• Obesity, metabolic factors and risk of different histological types of lung cancer: A Mendelian randomization study.

      Carreras-Torres, Robert; Johansson, Mattias; Haycock, Philip C; Wade, Kaitlin H; Relton, Caroline L; Martin, Richard M; Davey Smith, George; Albanes, Demetrius; Aldrich, Melinda C; Andrew, Angeline; et al. (2017)
      Assessing the relationship between lung cancer and metabolic conditions is challenging because of the confounding effect of tobacco. Mendelian randomization (MR), or the use of genetic instrumental variables to assess causality, may help to identify the metabolic drivers of lung cancer.
    • Occupational cancers - Epidemiology and certification.

      Wiszniewska, Marta; Lipińska-Ojrzanowska, Agnieszka; Witkowska, Anna; Tymoszuk, Diana; Kleniewska, Aneta; Kluszczyński, Dariusz; Walusiak-Skorupa, Jolanta; Nofer Institute of Occupational Medicine, Lodz, Poland (2017-12-05)
      The etiology of cancer is multifactorial. Malignant tumors caused by factors occurring in the work environment, classified as carcinogenic in humans, can be recognized as an occupational disease. Analysis of epidemiological data indicates a significant underestimation of occupational cancer, mainly due to long latency period of these diseases. This publication provides guidance to certify occupational etiology of malignant tumors, based on the reviews of existing legislation and medical literature, as well as on the experience of their authors. The publication presents the epidemiology of cancers, including occupational cancers, risk factors, occupational carcinogens and presents the principles of occupational cancer certification. Med Pr 2018;69(1):93-108.
    • Occupational diseases among farmers in Poland

      Szeszenia-Dabrowska, Neonila; Swiatkowska, Beata; Wilczynska, Urszula; Nofer Institute of Occupational Medicine, Lodz, Poland (2016)
      Background: The study’s objective is to present epidemiological situation concerning the incidence of occupational diseases among farmers in Poland. Material and Methods: All 3438 cases of occupational diseases diagnosed among farmers and obligatorily reported to the Central Register of Occupational Diseases (covering all the national territory and all the cases of occupational diseases diagnosed in Poland after 1970) over the years 2000–2014 were subjected to analysis. Results: The annual incidence in the analyzed period ranged 5–14 per 100 000 farmers. The analysis showed that about 90% of pathologies were induced by the biological agents. Almost every third pathology due to biological agents had allergic origin. Infectious and parasitic diseases accounted for 62% of the cases. Among them the diseases carried by ticks (93%) – borreliosis (85.8%) and tick-borne encephalitis (7.2%) were the most frequent ones. The age of farmers, in the case of whom bronchial asthma and allergic rhinitis were diagnosed, was significantly higher than the age of remaining employees of the national economy, in which these occupational diseases were recognized. Conclusions: The study indicates the necessity to introduce periodic health examinations programs focusing on agricultural workers to monitor health and well-being and improve working conditions and the working environment.
    • [Occupational diseases among healthcare and social workers in 2009-2016].

      Świątkowska, Beata; Hanke, Wojciech; Nofer Institute of Occupational Medicine (2018-10-30)
      The aim of the paper is to present statistical data on the occurrence of occupational diseases among healthcare and social workers in Poland in 2009-2016. All cards certifying that a case of occupational disease had been diagnosed in a patient belonging to this occupational group, received by the Central Register of Occupational Diseases, served as the basis of the study. Data is presented in absolute numbers and incidence rates. In the analysis, disease categories, voivodships and occupations were taken into account. In 2009-2016, as many as 1462 cases of occupational diseases were diagnosed for healthcare workers. In 2016, the number of cases was 42.6% lower than in 2009. Mean annual incidence rate in these years was 26.3 cases per 100 thousand workers. The most frequent were: infectious and parasitic diseases (64.8% of cases), peripheral nervous system diseases (9.6%), dermal diseases (8.9%), locomotor (8.3%), and chronic vocal organ disorders (3.2%). Among infectious or parasitic diseases, the most cases were viral hepatitis (56%) and tuberculosis (39%). Almost every second case of occupational disease in healthcare workers was detected in the nurses (47.8%). The incidence of occupational diseases in total and in the most frequent categories continued to decrease. One of the reasons for the decline is the improvement of working conditions resulting from the application of more modern instruments and apparatus as well as greater knowledge of the risks and the use of appropriate procedures. Med Pr 2018;69(5).
    • [Occupational diseases in Poland in 2016].

