10 pearls of radiation protection

Dosimeters are devices that measure cumulative radiation exposure. Use personal dosimetry (see further discussion in the Dosimetry section). Fluoroscopy time is a measure of time not dose. For low linear energy transfer radiation and low dose rates there is a good chance of repair between radiation insults. 10 Pearls: Radiation protection of patients in CT http://rpop.iaea.org 6. Good technique= _____ slices only when necessary, Pay attention to radiation dose values and compare with _________ ____________ __________ (___), Be aware of CT dose ______ and recommended dose levels for different body regions, Exam: CT head Peak skin dose is the highest radiation dose at any portion of a patients skin during a procedure. endobj We are exposed to radiation every day from natural sources like soil, rocks, and the sun. Remember: Some tissues of a growing child are more sensitive to radiation than adult Children have longer life span to manifest radiation effects 0000623077 00000 n The most common adverse reactions are thrombocytopenia, neutropenia, fatigue, nausea, vomiting, diarrhea. Use ceiling-suspended screens, lateral shields, and table curtains. 0000622746 00000 n Overall, the International Commission on Radiological Protection (ICRP) recommends a risk coefficient of 5% per sievert of radiation for fatal stochastic effects. Reduction of radiation follows the inverse square law with distance, such that doubling distance will quarter the dose. According to the Center for Disease Control (CDC), radiation dose between 50 mGy to 100 mGy is regarded inconclusive in terms of impact on the fetus. 0 We are also exposed to radiation from man-made sources like medical X-rays and smoke detectors. 0000092961 00000 n 0000093381 00000 n Scattered x-rays give up part of their energy during the scattering process, and thus energy deposited in tissues from scattered x-rays is lower than directly from the x-ray source. The disposable pads may also lead to a reduction in interventionalist hand dose, depending on positioning. 0000535469 00000 n Lastly, exposure duration should be limited whenever possible. In approving an interventional procedure, within the clinical context, consideration should be given to any previous radiation exposure of the patient, particularly in the last 60 days (dose review), the length of time between repeated procedures (if relevant), and the gender, age, size (e.g., bariatric), and pregnancy status of the patient. The duration of radiation exposure, distance from the radiation source, and physical shielding are the key facets in reducing exposure. endobj The other type of stochastic response to radiation exposure is heritable effects, where exposure of the reproductive cells may lead to disease in the children of the person exposed. Monitors radiation in the air, water, soils, and foods. 0000336077 00000 n Again, the issue of individual sensitivity to radiation exposure is relevant. Use pulsed fluoroscopy with the lowest frame rate possible to obtain images of acceptable quality. The thresholds for detrimental effects are generally thought to be above the range 0.1 to 0.2 Gy (100200 mGy). 0000005369 00000 n Annals of the ICRP. World neurosurgery. 0000335827 00000 n In comparison, there is a chance that a specificx-raycauses DNA damage that later develops into cancer, a stochastic effect. endobj This ensures protection irrespective of staff location, especially for scrub and scout nurses and radiographers/technologists who may be circulating in the room. It is determined in air so it does not include the backscatter from the patient, which is relevant when considering the dose to the patient. For example, after a 20-minute video was used to educate physicians on radiation best practices, it was found to reduce median fluoroscopy time by 30% to 50%. 0000131810 00000 n 0000621263 00000 n [3]For reference, 20 mSv/year roughly equates to2 to 3 abdominal and pelvic computed tomography (CT) scans or7TO 9 years of background radiation. 2 0 obj 0000337306 00000 n 0000037746 00000 n Several factors appear to increase the risk of radiation-induced cataract, including increasing age, gender (female), marital status (single), socioeconomic status (low), smoking history, and body mass index, among others. public radiation protection, which is the protection of individual members of the public and the population in general. Their findings show a greater percentage (22 of 26 cases, 85%) of left-sided malignancy , which is speculated to correlate with the higher levels of radiation typically received on the left side of the head because of the positioning of the interventionalist during a case. have facilitated a quasi registry of brain cancers in interventionalists (n=31) primarily through self-reporting. 2018 Apr [PubMed PMID: 28804031], Feel free to get in touch with us and send a message. 