|
Radiation risks from interventional fluoroscopy
The benefits of properly performed interventional fluoroscopy almost always
outweigh the radiation risk experienced by an individual. However, unnecessary
exposure to radiation can produce avoidable risk to both the patient and the
operator.
The short-term risk to patients is radiation-induced skin damage, which can
result from acute radiation doses of >= 2Gy. The extent of the skin injury may
not be known for weeks after the procedure. Repeated procedures increase the
risk of skin injury, because previous radiation exposure sensitizes the skin.
Long term effects include the potential risk of cancer. It is generally accepted
that there is probably no low dose "threshold" for inducing cancers, i.e. no
amount of radiation should be considered absolutely safe. Recent data from the
atomic bomb survivors (Pierce 2000) and medically irradiated populations
(UNSCEAR 2000) demonstrate small, but significant increases in cancer risk even
at the level of doses that are relevant to interventional fluoroscopy
procedures. The increased risk of cancer depends upon the age and sex of the
patient at exposure. Children are considerably more sensitive to radiation than
adults, as consistently shown in epidemiologic studies of irradiated
populations.
Health care providers are also at risk of radiation damage from chronic exposure
to radiation from these procedures. There are an increasing number of case
reports of skin changes on the hands and injuries to the lens of the eye in
operators and assistants (Faulkner 2001). Although cancer is uncommon, cancers
associated with radiation exposure in adults may include leukemia and breast
cancer (Yoshinaga 2004).
| Immediate |
Long-Term |
| Optimize dose to patient |
|
Use proper radiologic technique:
-
Maximize distance between x-ray tube and patient
-
Minimize distance between patient and image receptor
-
Limit use of electronic magnification
Control fluoroscopy time:
-
Limit use to necessary evaluation of moving structures
-
Employ last-image-hold to review findings
Control images:
-
Limit acquisition to essential diagnostic and documentation purposes
Reduce dose:
-
Reduce field size (collimate) and minimize field overlap
-
Use pulsed fluoroscopy and low frame rate
|
Include medical physicist in decisions
-
Machine selection and maintenance
Incorporate dose-reduction technologies and dose-measurement devices in equipment
Establish a facility quality improvement program that includes an appropriate
x-ray equipment quality assurance program, overseen by a medical physicist,
which includes equipment evaluation/inspection at appropriate intervals.
|
|
Minimize Dose to Operators and Staff |
|
Keep hands out of the beam
Use movable shields
Maintain awareness of body position relative to the x-ray beam:
-
Horizontal x-ray beam - operator and staff should stand on the side of the
image receptor
-
Vertical x-ray beam - the image receptor should be above the table
Wear adequate protection
-
Protective well-fitted lead apron
-
Leaded glasses
|
Improve ergonomics of operators and staff:
-
Train operators and staff in ergonomically good positioning when using
fluoroscopy equipment; periodicially assess their practice
-
Identify and provide the ergonomically best personal protective gear for
operators and staff
-
Urge manufacturers to develop ergonomically improved personal protective gear
-
Recommend research to improve ergonomics for personal protective gear
|
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