      Świątkowska, Beata; Hanke, Wojciech; Nofer Institute of Occupational Medicine (2018-12-18)
      The aim of the work is to present the epidemiological situation in the field of occupational diseases in Poland in 2016. The cases of occupational diseases identified in accordance with the applicable case law system in Poland and reported to the Central Register of Occupational Diseases in 2016 were analyzed. The analysis includes nosologic units, their causative factors as well as gender and age of patients. Absolute numbers and incidence rates per 100 000 employees were presented. In 2016, 2119 cases of occupational diseases were recorded in Poland, i.e. 14.3 cases per 100 000 employed persons. The incidence rate was mainly caused by pneumoconioses (28.5%), infectious or parasitic diseases (27.2%), chronic voice disorders (9.7%), chronic diseases of the peripheral nervous system (8.6%) and hearing loss (6.3%). The highest incidence was recorded in the mining and quarrying (329.7 cases), agriculture and forestry (23.8 cases), manufacturing (20 cases) and education (17.9 cases) and healthcare and social work activities (17.7 cases). In comparison with 2015, there was an increase in the number of cases of occupational diseases by 1.2%, which was influenced mainly by a larger (by 181 cases) number of pneumoconiosis. The epidemiological situation resulting from occupational diseases in our country, although it covers all identified cases, should be assessed with caution because the suspicion arises underestimation of certain diseases, especially cancer. Med Pr 2018;69(6):643-650.
    • [Occupational exposure to biological agents intentionally used in Polish enterprises].

      Kozajda, Anna; Szadkowska-Stanczyk, Irena; Nofer Institute of Occupational Medicine, Lodz, Poland (2015)
      The paper presents the intentional use of biological agents for industrial, diagnostic and research purposes in Polish enterprises.
    • Occupational exposure to chromium(VI) compounds

      Skowron, Jolanta; Konieczko, Katarzyna; Central Institute for Labour Protection – National Research Institute, Warszawa, Poland; Nofer Institute of Occupational Medicine, Łódź, Poland (2015)
      This article discusses the effect of chromium(VI) (Cr(VI)) on human health under conditions of acute and chronic exposure in the workplace. Chromium(VI) compounds as carcinogens and/or mutagens pose a direct danger to people exposed to them. If carcinogens cannot be eliminated from the work and living environments, their exposure should be reduced to a minimum. In the European Union the proposed binding occupational exposure limit value (BOELV) for chromium(VI) of 0.025 mg/m³ is still associated with high cancer risk. Based on the Scientific Commitee of Occupational Exposure Limits (SCOEL) document chromium(VI) concentrations at 0.025 mg/m³ increases the risk of lung cancer in 2–14 cases per 1000 exposed workers. Exposure to chromium(VI) compounds expressed in Cr(VI) of 0.01 mg Cr(VI)/m3 is responsible for the increased number of lung cancer cases in 1–6 per 1000 people employed in this condition for the whole period of professional activity.
    • Occupational exposure to diisocyanates in polyurethane foam factory workers

