Daniel Fung Kevin Burns The effect of radiation protection eyewear frame style on operator lens dose Daniel Fung Kevin Burns

Disclosures Dr. Fung has no affiliation or financial interest which should be disclosed Dr. Burns has no affiliation or financial interest which should be disclosed

Background In 2011, ICRP changed the occupational limit from 150mSv to 20mSv for the lens of the eye1 Increased risk of cataracts in personnel working in the interventional suite2 Multiple studies have shown significant reduction of radiation lens dose while wearing leaded eyewear3,4 There are no current studies that compare the different types of radiation protection eyewear Recent changes in our understanding of safe lens dose Many articles saying the benefits of lead glasses, but no direct comparison!

Objective To determine which radiation protection eyewear frame is most effective at reducing operator lens dose

Materials & Methods 16 different radiation protection eyewear Fit-over glasses (FG) Wrap-around glasses (WG) Standard glasses (SG) Tested in two different operator positions, Neck and Groin, using: Fluoroscopy (78 kVP, 8 mA) DSA (95 kVp, 23 mA) Dose was recorded using DoseView (Philips Healthcare) Height from floor to top of skin - 108 cm Patient torso thickness - 17cm Detector patient skin surface - 3cm Patient skin center to IR eye - 72cm

Materials & Methods Model # Type Lens Width Lens Height Side Shield #1 RG-33 Fitover 62 40 Yes #2 RG-554 Normal 52 36 #3 RG-1205 Wrap-around 64 35 No #4 RG-208 #5 RG-EGM 50 30 #6 RG-320 34 #7 RG-70PC-S 48 42 #8 RG-70PC+S #9 RG-375 #10 RG-MX30 53 32 #11 RG-533 65 #12 RG-206 33 #13 RG-703 59 #14 Rayshield SportsWrap #15 Nike Brazen 60 #16 WileyX P17 38 We were blinded during the study and tested them randomly as to limit bias Missing Rayshield SportsWrap lens width and lens height as the manufacturer has not provided the information

Materials & Methods Left: Brazen Right: RG-1205

Left: RG-208 Right: RG-206

Left:??? RG-375 Right: RG-703

Left: Neck Access Right: Groin Access

Results - Groin Access Model # Type 2min Fluoro mSv/h 1min DSA mSv/h 95%CI 0.07-0.09 No Eyewear Control 0.0747 0.5838 Ray Ban Sunglasses 0.0603 0.6342 RG-33 Fitover UD 0.063 RG-70PC-S Normal 0.0624 RG-70PC+S 0.0654 RG-206 0.1062 RG-320 0.0876 RG-375 0.0888 RG-554 0.0678 RG-208 Wrap-around 0.0798 RG-533 RG-703 0.0612 RG-1205 0.072 RG-EGM 0.1038 RG-MX30 0.0618 Nike Brazen WileyX P17 0.0744 Rayshield SportsWrap 0.1002 BLUE = statistically significant as it was above the CI RED = statistically significant as it was below the CI

Results - Neck Access Model # Type 2min Fluoro mSv/h 1min DSA mSv/h 95% CI 0.17 to 0.21 No Eyewear Control 0.1314 1.707 Ray Ban Sunglasses 0.1305 1.713 RG-33 Fitover UD 0.2448 RG-70PC-S Normal 0.1566 RG-70PC+S 0.1788 RG-206 0.2340 RG-320 0.2262 RG-375 0.1986 RG-554 0.1758 RG-208 Wrap-around 0.1752 RG-533 0.1836 RG-703 0.1404 RG-1205 0.1782 RG-EGM 0.2646 RG-MX30 0.1668 Nike Brazen 0.1368 WileyX P17 0.1458 Rayshield SportsWrap 0.183 BLUE = statistically significant as it was above the CI RED = statistically significant as it was below the CI

Results Lead eyewear resulted in a 7 to 9 fold decrease in radiation dose vs. control All lead glasses resulted in undetectable levels (<1µSv) during fluoroscopy Frame Type FG were lowest at groin: 0.063 mSv/h WG were lowest at neck: 0.175 mSv/h Individual Frames RG-708 (WG) was lowest at groin (0.0612 mSv/h) Nike Brazen (WG) was lowest at neck (0.1368 mSv/h) Only 1 pair of fit-over glasses tested, as the sample size is small. The most effective pair of glasses were a pair of WG. The larger lenses had the best radiation dose and the smaller lens had the worse radiation dose. This may also be due to the size of the DoseAware sensor.

Conclusions Radiation protection eyewear is very important for the reduction of lens dose Overall, wrap-around frames were found to be most effective at reducing radiation lens dose Larger lens sizes led to better radiation reduction Side shields had minimal effect on radiation dose based on one pair with detachable side shields

References International Commission on Radiological Protection (ICRP). Statement on tissue reactions. 2011. Radiation-associated Lens Opacities in Catheterization Personnel: Results of a Survey and Direct Assessments. Vano, Eliseo et al. Journal of Vascular and Interventional Radiology , Volume 24 , Issue 2 , 197 - 204 Comparing strategies for operator eye protection in the interventional radiology suite. RH Thornton, LT Dauer, et al. J Vasc Interv Radiol. 2010 Nov; 21(11): 1703–1707. Burns S, Thornton R, et al. Leaded Eyeglasses Substantially Reduce Radiation Exposure of the Surgeon's Eyes During Acquisition of Typical Fluoroscopic Views of the Hip and Pelvis. J Bone Joint Surg Am. 2013;95(14):1307–11. Jul 17.

Acknowledgements Bill Brown from Phillips Safety for lending us the radiation glasses Carol Cohen from CIRS for lending us the head phantom

Questions?