Radiological Protection in Fluoroscopically Guided Procedures Performed Outside the Imaging Department

Abstract

An increasing number of medical specialists are using fluoroscopy outside imaging departments, but there has been general neglect of radiological protection coverage of fluoroscopy machines used outside imaging departments. Lack of radiological protection training of those working with fluoroscopy outside imaging departments can increase the radiation risk to workers and patients. Procedures such as endovascular aneurysm repair, renal angioplasty, iliac angioplasty, ureteric stent placement, therapeutic endoscopic retrograde cholangio-pancreatography,and bile duct stenting and drainage have the potential to impart skin doses exceeding Gy. Although tissue reactions among patients and workers from fluoroscopy procedures have, to date, only been reported in interventional radiology and cardiology,the level of fluoroscopy use outside imaging departments creates potential for such injuries.A brief account of the health effects of ionising radiation and protection principles is presented in Section 2. Section 3 deals with general aspects of the protection of workers and patients that are common to all, whereas specific aspects are covered in Section 4 for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology,gastroenterology and hepatobiliary system, and anaesthetics and pain management.Although sentinel lymph node biopsy involves the use of radio-isotopic methods rather than fluoroscopy, performance of this procedure in operating theatres is covered in this report as it is unlikely that this topic will be addressed in another ICRP publication in coming years. Information on radiation dose levels to patients and workers, and dose management is presented for each speciality.

The Knowledge of Radiation and the Attitude Towards Radio-Protection among Urology Residents in India

“…Nearly one quarter of the residents in the survey did not know this. Medical personnel can prevent themselves from radiation by increasing the distance from the source of radiation or by leaving the operating room, if not actively involved in the procedure, when the radiation is being used [9]. We found that only about a quarter practiced this routinely.…”

“…They are made up of lead and decrease the amount of radiation received by the operator. Commonly a 0.5 mm lead shield is used [9]. Nearly one quarter of the residents in the survey did not know this.…”

The effect of surgical experience on the amount of radiation exposure from fluoroscopy during dynamic hip screw fixation

“…19 The maximum recommended occupational dose limit is 20mSv averaged over five years with no more than 50mSv in any one year. The ICRP also advocates three fundamental principles: justification, optimisation of protection and dose limitation.…”

“…The ICRP recommended configuration when using fluoroscopy is to have the intensifier above and the x-ray tube below the patient. 19 The operating personnel should always stand on the intensifier side as this reduces the amount of radiation received by a tenth. The use of additional protective devices such as thyroid collars and goggles should be considered, especially when operating on larger patients as patient size increases the skin dose and scattered radiation.…”

Radiation safety in the cardiac catheterization laboratory: Our responsibility to change

“…The many factors modulaing the dose in the cardiac cath lab are summarized in Table 2 and can reduce the dose by a factor of 10 to 100 [16][17][18] .…”