      Swierczynska-Machura, Dominika; Brzeznicki, Slawomir; Nowakowska-Swirta, Ewa; Walusiak-Skorupa, Jolanta; Wittczak, Tomasz; Dudek, Wojciech; Bonczarowska, Marzena; Wesolowski, Wiktor; Czerczak, Slawomir; Palczynski, Cezary; et al. (2015)
      Objectives: The aim of the study was to evaluate health effects of occupational exposure to diisocyanates (DIC) among polyurethane foam products factory workers. Material and Methods: Thirty workers had a physical examination, skin prick tests with common allergens, allergen-specific immunoglobulin E (IgE) antibodies to diisocyanates and pulmonary function tests. Concentrations of selected isocyanates in the workplace air samples as well as concentration of their metabolites in the urine samples collected from the workers of the plant were determined. Results: The most frequent work-related symptoms reported by the examined subjects were rhinitis and skin symptoms. Sensitization to at least 1 common allergen was noted in 26.7% of the subjects. Spirometry changes of bronchial obstruction of a mild degree was observed in 5 workers. The specific IgE antibodies to toluene diisocyanate (TDI) and 4,4’-methylenebis(phenyl isocyanate) (MDI) were not detected in any of the patients’ serum. Cellular profiles of the collected induced sputum (ISP) did not reveal any abnormalities. Air concentrations of TDI isomers ranged 0.2–58.9 μg/m3 and in 7 cases they exceeded the Combined Exposure Index (CEI) value for those compounds. Concentrations of TDI metabolites in post-shift urine samples were significantly higher than in the case of pre-shift urine samples and in 6 cases they exceeded the British Biological Monitoring Guidance Value (BMGV – 1 μmol amine/mol creatinine). We didn’t find a correlation between urinary concentrations of TDI, concentrations in the air and concentrations of toluenediamine (TDA) in the post shift urine samples. Lack of such a correlation may be an effect of the respiratory protective equipment use. Conclusions: Determination of specific IgE in serum is not sensitive enough to serve as a biomarker. Estimation of concentrations of diisocyanate metabolites in urine samples and the presence of work-related allergic symptoms seem to be an adequate method for occupational exposure monitoring of DIC, which may help to determine workers at risk as well as to recognize hazardous workplaces.
    • Occupational exposure to ionizing radiation and lens opacity in interventional cardiologists.

      Domienik-Andrzejewska, Joanna; Kałużny, Paweł; Piernik, Gabriela; Jurewicz, Joanna; Nofer Institute of Occupational Medicine (2019-10-16)
      Objectives: Interventional cardiologists (ICs) are occupationally exposed to low or moderate doses of ionizing radiation from repeated exposures. It is not clear whether these occupational conditions may affect their eye lens. Therefore, the risk of radiation-induced cataract in the cohort of Polish interventional cardiologists is analyzed in this paper. Material and Methods: The study group consisted of 69 interventional cardiologists and 78 control individuals occupationally unexposed to ionizing radiation. The eye lens opacities were examined using a slit camera and evaluated with Lens Opacities Grading System III. Cumulative eye lens doses were estimated retrospectively using a questionnaire including data on occupational history. Results: The average cumulative dose to the left and right eye lens of the ICs was 224 mSv and 85 mSv, respectively. Nuclear opalescence and nuclear color opacities in the most exposed left eye were found in 38% of the ICS for both types, and in 47% and 42% of the controls, respectively. Cortical opacities were found in 25% of the ICS and 29% of the controls. Posterior subcapsular opacities were rare: about 7% in the ICs group and 6% in the control group. Overall, there was some, but statistically insignificant, increase in the risk for opacity in the ICs group, relative to the control group, after adjusting for the subjects’ age, gender, smoking status and medical exposure (adjusted OR = 1.47, 95% CI: 0.62–3.59 for the pooled “any-eye any-type” opacity). There was also no evidence for an increased opacity risk with an increase in the dose. Conclusions: The study found no statistically significant evidence against the hypothesis that the risk of cataract in the group of the ICs occupationally exposed to low doses of ionizing radiation is the same as in the control group. Nevertheless, the adverse effect of ionizing radiation still cannot be excluded due to a relatively small study sample size
    • Occupational exposure to radon for underground tourist routes in Poland: Doses to lung and the risk of developing lung cancer.

