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:
Control fluoroscopy time:
Include medical physicist in decisions
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:
Wear adequate protection
Improve ergonomics of operators and staff: