.6 x5.4x1.7 cm (H x W x thickness) Weight. 158.6 g. Including batteries Linearity. Reading
within 10% of true value within calibration range
Analysis of data Data were expressed as mean and standard deviation and analysed by using
SPSS version 18.0. Categorical data were compared by using Chi-square test; while, the
recorded data using dependent t-test. A p < 0.05 was considered statistically significant
difference at 95% confidence interval.
;
Allocation: Non-Randomized, Endpoint Classification: Safety Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
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