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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR
DOI: 10.1055/s-0043-1775854
Original Article

Effects of Ionizing Radiation Exposure on Cataract among Radiation Workers of Interventional Cardiology in Indonesia

Wida Setiawati
1   Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
,
Syska Widyawati 
1   Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
,
Benny Zulkarnaien 
2   Department of Radiology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
,
Siska Suridanda Danny
3   Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia
,
Gitalisa Andayani
1   Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
,
Joedo Prihartono
4   Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Abstract

Purpose The aim of this study was to determine the prevalence of radiation-induced cataracts and its correlation with radiation exposure dose and radiation protection equipment use among radiation workers of interventional cardiology.

Methods This is a cross-sectional and retrospective case–control study. We included 180 subjects. The prevalence of radiation-induced cataracts was assessed using Scheimpflug analysis on the Pentacam-Oculus device. Individual cumulative radiation exposure dose and radiation protection equipment use were identified from questionnaires and personal dosimeters.

Results The prevalence of radiation-induced cataracts was 16.7%. The median cumulative radiation dose was 0.8 (0.1–35.6) Gy. A positive correlation was found between cumulative radiation dose and lens density (R Spearman = 0.64). We found 83.9% of subjects used ceiling-suspended shields in 71 to 100% of their working period. However, most subjects (40.6%) did not wear protective eyewear. There was a statistically significant increasing risk of radiation-induced cataracts and unresponsive use of radiation protection equipment. Subjects using ceiling-suspended shield in only 31 to 50% of their working period increased their cataract risk by 10.8 times (95% confidence interval [CI]: 1.05–111.49, p = 0.044). Meanwhile, subjects using protective eyewear in only 51 to 70% of their working period increased their cataract risk by 8.64 times (p = 0.001). Subjects who did not wear protective eyewear had an odd ratio of 164.3 (95% CI: 19.81–1363) compared to those who did.

Conclusion Radiation-induced cataracts among radiation workers of interventional cardiology depended on the radiation exposure dose and the use of radiation protection equipment.

Keywords

radiation workers - interventional cardiology - radiation-induced cataract

Ethical statement

All procedures performed in this study were following the ethical standards of the research committee of the Faculty of Medicine, Universitas Indonesia (No: 1167/UN2.F1/ ETIK/2018) and the National Cardiac Center Harapan Kita Hospital (No: LB.02.01/VII/312/KEP.002/2019).




