Entrance surface dose and induced DNA damage in blood lymphocytes of patients exposed to low-dose and low-dose-rate X-irradiation during diagnostic and therapeutic interventional radiology procedures

The ionizing radiation received by patients and health workers due to radiological imaging may increase the risks of radiation effects, such as cancer and cataracts. We have investigated the dose received by specific areas around the head and related this to DNA damage in the blood lymphocytes of subjects exposed to interventional imaging. The entrance surface doses (ESD) to the forehead, neck, and shoulder were measured with a thermoluminescence dosimeter (CaSO4 disc or polycrystalline powder of lithium tetraborate doped with Mn) and compared with that of dose area product (DAP). DNA damage was measured by gamma-H2AX, p53(ser15), chromosomal aberration (CA), and micronucleus (MN) assays in lymphocytes of patients (n = 75), before and 2 and 24 h after exposure. The measured ESD values were 230.5 +/- 4.9, 189.5 +/- 3.55 and 90.7 +/- 3.4 mGy for the forehead, neck, and shoulder, respectively. The DAP varied from 1.8 to 2047 Gy*cm(2), showing a correlation with fluoroscopy time (r = 0.417). Received doses did not increase early markers of DNA damage (gamma-H2AX and p53(ser15) assays), but residual damage (CA and MN frequencies) showed a significant (p < 0.001) increase at 2 and 24 h post-exposure compared to pre-imaging, despite poor correlation with DAP (r = 0.1). Our results show that interventional imaging procedures deliver significant radiation doses and induce measurable DNA damage in lymphocytes of subjects, highlighting the need for rigorous patient safety protocols.