0000174773 00000 n There are several comprehensive guidelines that provide useful information on operational requirements for radiation protection. Certainly, screening for specific mutations is a well-established and increasingly affordable practice in the context of patients with positive family histories of breast, ovarian, and colorectal cancers. It is not necessary to use additional lead aprons (and is most likely counterproductive because of the physical weight). 10 Pearls: Radiation protection of patients in fluoroscopy Image receptor Image receptor Image receptor Pulsed fluoroscopy reduces exposure X ray pulses 1 second. endobj %PDF-1.5 This provides better protection from scattered dose. A similar approach can be used to minimize exposure to medical professionals. It is recommended to download the freely available posters from the IAEA website, which are provided in multiple languages. 0000344090 00000 n The Agency supports other federal, state and local agencies by developing federal guidance and technical reports on radiation protection, and assists in response to radiological emergencies. [6][7][5], Radiation exposure canproduce biological effects as either a dose-dependent effect or a dose-dependent probability. Roguin etal. Aprons made of lead material typically last 10 years when well cared for (hung appropriately and cleaned). 0000623493 00000 n Registration and licensing for machine-generated sources of radiation. 2012 Nov; [PubMed PMID: 22832138], Lin Y, Internal radiation therapy: a neglected aspect of nuclear medicine in the molecular era. As vision impairment worsens, cataract surgery can be required. QjO[ ok;[HwWW+o/RyXn3#mN uOEEQX+q,1K 40pfzVM/>vgJs2CAT;S34L.+^DLH~vF5g#fhA#[m$,z"y^9 ;:Xd} Typically, measures that reduce the dose to the patient also reduce the dose to staff. The low compliance rate for wearing leaded eyeglasses demonstrates an area for improvement. Avoid exposing the same area of the skin in different projections (skin sparing). Magnification significantly increases the exposure to the patient; therefore, magnification should be used judiciously. However, much thinner, more flexible materials are now available. xZYk\~?G{@WZ@4Z0&d!fLsZ2BjuZ^9N_~z>}:Nezx{s'm_noGO foogA??OOce M58OEYp:Dyce *v7sM"N:,v^Mj=f \ Circulating staff in the room may also receive high scatter doses, particularly the nurses providing sedation to the patient and communicating with them. 4 0 obj Shorter scan length= -___-____ % dose reduction, good technique= ________ scan lengths to what is necessary, Restrict scan lengths to what is necessary, good technique= always _______ the area of interest in isocenter of CT gantry, Always center area of interest in isocenter of CT gantry, good technique= all CT protocols should state the _______ and ______ locations for different clinical indications. It includes contributions from both the primary x-ray beam and from scattered radiation (including backscatter from the patient). The effectiveness of distance from the source of radiation (the patient anatomy being imaged is the primary source of scatter) should not be underestimated. Get email alerts based on your topic preferences like news releases, job openings, emergency updates and more! For an interventionalist, the full range of personal protective equipment available and recommended can be burdensome, particularly for the duration that it needs to be worn. Minimize number of frames and cine runs to clinically acceptable level Avoid using the acquisition 232 107 Minimize distance between the patient and the image receptor. 0000009249 00000 n .Nu.{M|*j(Yb9l_7 wo}$gj>0.&}br8`QMiEMV$>`Z'nI Scattering exposure levels decrease proportionally with the inverse of the distance squared from the x-ray source. It is unlikely that a procedure will be stopped due to radiation dose alone, because the clinical benefit of a successful procedure almost always exceeds any detriment to the patient due to radiation. This leads to controversy. Multiphase CT can increase the dose by as much as 2-3 folds over single phase CT. What should be adjusted according to patient and body part? The As Low as Reasonably Achievable (ALARA) principle, defined by the code of federal regulations, was created to ensure that all measures to reduce radiation exposure have been taken while acknowledging that radiation is an integral part of diagnosing and treating patients. Portable rolling shields, which do not require installation, can protect staff in operating rooms and interventional settings. 