Publication History

Article published online:
07 November 2023

© 2023. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 American Academy of Ophthalmology. Pathology. In: Lens and Cataract Basic and Clinical Science Course. California: American Academy of Ophthalmology; 2014: 39-93
    Google Scholar
  • 2 Khan DZ, Lacasse MC, Khan R, Murphy KJ. Radiation cataractogenesis: the progression of our understanding and its clinical consequences. J Vasc Interv Radiol 2017; 28 (03) 412-419
    CrossrefPubMedGoogle Scholar
  • 3 Jacob S, Boveda S, Bar O. et al. Interventional cardiologists and risk of radiation-induced cataract: results of a French multicenter observational study. Int J Cardiol 2013; 167 (05) 1843-1847
    CrossrefPubMedGoogle Scholar
  • 4 Ciraj-Bjelac O, Rehani MM, Sim KH, Liew HB, Vano E, Kleiman NJ. Risk for radiation-induced cataract for staff in interventional cardiology: is there reason for concern?. Catheter Cardiovasc Interv 2010; 76 (06) 826-834
    CrossrefPubMedGoogle Scholar
  • 5 Statement on tissue reactions [Internet]. Ottawa: International Commission on Radiological Protection; 2011. Available at: https://www.nrc.gov/docs/ML1326/ML13269A317.pdf
    PubMed
  • 6 Vano E, Kleiman NJ, Duran A, Romano-Miller M, Rehani MM. Radiation-associated lens opacities in catheterization personnel: results of a survey and direct assessments. J Vasc Interv Radiol 2013; 24 (02) 197-204
    CrossrefPubMedGoogle Scholar
  • 7 Radiation protection and safety of radiation sources: international basic safety standards [Internet]. Vienna: International Atomic Energy Agency; 2014. Available at: https://www-pub.iaea.org/MTCD/Publications/PDF/Pub1578_web-57265295.pdf 2011
    PubMed
  • 8 Keselamatan radiasi pada penggunaan pesawat sinar-X dalam radiologi diagnostik dan intervensional. Jakarta: Badan Pengawas Tenaga Nuklir Republik Indonesia; 2020. Report No.: Peraturan Badan Pengawas Tenaga Nuklir Republik Indonesia Nomor 4 Tahun 2020
    PubMed
  • 9 Radiation dose management for fluoroscopically-guided interventional medical procedures. Report No.: 168. [Internet]. Maryland: National Council on Radiation Protection and Measurements; 2010. Available at: https://ncrponline.org/shop/reports/report-no-168-radiation-dose-management-for-fluoroscopically-guided-interventional-medical-procedures/
    PubMed
  • 10 Antic V, Ciraj-Bjelac O, Rehani M, Aleksandric S, Arandjic D, Ostojic M. Eye lens dosimetry in interventional cardiology: results of staff dose measurements and link to patient dose levels. Radiation protection dosimetry 2013; 154 (03) 276-284
    CrossrefPubMedGoogle Scholar
  • 11 International Atomic Energy Agency. Recommendations of the Working Group on Interventional Cardiology on Occupational Doses to the Lens of the Eye in Interventional Cardiology: The Information System on Occupational Exposure in Medicine, Industry and Research (ISEMIR). In: International Atomic Energy Agency;. 2014 . Accessed September 6, 2023 at: http://www-ns.iaea.org/standards/
    PubMedGoogle Scholar
  • 12 Oculus Pentacam Interpretation Guide.;. 2013 . Accessed September 6, 2023 at: www.oculus.de
    PubMedGoogle Scholar
  • 13 Rosales P, Marcos S. Pentacam Scheimpflug quantitative imaging of the crystalline lens and intraocular lens. J Refract Surg 2009; 25 (05) 421-428
    CrossrefPubMedGoogle Scholar
  • 14 Rencana strategi nasional penanggulangan gangguan penglihatan dan kebutaan (PGPK) untuk mencapai vision 2020 [Internet]. Jakarta: Departemen Kesehatan RI dan PERDAMI; 2003. Available from: http://perpustakaan.kemkes.go.id/inlislite3/opac/detail-opac?id=2644 2005
    PubMed
  • 15 Tan AG, Kifley A, Tham YC. et al. Six-year incidence of and risk factors for cataract surgery in a multi-ethnic Asian population: the Singapore Epidemiology of Eye Diseases Study. Ophthalmology 2018; 125 (12) 1844-1853
    CrossrefPubMedGoogle Scholar
  • 16 Vano E, Kleiman NJ, Duran A, Rehani MM, Echeverri D, Cabrera M. Radiation cataract risk in interventional cardiology personnel. Radiat Res 2010; 174 (04) 490-495
    CrossrefPubMedGoogle Scholar
  • 17 Elmaraezy A, Ebraheem Morra M, Tarek Mohammed A. et al. Risk of cataract among interventional cardiologists and catheterization lab staff: a systematic review and meta-analysis. Catheter Cardiovasc Interv 2017; 90 (01) 1-9
    CrossrefPubMedGoogle Scholar
  • 18 Thome C, Chambers DB, Hooker AM, Thompson JW, Boreham DR. Deterministic effects to the lens of the eye following ionizing radiation exposure: is there evidence to support a reduction in threshold dose?. Health Phys 2018; 114 (03) 328-343
    CrossrefPubMedGoogle Scholar
  • 19 Zett-Lobos C, Vera-Muñoz F, Arriola-Alvarez K. et al. [¿Es Suficiente La Protección Otorgada Por Gafas Plomadas En Cardiología Intervencionista?]. Protection against ionizing radiation by leaded glass googles during interventional cardiology. 2013;141 PubMed
    PubMedGoogle Scholar
  • 20 Fetterly KA, Mathew V, Lennon R, Bell MR, Holmes DR, Rihal CS. Radiation dose reduction in the invasive cardiovascular laboratory: implementing a culture and philosophy of radiation safety. JACC: Cardiovascular Interventions 2012; 5 (08) 866-873
    PubMedGoogle Scholar