      Walczak, Katarzyna; Olszewski, Jerzy; Politanski, Piotr; Zmyslony, Marek; Nofer Institute of Occupational Medicine, Łódź, Poland (2017-07-14)
      Radon concentrations for 31 Polish underground tourist routes were analyzed. The equivalent dose to the lung, the effective dose and the relative risk were calculated for employees of the analyzed routes on the grounds of information on radon concentrations, work time, etc.
    • Occupational exposure to selected isocyanates in Polish industry

      Brzeznicki, Slawomir; Bonczarowska, Marzena; Nofer Institute of Occupational Medicine, Lodz, Poland (2015)
      Isocyanates constitute a group of highly reactive, low molecular weight chemicals used worldwide for polyurethane manufacturing. The occupational exposure to these compounds is a major cause of occupational asthma, thus it is very important to monitor their concentration in the workplace atmosphere. The aim of the study was to measure the concentration of 4,4’-methylenediphenyl diisocyanate (MDI; CAS 101-68-8), toluene-2,4-di-isocyanate (2,4-TDI; CAS 584-84-9), toluene-2,6-di-isocyanate (2,6-TDI; CAS 91-08-7) and hexamethylene di-isocyanate (HDI; CAS 822-06-0) in the work environment for evaluation of the occupational exposure to these compounds. Material and Methods: Determination of concentrations of selected isocyanates was carried out in 21 manufacturing plants, during different industrial processes. The collected air samples (personal samples) were analyzed by means of the high-performance liquid chromatography (HPLC). Results: The presented results represent the 1st data on the occupational exposure to isocyanates in Poland. This set of data is generally indicative of concentrations of analyzed isocyanates that are low and do not exceed the maximum admissible concentration (MAC) values in Poland. Elevated concentrations (above the MAC value) were found only for the TDI in the course of manufacturing of polyurethane foam blocks. Conclusions: Results of many studies show that low concentrations of isocyanates (particularly of low volatility like for example MDI) in the air cannot exclude the possibility of additional absorption of these compounds through skin. Taking into consideration all the uncertainties associated with the evaluation of the risk of exposure to isocyanates based solely on measurement of their levels in the air, it would seem that the simultaneous application of environmental and biological monitoring would only facilitate a reliable assessment of the occupational exposure risk.
    • [The occurrence of asbestos-related diseases among former employees of asbestos processing plants in Poland].

      Świątkowska, Beata; Nofer Institute of Occupational Medicine (2019-12-03)
      Wstęp: Pomimo że w Polsce w produkcji nie stosuje się już azbestu, wciąż odnotowywane są nowe przypadki chorób azbestozależnych wśród pracowników narażonych w przeszłości na pył azbestu. Sytuacja ta jest związana ze specyfiką biologicznego działania tego minerału: następstwa zdrowotne ekspozycji na azbest mogą się ujawniać nie tylko podczas trwania narażenia, ale także wiele lat po nim. Celem analizy była ocena występowania chorób uznanych za zawodowe u osób narażonych na pył azbestu, które zgłosiły się na badania lekarskie w ramach ogólnopolskiego programu Amiantus. Materiał i metody: Materiał badawczy stanowiły karty badania programu wypełniane przez lekarzy przeprowadzających badania, jak również wyniki odczytu zdjęć radiologicznych płuc zapisane na formularzu Międzynarodowego Biura Pracy (International Labour Organization − ILO). Analizą objęto 8049 osób, w tym 37% kobiet przebadanych w latach 2000−2017. Wyniki: W badanej grupie byłych pracowników zakładów przetwórstwa azbestu chorobę zawodową stwierdzono u 1993 osób (25%), w tym u 584 kobiet (19%). Najczęstszą chorobą zawodową była pylica azbestowa (76% schorzeń zawodowych) oraz choroby opłucnej (17%). Nowotwory złośliwe stanowiły 7% przypadków w tej grupie. Analiza wykazała wzrost częstości występowania chorób układu oddechowego wraz z wiekiem badanych, ich stażem pracy w zakładach przetwórstwa azbestu, jak również ze zwiększaniem się skumulowanego wskaźnika narażenia. Ocena radiogramów klatki piersiowej wykazała zmiany radiologiczne wśród 75% badanych, przy czym zmiany upoważniające do rozpoznania azbestozy zgodnie z obowiązującymi w Polsce kryteriami wystąpiły u 23% badanych osób. Przyjęcie kryteriów międzynarodowych zwiększyłoby częstość występowania azbestozy jako choroby zawodowej o 19% w badanej grupie. Wnioski: Wzrost odsetka osób ze stwierdzoną chorobą zawodową świadczy o pogarszającej się kondycji zdrowotnej pracowników objętych badaniami, jak również o dobrej wykrywalności schorzeń azbestozależnych w ramach opieki nad pracownikami narażonymi w przeszłości na pył azbestu. Wyniki analizy wskazują na konieczność podjęcia w Polsce dyskusji nad wdrożeniem międzynarodowych kryteriów rozpoznawania pylicy azbestowej.
    • Occurrence of occupational diseases in Poland, 2014