0000008512 00000 n [16]Brachytherapy comes with its side effects, which differ from ionizing radiation from medical imaging. <> Review how radiation is measured, and understand the concept of radiation's half-life value. However, getting into a routine practice of utilizing protective equipment is considered essential given the increasing occupational doses within the interventional suite and the expanding scientific knowledge of deleterious effects from exposure. It is thought that reducing damage will ultimately reduce the risk of radiation-induced carcinogenesis. Reference levels: __________, Exam: CT adult chest The most common tissue reactions for patients seen in image-guided interventional procedures are those occurring in the skin. 0000337136 00000 n The dose limits recommended by the ICRP for people working with radiation are an effective dose of 20 mSv per year over 5 years, not to exceed 50 mSv in any one year. For health professionals Health professionals can find answers to frequently asked questions about different medical procedures and the safe use of ionizing radiation in medicine. 2 0 obj Keep hands outside the primary beam unless totally unavoidable Hands inside the central area of the primary beam will increase exposure factors (kV, mA) and doses to patient and staff Thyroid protection Lead glass eyewear with side protection 1. Any amount of radiation exposure will increasethe risk ofstochastic effects, namely the chances of developing malignancy following radiation exposure. 2015 Sep [PubMed PMID: 26445567], Leonard RB,Ricks RC, Emergency department radiation accident protocol. At higher doses where the likelihood of multiple interactions in a cell increases, the shape of the response curve is more likely to be linear-quadratic. The level of protection depends on positioning of the shield and may need to be adjusted during the procedure to be effective. As medical imaging evolves, so does the medical communitys understanding of how to protect people from ionizing radiation. In particular, clinicians or medical staff that use fluoroscopic imagingoutside of dedicated radiologyor interventionaldepartments have low adherence to radiation safety guidelines. Updated: 01/05/2022 . Most body CT exams should be performed with the use of _____. !t5Sq. )\8SWa'g`g&fPs8AO&--X& <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 29 0 R 30 0 R 51 0 R 57 0 R] /MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 0000175431 00000 n JBJS reviews. Although not always practical for the interventionalist who, by necessity, must be close to the radiation source, it should be kept in mind for others within the room. What are some simple ways to notify patients to inform the tech of possible pregnancy? Given the inverse square law relationship for dose and distance and the rate at which the area of the beam changes with distance, this means that DAP/KAP is constant at any distance from the x-ray tube. Protocol development and education strategies have been effective in multiple specialties. 1 0 obj Physicians, surgeons, and radiologic personnel all play a key role in educating patients on the potential adverse effects of radiation exposure. 0000092602 00000 n 10 Pearls: Radiation protection of staff in fluoroscopy 10 Pearls: Radiation protection of staff in fluoroscopy Reducing patient dose always results in staff dose reduction 1. Annals of the ICRP. This includes biological aspects, physical concepts, biophysical dosimetry, external and internal personal dosimetry and monitoring, environmental and workplace monitoring, accident . 0000570591 00000 n [3]It is important to note that deterministic effects are determined by the cumulative amount of radiation exposure an organ or tissue experiences over time (thelifetime equivalent dose). *>C$lQ^3}l~j@|E,cec7WL}4sbamZjH^$HfM\LR{/Qh:k# These are constructed of a lead equivalent glass or acrylic, allowing visualization of the patient through the shield. A typical complaint when wearing lead glasses is that they fog and reduce vision. 4 0 obj radiation dose to patients Start using images with some noise without loss of diagnostic information Image Quality: Unnecessarily high Image Quality: Adequate for diagnosis Images courtesy of: MK Kalra, S. Singh, MGH Webster Center for Advanced Research and Education in Radiation 10 Pearls: Radiation protection of patients in CT Related Poster! 338 0 obj <>stream 2SO2(g)+O2(g)2SO3(g). [52,y{Nlh.m]^V1xb Fxheq9|CQ OCZ?t]l~2%`2%y"D/QLT'dL>03-] How would the following change the rate of the reaction shown here? vo(UH.BXyo~e2wBt Diagnostic images can be obtained at 50-75% lower radiation dose compared to routine or general use protocols. EPA standards set protective limits on the radioactivity in soil, water and air that comes from human activities. Journal of biomedical research. In the study of interventionalists performing EVAR procedures, blood samples were also exposed to known doses of radiation invitro. Staff can lower their exposure levels by a factor of four by doubling their distance from the source. % [14]Interestingly, the opacification of the posterior lens, in comparison to the other locations, is relatively specific to radiation exposure. for lung nodule follow up or kidney stones? It is recognized that people with genetic disorders involving an impaired genetic response to DNA repairfor example, ataxia telangiectasiahave higher susceptibility to radiation effects or are considered more radiosensitive. 