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Eyes; Medical radiation; Radiation exposure; Conjunctivitis; Dry eye syndrome

Introduction

The use of medical radiation for diagnostic and therapeutic purposes continues to increase worldwide. Outside of inpatient radiology services, the use of fluoroscopy has increased and now encompasses multiple specialties. For the pain interventionist, there has been exponential growth of the number of fluoroscopy-guided procedures in the past decade. With procedures such as epidural steroid injections, studies have demonstrated increased accuracy, precision, and patient safety with fluoroscopic guidance [1]. Furthermore, the improvement of technology and expansion of more percutaneous and less open procedures appears to be increasing the use of fluoroscopy guidance for the pain interventionist.

In the realm of modern medicine, interventional pain physicians play a pivotal role in the management of patients suffering from chronic pain conditions. These skilled medical professionals utilize various image-guided techniques, such as fluoroscopy and X-rays, to accurately diagnose and treat their patients. While these procedures have undoubtedly revolutionized pain management, they also pose potential health risks for the physicians themselves, particularly in terms of radiation exposure to the eyes [2].

The eyes are one of the most sensitive organs in the human body, and prolonged exposure to ionizing radiation can have severe consequences on ocular health. Interventional pain physicians, who regularly perform fluoroscopy-guided injections and other image-guided procedures, are at an increased risk of developing eye-related health issues due to the cumulative effects of radiation exposure.

Multiple epidemiological studies from Hiroshima, Nagasaki, and children survivors from Chernobyl have demonstrated a correlation between low-dose radiation exposure and induced cataracts. Klein et al. reported that subjects with diagnostic X-ray exposure have higher incidence of posterior subscapular cataracts. There has been growing concern regarding lens opacities and cataract formation in relation to radiation exposure in the interventional radiology setting [3]. There is also demonstrable evidence within the past decade for a genetic component of cataract development, which further elucidates some of the mechanisms behind DNA damage and response and repair pathways. These genetically predisposed mechanisms have been discovered in animal models, and to go into depth at this time is beyond the scope of this narrative review.

Throughout the article, we will explore the specific dangers posed by radiation exposure to the eyes, the various ocular conditions that can arise, and the long-term implications for physicians' well-being and professional practice. Moreover, we will examine the established safety guidelines and personal protective equipment (PPE) that can effectively reduce radiation exposure during pain intervention procedures [4]. Furthermore, we will emphasize the significance of continuous medical education and technological advancements in promoting safer imaging practices. Investing in state-of-the-art fluoroscopy systems with dose-reduction capabilities can significantly minimize radiation risks, both for physicians and their patients.

As we journey through the article, it becomes evident that mitigating radiation risks requires a collaborative effort among healthcare professionals, medical institutions, and the physicians themselves. Cultivating a culture of radiation safety, raising awareness about potential risks [5], and encouraging adherence to safety protocols are vital steps in protecting the eye health of pain intervention physicians.

Understanding the risks: radiation exposure and eye health

Radiation is an essential tool in interventional pain procedures, aiding physicians in visualizing internal structures, guiding needle placements, and delivering treatments accurately. However, the regular use of fluoroscopy and other imaging modalities increases the likelihood of prolonged exposure to scattered and direct X-rays, which can have adverse effects on ocular tissues [6].

The eye is a particularly sensitive organ to radiation, and cumulative exposure over time can lead to various ocular conditions. Cataracts, characterized by clouding of the eye's natural lens, are a common consequence of prolonged radiation exposure. Other potential risks include dry eye syndrome, conjunctivitis, and even retinal damage, which may impact a physician's ability to provide quality care.

Adhering to safety guidelines

To protect their eyes from radiation risks, pain intervention physicians must diligently adhere to established safety guidelines. Some essential practices include:

Personal protective equipment (PPE): Wearing leaded aprons, thyroid collars, and leaded glasses significantly reduces exposure to scattered radiation during procedures. These specially designed leaded glasses effectively shield the eyes from harmful X-rays without compromising visibility [7].

Maintaining safe distances: Physicians should keep a safe distance from the X-ray source whenever possible and stand behind protective barriers during fluoroscopy. Maximizing distance reduces the intensity of radiation exposure.

Limiting exposure time: Minimizing the duration of fluoroscopy and other imaging procedures whenever feasible can significantly lower radiation exposure risks [8].

Positioning and shielding techniques: Properly positioning the patient and utilizing shielding devices can help concentrate the radiation beam on the intended area, reducing scatter radiation. Regular eye check-ups: Pain intervention physicians should schedule routine eye examinations to monitor any potential radiationrelated eye issues and address them promptly.

Investing in technology and education

Advancements in medical technology have paved the way for safer imaging practices. Upgrading to modern fluoroscopy systems with dose-reduction capabilities can significantly lower radiation exposure for both patients and physicians [9]. Additionally, continuous medical education and training programs focused on radiation safety equip pain intervention physicians with updated knowledge and best practices for minimizing risks.

Collaboration and awareness

Radiation safety should be a collaborative effort involving the entire medical team. By fostering a culture of awareness and accountability, healthcare institutions can encourage physicians, technicians, and support staff to prioritize radiation safety measures consistently [10].

Conclusion

The eyes are invaluable assets for any medical professional, particularly for interventional pain physicians whose precise vision is essential for patient care. Recognizing the risks of radiation exposure to their eyes and implementing effective mitigation strategies is not only crucial for their own well-being but also for ensuring the delivery of safe and high-quality medical care to their patients. By staying informed about the latest safety guidelines, adopting advanced technologies, and fostering a culture of radiation safety, pain intervention physicians can continue to make a positive impact on their patients' lives while safeguarding their own eye health.

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