      Szeszenia-Dabrowska, Neonila; Wilczynska, Urszula; Nofer Institute of Occupational Medicine, Lodz, Poland (2016)
      Background: The aim of the annual analysis of the incidence of occupational diseases in Poland is to evaluate the extent of the incidence and to identify its causes as well as activities involving factors that are harmful or annoying to such an extent that they result in occupational diseases. Material and Methods: Occupational diseases reporting forms supplied to the Central Register of Occupational Diseases were used as the study material. Results: In 2014, there were 2351 cases of occupational diseases recorded, i.e., 16.5 cases per 100 thousand of employees. The most numerous categories comprised infectious or parasitic diseases (borreliosis), pneumoconiosis, voice disorders and hearing loss (in total 79.7% of cases). The main causative factors of occupational diseases were as follows: industrial dust containing free silica, tick-transmitted Borrelia spirochete, and the way the work is done, including excessive vocal effort, and noise. The highest incidence per 100 thousand workers were recorded in mining and quarrying (296), manufacturing (24.9), education (24.6), agriculture and forestry (24.2) sectors. Conclusions: Compared with the previous year, there was a slight increase in the number of cases of certified occupational diseases (6.2%), primarily due to the increased incidence of Lyme disease. The incidence of voice disorders among teachers continues to vary considerably in individual provinces (0–11.3/10 000), reflecting the use of non-uniform diagnostic and certification methods.
    • Occurrence of radon in the polish underground tourist routes

      Olszewski, Jerzy; Zmyslony, Marek; Wrzesien, Malgorzata; Walczak, Katarzyna; Nofer Institute of Occupational Medicine, Lodz, Poland; University of Lodz, Łódź, Poland (2015)
      Wstęp: W Polsce funkcjonuje około 200 podziemnych tras turystycznych. Są to jaskinie, kopalnie oraz podziemne budowle. W niniejszej pracy przedstawiono wyniki badań mających na celu rozpoznanie zakresu występowania stężeń radonu we wnętrzach podziemnych tras turystycznych. Materiał i metody: W celu oszacowania stopnia zagrożenia przeprowadzono okresowe (1–2-miesięczne) pomiary stężeń radonu. Wykonano je w okresie letnim za pomocą detektorów śladowych typu Tastrak. Określono średnie stężenie radonu w powietrzu w 66 podziemnych trasach turystycznych w Polsce. Wyniki: W wyniku przeprowadzonych badań uzyskano 259 pomiarów średnich stężeń radonu. Średnia arytmetyczna wyników wyniosła 1610 Bqm–3, maksymalne zmierzone stężenie – ponad 20 tys. Bqm–3, a stężenie minimalne – 100 Bqm–3 (próg czułości metody). Stwierdzono, że w 67% tras średnie stężenie radonu przekroczyło wartość 300 Bqm–3, natomiast w 22 podziemnych trasach przekroczyło 1000 Bqm–3. Wnioski: Występujący w podziemnych trasach turystycznych radon w wielu przypadkach może stanowić problem organizacyjno-prawny i zdrowotny. Należy opracować program działań, których celem będzie obniżenie stężeń radonu w podziemnych trasach, szczególnie zlokalizowanych w zamkniętych kopalniach.
    • Ocena rentgenowskich aparatow stomatologicznych pod katem narazenia pacjentow na promieniowanie jonizujace.

