The ORAMED project (Optimization of Radiation Protection of Medical Staff) was launched in 2008 within the European Atomic Energy Community’s Seventh Framework Programme (FP7/2007–2011) under grant agreement no 211361. The goals of the project focussed on improving knowledge on extremity and eye lens exposures in medicine, combined with an optimization of the use of active personal dosemeters.
The state-of-the-art analysis identified the medical applications where radiation protection of staff required further investigation. The fact that extremity doses can surpass operational limits in nuclear medicine was highlighted by the analysis. It was also shown that the doses reported in the literature vary greatly depending on radiation protection measures and the working methods of the personnel. As a consequence of the definition that the dose limit for the skin should be applied to “the dose averaged over 1 cm² area of skin regardless of the area exposed”, extremity monitoring should measure local skin dose at the location with, presumably, the highest exposure. This requirement is a difficult issue in extremity dosimetry and causes severe practical problems. Furthermore, the dose estimates obtained in research studies are much higher than the reported values in national dose registries, indicating that the present dose assessment is clearly underestimating the real radiological risk of nuclear medicine staff.
Moreover, in interventional radiology and cardiology workplaces, extremity doses can also be high and even exceed the occupational limits. Routine monitoring of extremities is also difficult, since “the most exposed area” according to ICRP recommendations cannot be found easily a priori. Only finger or wrist doses are reported, while doses to the eye lens and feet are lacking and these can be even higher if proper radiation protection measures are not in place. Physician’s working methods and radiation protection means are factors of crucial importance.
An increased prevalence of radiation-related lens opacities in interventional radiologists has been reported in recent years. However, eye lens doses are never measured or calculated in routine dosimetry and there is a lack of data available in the literature. One reason for this is that, up to now, there has been no practical dosemeter available for eye lens dosimetry. Furthermore, procedures to measure eye lens doses in terms of Hp(3) (i.e. stating a proper phantom for conversion coefficient evaluation and calibration procedure) were not available. The fact that recently ICRP has recommended reducing the eye lens dose limit from 150 mSv down to 20 mSv per year, with no single year exceeding 50 mSv, will increase the importance of eye lens dosimetry.
Active personal dosemeters (APD) have been found to be very efficient tools to reduce occupational doses in many applications of ionizing radiation. Interventional radiology operators belong to a specific worker category who can benefit from a real-time, accurate assessment of their dose. Unfortunately, the current technology of APDs does not suit all the specificities of the X-ray fields encountered in interventional radiology characterized by low energy photons [20–100 keV] and pulsed radiation with high instantaneous dose rates.
ORAMED focused on the development of methodologies for better assessing and reducing exposures to medical staff. The project was carried out from January 2008 up to February 2011. Its general objective was achieved through the development of five main topics, structured in five work packages.
WP1: Extremity dosimetry and eye lens dosimetry in interventional radiology and cardiology
WP2: Development of practical eye lens dosimetry
WP3: Optimization of the use of active personal dosemeters in interventional radiology and cardiology
WP4: Extremity dosimetry in nuclear medicine
WP5: Training and dissemination.
The ORAMED project has produced an extensive database of measurements of extremity doses in interventional radiology/cardiology and in nuclear medicine. Moreover, an analytic series of simulations were performed in order to determine the main parameters that influence the extremity and eye lens doses. The size of the databases and the quantity of measurements and simulations are unique, and these data can be used for many years to come as a reference. Analysis of this enormous amount of data has been very comprehensive, and has drawn clear and important conclusions on the different factors of influence. The determination of the ratio of the dose at the maximum exposed area to the monitoring position on the hands in nuclear medicine allows practical application of routine extremity monitoring. At the same time, Monte Carlo computational studies of a large variety of operational scenarios allowed to better analyze and classify the procedures from the radiation dose assessment point of view. The attention paid to the practical aspects of active dosimetry has improved radiation protection for medical staff and will also guide manufacturers to improve the current status. In addition, the eye lens dosimetry in interventional radiology and cardiology will be very important in the coming years, now that the eye lens dose limit is to be lowered. The database contains measured eye lens doses for different procedures and situations and it is now possible to measure Hp(3) with a specially designed eye lens dosemeter, a specific Hp(3) phantom and specific calibration procedures. The ORAMED consortium is convinced that the work done will effectively increase awareness on radiation protection aspects for medical staff, will improve the monitoring of these occupational doses and, through the practical guidelines, will also reduce the operational exposure of medical staff.
The ORAMED project was concluded with an especially dedicated workshop, The International Workshop on Optimization of Radiation Protection of Medical Staff, ORAMED 2011, organized in Barcelona from 20 to 22 January 2011. This special issue of Radiation Measurements constitutes the proceedings of the Workshop. Together with the ORAMED consortium, the workshop had the collaboration of the Directorate General of R & D of the European Commission (EC DG-RCD), the International Atomic Energy Agency (IAEA), the European Radiation Dosimetry Group (EURADOS), the Spanish Nuclear Safety Council (CSN), the Spanish Radiation Protection Society (SEPR) and the Universitat Politècnica de Catalunya (UPC). The workshop was sponsored by EC DG-RCD, Generalitat de Catalunya, UPC and the instrument companies, Mirion Technologies, Philips and Rad Pro, who presented their latest developments in the field.
The workshop was attended by about 150 professionals from more than 30 countries. Medical personnel in the fields of interventional radiology, interventional cardiology and nuclear medicine, as well as radiation protection officers, dosimetry specialists, medical physicists and regulators participated actively in the event. The workshop focused on the dissemination of the ORAMED project results. A range of invited speakers from professional societies and international bodies involved in the field of radiation protection were present. Specific training sessions and a round table discussion were also held. The submitted scientific contributions were distributed in oral and poster presentations. Authors of oral presentations were invited to submit a paper for this special issue. Most of the submitted papers were accepted for publication after a double peer-review. The final document includes 30 papers, 16 directly derived from the ORAMED project. We are very grateful to the panel of reviewers who contributed to the quality of the papers by providing useful recommendations and suggesting improvements to the authors’ manuscripts. We are also thankful to the members of the Elsevier team for their helpful assistance in the preparation of this publication.
The present proceedings confirm that the workshop was an important scientific event in the field of radiation protection of medical staff and all the latest developments were presented.
During and after the ORAMED project a great deal of effort has been devoted to the dissemination of the project results. Together with the publication of this volume, a major tool for dissemination is the ORAMED website: www.oramed-fp7.eu. This website will remain active for many years after the project has ended. A lot of information, such as the deliverables, the guidelines, the training material and the presentations of the ORAMED workshop, are freely available at this website.