ARRS 2022 Abstracts

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E1930. Comprehensive Eye Care: What Radiologists Need to Know
Authors
  1. Jeffrey Xing; University of Virginia
  2. Dionysios Koroulakis; University of Virginia
  3. Stephen Keffer; University of Virginia
  4. Michael Hanley; University of Virginia
Background
Eye complaints are not uncommon among practicing radiologists. Yet, many trainees, attendings, and staff are not well informed on how to mitigate ophthalmologic risks in radiology. Occupational risks to the eye stem from cumulative lifetime exposure to both visible light and ionizing radiation. International guidelines from the International Commission on Radiological Protection (ICRP) have periodically lowered annual exposure limits to ionizing radiation, but the adoption is heterogeneous. Moreover, new large cohort studies in the field of radiology have revealed persistent cataract risk at levels an order of magnitude below the current IRCP annual exposure guideline. Amidst the gap between society guidelines and heterogeneous real-world practice, new technologies have emerged to mitigate occupational risks. These warrant an updated review with practical takeaways presented in a digestible way for the everyday radiologist.

Educational Goals / Teaching Points
The objective of this educational review is to examine the evidence for heterogeneous eye care practices in radiology in the context of currently understood mechanisms contributing to eye strain or injury. By the end of this review, the audience should be able to 1) understand the mechanisms of eye strain and eye injury in the practice of radiology; 2) appreciate evolving international guidelines on best practices for eye safety in radiology; and 3) weigh the current evidence for risks versus benefits of eye care practices in Radiology. The target audience includes trainees, practicing radiologists, fluoroscopic interventionalists (cardiology, urology, etc), technologists, and other radiation equipment operators.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
First, the currently understood pathophysiologic mechanisms for eye strain and eye injury are reviewed to contextualize existing society safety guidelines as well as emerging evidence on eye care practices. These mechanisms include effects of short-wave length visible light (especially blue light) on melatonin dysregulation, retina damage, lens damage, and fluorescent glare, as well as dose-dependent effects of ionizing radiation on accelerated cataract formation, neovascular glaucoma, and retina damage. Second, the current society guidelines are briefly reviewed including the IRCP ionizing radiation exposure limits to the eye, and whether the "threshold" model is compatible with recent largescale studies. Third, key eye care practices are addressed including: utility of blue light filters (both software and hardware), appropriate use of lead glasses and other radiation safety practices (optimal positioning, shielding, and dosimetry), utility of annual eye exams, and risks of corrective eye surgery (including low light halo effects).

Conclusion
Eye strain and injury are inherent risks in the field of radiology but are relatively simple to address. Occupational risks stemming from distinct biological responses to blue light and ionizing radiation are mitigated by adopting new technologies as well as staying aware of best practices based on evolving evidence.