      Olszewski, Jerzy; Wrzesien, Małgorzata; Nofer Institute of Occupational Medicine, Lodz, Poland (2017-06-27)
      The use of X-ray in dental procedures causes exposure of the patient to ionizing radiation. This exposure depends primarily on the parameters used in tooth examination. The aim of the study was to determine the patients exposure and to assess the technical condition of X-ray tubes.

      Rydzyński, Konrad; Bieńkowski, Paweł; Bortkiewicz, Alicja; Karpowicz, Jolanta; Kieliszek, Jarosław; Politański, Piotr; Staniec, Kamil; Zmyślony, Marek; Nofer Institute of Occupational Medicine (2019)
      Raport powstał na zlecenie Ministerstwa Zdrowia w ramach Narodowego Programu Zdrowia na lata 2016-2020 pn. „Ekspertyza dotycząca potencjalnych efektów biologicznych działania elektromagnetycznych fal milimetrowych (EFM) emitowanych przez urządzenia systemu 5G na organizm człowieka” w zakresie celu operacyjnego nr 4, punkt 3.1h.
    • OELs derivation in Poland and in the former Eastern Bloc with reference to approaches and practices applied in the EU

      Socko, Renata; Czerczak, Slawomir; Kupczewska-Dobecka, Malgorzata; Nofer Institute of Occupational Medicine, Lodz, Poland (2015)
      Based on the literature, current legislation and the European Union (EU) directives, the rules to protect the health of workers in Poland and the countries of the former Eastern Bloc were analyzed. Since 2002, the activities in the field of hygiene standards in the countries of the former Eastern Bloc have been correlated with the EU policy. The functioning of the system of maximum admissible concentrations (MAC) having been implemented in Poland for many years before the accession to the EU, has provided for a relatively quick adjustment of Polish regulations on chemicals to the relevant European law. The Polish list includes 543 substances. In the former Eastern Bloc countries, intensification of work after joining the EU has caused the lists in those countries to contain from 285 substances in Slovakia to 780 in Lithuania. Currently, all substances included in the EU lists (up to and including the 3rd list of occupational exposure limit values of the Directive 2009/161/EC) have been governed by the Polish, Lithuanian, Czech, Latvian and Hungarian law. In Estonia and Slovakia the provisions of the Directive 2006/15/EC establishing the second list of occupational exposure limits have been implemented. Individual national lists contain much more chemicals than the EU list containing currently 122 substances. The legislative process in the EU is slow, and that is why the national law is important and necessary due to the local needs in selected areas. It is necessary to correlate the activities in the field of determining regional occupational exposure limit (OEL) values in the countries of the Eastern Bloc and the EU.
    • Optimization of ultra-performance liquid chromatography (UPLC) with fluorescence detector (FLD) method for the quantitative determination of selected neurotransmitters in rat brain.

