Protection of the lens in fluoroscopic procedures: international standards, implementation gaps, and roadmap for Chile

Sergio Ramos-Avasola, Escuela de Tecnología Médica, Facultad de Ciencias, Universidad San Sebastián, Santiago, Chile
Nayareth Cardenas, Escuela de Tecnología Médica, Facultad de Ciencias, Universidad San Sebastián, Santiago, Chile
Alexis Flores, Escuela de Tecnología Médica, Facultad de Ciencias, Universidad San Sebastián, Santiago, Chile
Ignacio Galaz, Escuela de Tecnología Médica, Facultad de Ciencias, Universidad San Sebastián, Santiago, Chile
Sebastián Ortega, Escuela de Tecnología Médica, Facultad de Ciencias, Universidad San Sebastián, Santiago, Chile
Andrea Ovando-Tellez, Escuela de Tecnología Médica, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile
Cristóbal Guerrero, Departamento de Salud Ocupacional, Instituto de Salud Pública, Chile
Jorge Gamarra, Departamento de Irradiaciones, Departamento de Dosimetría, Comisión Chilena de Energía Nuclear. Santiago, Chile
Nitza Espinosa, Unidad de Hemodinamia, Hospital Regional Dr. Juan Noé Crevani, Arica, Chile

Interventional fluoroscopy exposes clinical teams to ionizing radiation, primarily to scattered radiation generated by the interaction of the X-ray beam with the patient, which constitutes the main source of occupational exposure for the operator. The eye lens is a critical organ because of its radiosensitivity and location outside the protection provided by the lead apron. Epidemiological evidence among interventional personnel has documented a higher frequency of posterior subcapsular opacities and cataracts, with patterns consistent with exposure geometry and evidence of a dose-response relationship. These findings supported the reduction in the occupational dose limit for the eye lens recommended by the International Commission on Radiological Protection and the strengthening of radiation protection measures, including specific dosimetric monitoring. This review integrates radiobiological and epidemiological evidence with international standards applicable to fluoroscopic procedures and examines the Chilean context, characterized by a regulatory framework that is not fully aligned with recent international recommendations and by gaps in specific monitoring, including the operational quantity Hp(3), and in the use of eye protection. Strengthening eye lens protection through regulatory updates, dosimetric standardization, optimization of practices, continuous training, and occupational ophthalmologic surveillance is proposed to reduce cumulative exposure and prevent radiation-induced lens damage.

Keywords: Fluoroscopy. Eye lens. Radiation protection. Personal dosimetry. Radiation-induced cataract.