{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T15:13:19Z","timestamp":1780758799311,"version":"3.54.1"},"reference-count":25,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T00:00:00Z","timestamp":1742428800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Research Foundation of Korea (NRF) grant funded by the Korea government (MIST)","award":["RS-2023-00240665"],"award-info":[{"award-number":["RS-2023-00240665"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Fluoroscopy has been widely adopted in interventional pulmonology, as it facilitates real-time visualization of the bronchoscope, endobronchial ultrasound, and biopsy tools during procedures. The purpose of this study was to evaluate the effectiveness of radiation shields in minimizing scattered X-ray dose to the bronchoscopist in a phantom study and to determine the dose of scattered X-ray dose to medical staff with radiation shields in clinical application. Methods: An anthropomorphic torso phantom was positioned on the fluoroscopic table between the C-arm X-ray tube and the image detector to mimic bronchoscopic operations. Upper and lower body lead shields were used to examine the effectiveness of radiation shielding. Scatter radiation rates were assessed at a first operator location using real-time dosimeters with and without protective devices. In clinical application, the scattered X-ray dose of the first operator and main assistant was measured using wearable radiation dosimeters during 20 procedures. Results: In the phantom study, scattered radiation without shielding was 266.34 \u00b1 8.86 \u03bcSv\/h (glabella), 483.90 \u00b1 8.01 \u03bcSv\/h (upper thorax), 143.97 \u00b1 8.20 \u03bcSv\/h (hypogastrium), and 7.22 \u00b1 0.28 \u03bcSv\/h (ankle). The combination of upper and lower body lead shields reduced the scattered X-ray dose by 98.7%, 98.3%, 66.2%, and 79.9% at these levels, respectively. In clinical application, mean scattered X-ray dose rates were 0.14 \u00b1 0.05 \u03bcSv\/procedure (eye), 0.46 \u00b1 0.51 \u03bcSv\/procedure (chest), 0.67 \u00b1 0.50 \u03bcSv\/procedure (hypogastrium), and 1.57 \u00b1 2.84 \u03bcSv\/procedure (assistant\u2019s wrist). Conclusions: The combination of radiation shields significantly reduced the scattered X-ray dose at the operator site in the phantom study. The scattered X-ray dose to medical staff during bronchoscopy can be kept at a low level with the aid of a shielding system.<\/jats:p>","DOI":"10.3390\/jcm14062114","type":"journal-article","created":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T05:03:59Z","timestamp":1742447039000},"page":"2114","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effectiveness of Radiation Shields to Minimize Operator Dose in the Bronchoscopy Suite: A Phantom Study and Clinical Application"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3960-3469","authenticated-orcid":false,"given":"Hosang","family":"Jeon","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Woon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Hyeon","family":"Joo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongkan","family":"Ki","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0883-2461","authenticated-orcid":false,"given":"Suk-Woong","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won Chul","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2075-4702","authenticated-orcid":false,"given":"Seong Hoon","family":"Yoon","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4328-0818","authenticated-orcid":false,"given":"Yun Seong","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1949-4798","authenticated-orcid":false,"given":"Seung Hyun","family":"Yong","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8834-7302","authenticated-orcid":false,"given":"Hyun Sung","family":"Chung","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine, National Cancer Center, Goyang 10408, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taehoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1840-150X","authenticated-orcid":false,"given":"Hee Yun","family":"Seol","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Asano, F., Ishida, T., Shinagawa, N., Sukoh, N., Anzai, M., Kanazawa, K., Tsuzuku, A., and Morita, S. (2017). Virtual bronchoscopic navigation without X-ray fluoroscopy to diagnose peripheral pulmonary lesions: A randomized trial. BMC Pulm. Med., 17.","DOI":"10.1186\/s12890-017-0531-2"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.jtho.2018.11.013","article-title":"Electromagnetic Navigation Bronchoscopy for Peripheral Pulmonary Lesions: One-Year Results of the Prospective, Multicenter NAVIGATE Study","volume":"14","author":"Folch","year":"2019","journal-title":"J. Thorac. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1183\/13993003.00051-2016","article-title":"Transbronchial needle aspiration in peripheral pulmonary lesions: A systematic review and meta-analysis","volume":"48","author":"Mondoni","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1097\/LBR.0000000000000783","article-title":"Cone-beam CT and Augmented Fluoroscopy-guided Navigation Bronchoscopy: Radiation Exposure and Diagnostic Accuracy Learning Curves","volume":"28","author":"Verhoeven","year":"2021","journal-title":"J. Bronchol. Interv. Pulmonol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1002\/ccd.22947","article-title":"Reduction of scatter radiation during transradial percutaneous coronary angiography: A randomized trial using a lead-free radiation shield","volume":"79","author":"Politi","year":"2012","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_6","first-page":"313","article-title":"Impact of a Disposable Sterile Radiation Shield on Operator Radiation Exposure During Percutaneous Coronary Intervention of Chronic Total Occlusions","volume":"27","author":"Shorrock","year":"2015","journal-title":"J. Invasive Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1088\/0952-4746\/36\/2\/309","article-title":"The impact of various protective tools on the dose reduction in the eye lens in an interventional cardiology-clinical study","volume":"36","author":"Domienik","year":"2016","journal-title":"J. Radiol. Prot."