      Stragierowicz, Joanna; Darago, Adam; Brzeznicki, Slawomir; Kilanowicz, Anna; Nofer Institute of Occupational Medicine, Lodz, Poland (2017-07-26)
      Glutamate (Glu) and γ-aminobutyric acid (GABA) are the main neurotransmitters in the central nervous system for excitatory and inhibitory processes, respectively. Monitoring these neurotransmitters is an essential tool in establishing pathological functions, among others in terms of occupational exposure to toxic substances.
    • Papain-induced occupational rhinoconjunctivitis and asthma – A case report

      Tymoszuk, Diana; Wiszniewska, Marta; Walusiak-Skorupa, Jolanta; Nofer Institute of Occupational Medicine, Lodz, Poland (2016)
      This report presents a case of occupational asthma, rhinitis and conjunctivitis to papain in a 50-year-old herbs and spices packer, with documented increased eosinophilia in induced sputum and in the nasal lavage fluids after a specific inhalation challenge test (SICT) and specific nasal challenge test (SNCT) with this enzyme. Immunoglobulin E-mediated (IgE) sensitization to papain was confirmed by positive results of a skin prick test with specific solution. Specific inhalation and nasal challenge tests demonstrated a direct and significant link between the exposure to this protease and the allergic response from the respiratory system. Additionally, the SNCT induced a severe reaction of the conjunctivae and a significant increase in the count of eosinophils in tears, despite the lack of direct contact of the allergen with the conjunctiva. W artykule opisano przypadek zawodowej astmy oskrzelowej, alergicznego nieżytu nosa i zapalenia spojówek wywołanych papainą u 50-letniej pakowaczki ziół i przypraw. W badaniu cytologicznym udokumentowano wzrost odsetka eozynofilów w indukowanej plwocinie i popłuczynach nosowych po swoistej próbie prowokacyjnej wziewnej i donosowej z tym enzymem. Zależną od immunoglobuliny E (IgE) nadwrażliwość pacjentki na papainę potwierdzono dodatnimi wynikami punktowych testów skórnych z roztworem tej proteazy. Wyżej wymienione próby prowokacyjne wykazały istotny związek między ekspozycją na papainę a reakcją alergiczną ze strony układu oddechowego. Ponadto swoista próba prowokacyjna donosowa wywołała wzmożoną reakcję ze strony spojówek i istotny wzrost odsetka eozynofilów we łzach mimo braku bezpośredniego kontaktu alergenu ze spojówkami.
    • Past and present work practices of European interventional cardiologists in the context of radiation protection of the eye lens-results of the EURALOC study.

      Domienik-Andrzejewska, Joanna; Ciraj-Bjelac, Olivera; Askounis, Panagiotis; Covens, Peter; Dragusin, Octavian; Jacob, Sophie; Farah, Jad; Gianicolo, Emilio; Padovani, Renato; Teles, Pedro; et al. (2018-09)
      This paper investigates over five decades of work practices in interventional cardiology, with an emphasis on radiation protection. The analysis is based on data from more than 400 cardiologists from various European countries recruited for a EURALOC study and collected in the period from 2014 to 2016. Information on the types of procedures performed and their annual mean number, fluoroscopy time, access site choice, x-ray units and radiation protection means used was collected using an occupational questionnaire. Based on the specific European data, changes in each parameter have been analysed over decades, while country-specific data analysis has allowed us to determine the differences in local practices. In particular, based on the collected data, the typical workload of a European cardiologist working in a haemodynamic room and an electrophysiology room was specified for various types of procedures. The results showed that when working in a haemodynamic room, a transparent ceiling-suspended lead shield or lead glasses are necessary in order to remain below the recommended eye lens dose limit of 20 mSv. Moreover, the analysis revealed that new, more complex cardiac procedures such as chronic total occlusion, valvuloplasty and pulmonary vein isolation for atrial fibrillation ablation might contribute substantially to annual doses, although they are relatively rarely performed. The results revealed that considerable progress has been made in the use of radiation protection tools. While their use in electrophysiology procedures is not generic, the situation in haemodynamic procedures is rather encouraging, as ceiling-suspended shields are used in 90% of cases, while the combination of ceiling shield and lead glasses is noted in more than 40% of the procedures. However, we find that still 7% of haemodynamic procedures are performed without any radiation protection tools.