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Interventional Fluoroscopy: Reducing Radiation Risks for Patients and Staff

  • Posted: 04/18/2005

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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.

Risk to patients

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.

Risk to health care providers

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).

Strategies to Manage Radiation Dose to Patients and Operators

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