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1093\/jrr\/rrx039","article-title":"Effectiveness of additional lead shielding to protect staff from scattering radiation during endoscopic retrograde cholangiopancreatography procedures","volume":"59","author":"Morishima","year":"2018","journal-title":"J. Radiat. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e027729","DOI":"10.1136\/bmjopen-2018-027729","article-title":"Radiation protection effect of mobile shield barrier for the medical personnel during endoscopic retrograde cholangiopancreatography: A quasi-experimental prospective study","volume":"9","author":"Chung","year":"2019","journal-title":"BMJ Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"926876","DOI":"10.1155\/2014\/926876","article-title":"Occupational Radiation Exposure during Endoscopic Retrograde Cholangiopancreatography and Usefulness of Radiation Protective Curtains","volume":"2014","author":"Minami","year":"2014","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"745","DOI":"10.2214\/AJR.16.16556","article-title":"Radiation protection for the fluoroscopy operator and staff","volume":"207","author":"Meisinger","year":"2016","journal-title":"Am. J. Roentgenol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1159\/000540102","article-title":"Radiation Principles, Protection, and Reporting for Interventional Pulmonology: A World Association of Bronchology and Interventional Pulmonology White Paper","volume":"103","author":"Wijma","year":"2024","journal-title":"Respiration"},{"key":"ref_13","first-page":"1469","article-title":"Radiation dose to patients and clinicians during fluoroscopically-guided biopsy of peripheral pulmonary lesions","volume":"55","author":"Steinfort","year":"2010","journal-title":"Respir. Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1093\/jjco\/hyt224","article-title":"The dose and risk factors for radiation exposure to medical staff during endobronchial ultrasonography with a guide sheath for peripheral pulmonary lesions under X-ray fluoroscopy","volume":"44","author":"Katsurada","year":"2014","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1093\/jrr\/rraa034","article-title":"Radiation eye dose to medical staff during respiratory endoscopy under X-ray fluoroscopy","volume":"61","author":"Haga","year":"2020","journal-title":"J. Radiat. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1093\/rpd\/ncac028","article-title":"Does Radiological Protection Training or a Real-Time Staff Dosemeter Display Reduce Staff Doses during X-Ray-Guided Pulmonary Bronchoscopy?","volume":"198","author":"Lundvall","year":"2022","journal-title":"Radiat. Prot. Dosim."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1016\/j.chest.2019.10.042","article-title":"Sensitivity of Radial Endobronchial Ultrasound-Guided Bronchoscopy for Lung Cancer in Patients With Peripheral Pulmonary Lesions: An Updated Meta-analysis","volume":"157","author":"Vakil","year":"2020","journal-title":"Chest"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1177\/0146645320956517","article-title":"Lifetime radiation risk of stochastic effects\u2014Prospective evaluation for space flight or medicine","volume":"49","author":"Ulanowski","year":"2020","journal-title":"Ann. ICRP"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1007\/s00270-009-9756-7","article-title":"Occupational radiation protection in interventional radiology: A joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology","volume":"33","author":"Miller","year":"2010","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4537","DOI":"10.1118\/1.4730504","article-title":"Radiation shielding materials and radiation scatter effects for interventional radiology (IR) physicians","volume":"39","author":"McCaffrey","year":"2012","journal-title":"Med. Phys."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Yu, C.-Y., Chou, W.-T., Liao, Y.-J., Lee, J.-H., Liang, J.-A., and Hsu, S.-M. (2017). Impact of radiation attenuation by a carbon fiber couch on patient dose verification. Sci. Rep., 7.","DOI":"10.1038\/srep43336"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"W900","DOI":"10.2214\/AJR.10.6396","article-title":"Clarifying and visualizing sources of staff-received scattered radiation in interventional procedures","volume":"197","author":"Chida","year":"2011","journal-title":"Am. J. Roentgenol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"145","DOI":"10.3344\/kjp.2018.31.3.145","article-title":"Three principles for radiation safety: Time, distance, and shielding","volume":"31","author":"Kim","year":"2018","journal-title":"Korean J. Pain."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s12194-022-00660-8","article-title":"What are useful methods to reduce occupational radiation exposure among radiological medical workers, especially for interventional radiology personnel?","volume":"15","author":"Chida","year":"2022","journal-title":"Radiol. Phys. Technol."},{"key":"ref_25","unstructured":"The 2007 Recommendations of the International Commission on Radiological Protection (2007). ICRP publication 103. Ann ICRP, 37, 9\u201334."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/6\/2114\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:56:56Z","timestamp":1760029016000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/6\/2114"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,20]]},"references-count":25,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14062114"],"URL":"https:\/\/doi.org\/10.3390\/jcm14062114","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,20]]}}}