Contents lists available at ScienceDirect Physica Medica journal homepage: www.elsevier.com/locate/ejmp Original paper Surgeon eye lens dose monitoring in catheterization lab: A multi-center survey Invited for ECMP 2018 Focus Issue Margherita Betti a , Lorenzo Nicola Mazzoni a, ⁎ , Giacomo Belli b , Luca Bernardi a , Sara Bicchi a , Simone Busoni b , David Fedele a , Luca Fedeli c , Chiara Gasperi d , Cesare Gori c,e , Mariagrazia Quattrocchi f , Adriana Taddeucci b , Mirko Vigliotti g , Angela Vaiano a , Francesco Rossi b a Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy b Azienda Ospedaliero-Universitaria Careggi, Medical Physics Unit, Firenze, Italy c Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Sesto Fiorentino, Firenze, Italy d Azienda Usl Toscana Sud-Est, Medical Physics Unit, Arezzo, Italy e INFN, Sezione di Firenze, Sesto Fiorentino, Italy f Azienda Usl Toscana Nord-Ovest, Medical Physics Unit, Lucca, Italy g Azienza USL Toscana Centro, Cardiology Unit, Pistoia, Italy ARTICLE INFO Keywords: Surgeon eye lens dosimetry Radiation protection during catheterization procedures ISO accredited dosimetry service ABSTRACT Purpose: To perform a multi-centre survey on the eye lens equivalent dose absorbed by primary interventionalist during catheterization procedures, using a personal dosimeter placed close to the eye lens. Methods: 15 different cardiologists working in 3 different centers, for a total of 5 operating rooms were enrolled. All of them were provided with a single thermoluminescent dosimeter positioned on the inner side of the temples of eyeglasses. The dose monitoring, performed on a two-months basis, started in 2016 and is still running. All dose measurements were performed by a ISO 17025 standard accredited dosimetry service thus providing certified uncertainties as well. Correlation of eye lens and wrist dose with KAP was also investigated. Results: A total number of 101 eye lens measurements were performed. Annual eye lens dose estimation was obtained for all 15 surgeons (mean, mode, range, standard deviation: 10.8, 8, 4.9–27.3, 5.6 mSv, respectively). Uncertainties on annual eye lens dose estimations ranged between 10% and 20%. No significant correlation was found between eye lens dose and KAP. Conclusions: Cardiologists involved in catheterization procedures may receive annual eye lens doses close to the ICRP 118 dose limit and thus individual monitoring with a dedicated dosimeter should be carried out. Uncertainty assessment play a relevant role in eye lens equivalent dose estimation to ensure not to exceed dose limit. 1. Introduction Interventional procedures involve high radiation doses [1]. Moreover, recent studies showed a significant increase in lens opacities associated with radiation exposure in interventional cardiol- ogists compared to what expected [2–4]. For professional exposure, the Euratom Directive 59/2013 reduced the equivalent dose limit for the eye lens up to a factor of 7.5 compared to the previous Directive. It is noteworthy that the dose difference be- tween non exposed and exposed workers may be reduced to only 5 mSv, introducing a severe issue regarding the accuracy of lens equivalent dose estimations [5]. To date there are no unique indications regarding the use of pro- tection devices and dose measurement strategies for the lens, while the IEC 62387 standard defined the methods of measurement, which must be carried out in terms of H p (3) [6,7]. To evaluate lens dose it is possible to use direct or indirect methods. The first involves the use of passive dosimeters, placed close to the eye, both in vivo or using anthropomorphic phantom [2,8]. The seconds are based on numerical equivalent dose estimations, derived from body or https://doi.org/10.1016/j.ejmp.2019.03.027 Received 3 December 2018; Received in revised form 27 March 2019; Accepted 27 March 2019 ⁎ Corresponding author at: Azienda USL Toscana Centro, Medical Physics Unit Pistoia Prato, Ospedale San Jacopo, Via Ciliegiole, 98, 51100 Pistoia (PT), Italy. E-mail address: mazzoniln@gmail.com (L.N. Mazzoni). Physica Medica 60 (2019) 127–131 Available online 04 April 2019 1120-1797/ © 2019 Published by Elsevier Ltd on behalf of Associazione Italiana di Fisica Medica. T