radiation protection in fluoroscopy...formed the joint task force on adult radiation protection to...
TRANSCRIPT
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Radiation Protection in Fluoroscopy
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Physicians performing fluoroscopic guided procedures should be aware of the
potential for serious radiation-induced skin injury to the patient. Occasionally
this is an unavoidable consequence of the time required to perform complex
procedures. Some of this exposure, however, can be minimized through a
better understanding of how the equipment works and how some operational
procedures affect the total skin dose.
Good radiation protection procedures and personnel skills are essential for
reducing both staff and patient exposure.
All personnel involved in the radiologic examination have a role in making sure
all patients’ procedures are performed in a safe manner.
Introduction
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Major Points:
Factors affecting staff doses
Factors affecting both staff and patient doses
Factors affecting patient doses
Protection tools
Radiation protection rules
Image Wisely and Image Gently
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Radiation Protection in
Fluoroscopy
Factors affecting staff doses
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Factors affecting staff doses The main source of radiation for the staff
in a fluoroscopy room is the patient (scattered radiation).
The scattered radiation is not uniform around the patient.
The level of dose rate around the patient is a complex function of a great number of factors.
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Factors affecting staff doses
Scattered dose
rate is higher
near the area
into which the
X-ray beam
enters the
patient
0.03 rem/h
0.06 rem/h
0.09 rem/h100 kV
11x11 cm
1m patient distance
patient thickness 18 cm
1 mA
ANGLE DEPENDENCE
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Scattered
dose rate is
higher when
field size
increases
0.03 rem/h
0.06 rem/h
0.09 rem/h100 kV
1m patient distancePatient
thickness 18 cm
0.07 rem/h
0.11 rem/h
0.13 rem/h
17x17 cm11x11 cm 17x17 cm
1 mA
FIELD SIZE DEPENDENCE
Factors affecting staff doses
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Scattered
dose rate is
lower when
there is more
distance from
the patient
100 kV
11x11 cm
1 mA
rem/h at 1mrem/h at 0.5m
DISTANCE VARIATION
Factors affecting staff doses
0.32
0.24
0.12
0.08
0.06
0.03
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X-ray Tube Position Position the X-ray tube
under the patient not
above the patient.
The largest amount of
scatter radiation is
produced where the X-
ray beam enters the
patient.
By positioning the X-ray
tube below the patient,
you decrease the
amount of scatter
radiation that reaches
your upper body.
X-ray Tube
Image Intensifier
Factors affecting staff doses
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Radiation Protection in
Fluoroscopy
Factors affecting staff and patient
doses
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Collimation Collimating tightly
to the area of interest:
➢Reduces the
patient’s total
focal skin
exposure.
➢ Improves image
contrast.
➢Scatter radiation
to the operator
and staff will also
decrease.
Factors affecting staff and patient doses
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CHANGING
FROM NORMAL
FLUOROSCOPY
MODE TO THE
BOOST HIGH
DOSE RATE
MODE
INCREASES
DOSE RATE
Factors affecting staff and patient doses
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OVERUSE OF
MAGNEFICATION
MODE
INCREASES
DOSE RATE
Factors affecting staff and patient doses
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IF PATIENT
SIZE
INCREASES
PATIENT SKIN
DOSE AND THE
LEVEL OF
SCATTERED
RADIATION
INCREASE
SUBSTANTIALLY
Factors affecting staff and patient doses
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Radiation Protection in
Fluoroscopy
Factors affecting patient doses
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CHANGING
FROM HIGH TO
LOW NOISE
MODE (FOR CINE
AND DSA -
Digital
Subtraction
Angiography)
INCREASES
DOSE PER
IMAGE
Factors affecting patient doses
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THE USE OF
THE GRID
INCREASES
PATIENT SKIN
ENTRANCE
DOSE
Factors affecting patient doses
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CHANGING TO A
SMALLER IMAGE
INTENSIFIER
FIELD
CAN INCREASE
PATIENT
ENTRANCE DOSE
Factors affecting patient doses
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CHANGING FROM
CONVENTIONAL
FLUOROSCOPY
TO DIGITAL MODE
CAN DECREASE
DOSE RATE
Factors affecting patient doses
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USING PULSED
FLUORO INSTEAD
OF CONTINUOUS
FLUORO
1 pps: 5% of dose
2 pps: 10% of dose
4 pps: 20% of dose
Factors affecting patient doses
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Radiation Protection in
Fluoroscopy
Protection tools
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• Time
Decrease the time
• Distance
Inverse Square Law
Double the distance receive 1/4 the dose
• Shielding
Aprons: 0.25 mm Pb equivalent
Thyroid collar, Pb gloves, rollaway shields
Patient shielding
• Dosimeter Badge
Collar and waist badges,
ring badges, dosimeter storage, control badges
Protection tools
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Protection tools
TIME
- Take foot off fluoro pedal if physician is not viewing the image monitor
- Use last image hold (freeze frame)
- Five-minute timer
- Use pulsed fluoro instead of continuous fluoro
1 pps: 5% dose with respect to continuous fluoro
2 pps: 10% 4 pps: 20%
- Low-Dose mode: 40% dose of normal fluoro
- Pulsed Low-Dose provides further reduction with respect to Normal
Dose continuous mode:
1 pps = 2% of dose; 2 pps = 4%; 4 pps = 8%; 8 pps = 15%
- Record fluoro time and calculate rads delivered—report if more than 300
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Protection tools DISTANCE
- One step back from tableside:
cuts exposure by factor of 4
- Move image intensifier close to patient:
less patient skin exposure
less scatter and sharper image
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Protection tools SHIELDING
- Pb (or Pb equivalent) aprons: can cut exposure by factor of 20
- Thyroid collars, Pb gloves, eye glasses, wrap around aprons
- Properly used rollaway shields
- Use shielded rooms
- Patient shielding: thyroid, eyes, gonads
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Protection tools DOSIMETER BADGES
- Always wear your collar dosimeter outside the Pb apron
- Be sure to turn in your dosimeter on time for a proper exposure reading—results may not be accurate and a late fee will be assessed
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Protection tools
DRAPED D-Distance
Inverse square law, primarily for the operator
R-Receptor
Keep image receptor close to patient and collimate
A-Angles
Avoid steep angles
P-Pedal
Keep foot off pedal except when looking at the monitor
E-Extremities
Keep patient and operator extremities out of the beam
D-Dose
Avoid cine, adjust frame rate, wear personal dosimeter
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Radiation Protection in
Fluoroscopy
Radiation protection rules
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Radiation protection rules
• Minimize cine & high-dose fluoro
• A licensed radiological technologist or
credentialed professional practitioner
are the only personnel who may operate
(turn on) a fluoroscopy machine, position a
patient, or select the technique
• Patient’s exposure documentation
- document skin areas irradiated
- document fluoro time in patient record
- calculate and document patient exposure
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• Standard Operating Procedures
- each clinical protocol / procedure
- modes of operation, image recording
- emphasis on minimizing duration
- risk / benefit on a case-by-case basis
• Equipment Quality Control
- preventative maintenance
- calibrations
- radiation output values
- check and document Pb aprons, shields, gloves annually
Radiation protection rules
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Radiation Protection in
Fluoroscopy
Image Wisely
&
Image Gently
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Image Wisely
The American College of Radiology and the Radiological Society of North America
formed the Joint Task Force on Adult Radiation Protection to address concerns about
the surge of public exposure to ionizing radiation from medical imaging. The Joint
Task Force collaborated with the American Association of Physicists in Medicine and
the American Society of Radiologic Technologists to create the Image Wisely
campaign with the objective of lowering the amount of radiation used in medically
necessary imaging studies and eliminating unnecessary procedures.
Image Wisely offers resources and information to radiologists, medical physicists,
other imaging practitioners, and patients.
www.imagewisely.org
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Image Gently
The Image Gently Alliance is a coalition of health care organizations dedicated to
providing safe, high quality pediatric imaging worldwide. The primary objective of the
Alliance is to raise awareness in the imaging community of the need to adjust
radiation dose when imaging children. The ultimate goal of the Alliance is to change
practice.
The Image Gently Alliance began as a committee within the Society for Pediatric
Radiology in late 2006. In 2007, The SPR leadership reached out to friends and
colleagues in sister societies representing the key members of the imaging team,
ACR, ASRT and AAPM, to form "the Writers Group." These organizations developed
the concept of the Alliance and their representatives developed the campaign in the
summer of 2007.
www.imagegently.org
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Radiation Protection in
Fluoroscopy
Summary
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Summary
Many physical factors may significantly
affect patient and staff dose while working
with fluoroscopy equipment: beam angle,
distance from the source, image intensifier
diameter, and type of fluoroscopy system.
Do not overuse magnification modes
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Summary
Wear protective aprons and dosimeters
Know where scatter is highest
Keep your distance, as far as is practical
Click here to complete the required
Physician Fluoroscopy Quiz