0000092347 00000 n Maximum sensitivity for malformation is during major organogenesis (38 weeks) and for IQ reduction during brain development (815 weeks) with continuing sensitivity in weeks 16 to 25, again both with a threshold around 0.1 Gy, although this may be lower. Some tissues in children are more sensitive to radiation and they have a longer lifespan over which cancer effects may be expressed 5. Leaded aprons, which are required in most states, commonly come in thicknesses of 0.25 mm, 0.35 mm, and 0.5 mm. Scattered radiation also penetrates from the side, and glasses with side shields are preferred, although this does add to the weight of the glasses. This is indicative of the higher radiosensitivity of the lens compared with other tissues. Following the ALARA principle, health care workers should confirm that the benefits of the exposure outweigh the risks and strive to decrease radiation exposure as far below the dose limits as practical. [4]This ionization produces free radicals, chemically active compounds that can indirectly damage DNA. As doses increase above the threshold the severity of the effect also increases. 0000623100 00000 n In addition, the medications that the patient is taking should be considered. This consultation also provides an opportunity to discuss any concerns regarding the risks of radiation exposure while pregnant. 2020 Jan; [PubMed PMID: 31899700], Hayda RA,Hsu RY,DePasse JM,Gil JA, Radiation Exposure and Health Risks for Orthopaedic Surgeons. 0000005095 00000 n 2014 Jul; [PubMed PMID: 24794798], Lpez M,Martn M, Medical management of the acute radiation syndrome. 'u 0000623301 00000 n EPA's Role in Radiation Protection. The Office of Radiation Protection in Washington works to protect the health and safety of people in Washington from unnecessary exposure to radiation. Because of the level of potential radiation exposure for interventionalists, you should always wear, at a minimum, one personal dosimeter on the inside of the protective apron at chest level. 1 0 obj Multiple pass or phase CT should NOT be performed routinely Multiphase CT can increase the dose by as much as 2-3 folds over single phase CT 10. stream <> Other international studies pool data on survivors of Chernobyl, employees of the nuclear power industry, and those exposed during nuclear accidents such as Fukushima. The Office of Radiation Protection protects and improves the health of people in Washington State by ensuring exposure to radiation is as low as reasonably achievable. Staff who comply with dosimeter regulations can receive feedback about where and when they are receiving radiation doses, which can help audit behaviors and promote increased safety awareness. Vary the beam entrance port by rotating the tube around the patient. Understandably this causes anxiety both for the patient and for the interventionalist who must decide whether to perform the procedure, but also for pregnant interventionalists and other staff who may worry about the exposure of their unborn child. It is better to choose the one that can neutralize the EMF production from all . Radiation exposure in utero is known to cause threshold-based effects such as prenatal death, malformation, reduction in IQ, and a stochastic risk related to childhood leukemia and cancer. The effective dose isthe sum over theentire body of the individual organ equivalent doses and is expressed in millisieverts (mSv). Perform scan only if it is indicated! Radiation Protection of Staff (IAEA 10 Pearls) 39: 1. The Ashkenazi Jewish population, for instance, has a 2% chance of carrying a BRCA germ-line mutation that predisposes to impaired p53-mediated DNA, the consequence of which manifests as increased risk of breast, ovarian, peritoneal, and prostate cancers. The International Atomic Energy Agency (IAEA) neatly packages these into the 10 pearls for radiation protection of the patient and staff, which are summarized below. The upper body is already well protected by a standard lead apron. 9. Screening would have to be performed strictly in the context of appropriate counselling and informed interpretation. The annual limit for the hands and the feet is 500 mSv. stream 0000011317 00000 n The recent study demonstrating DNA damage to interventionalists performing EVAR procedures recommends the use of leg shields . Documentation should be performed with last image hold whenever possible and not with cine (acquisition) images. Decreased exposure can be achieved instead by usingpulsed fluoroscopy, which obtains about five images per second without sacrificing imaging quality. Explain how a ligand can bind to a membrane-bound receptor in a smooth muscle cell and cause sustained contraction for a prolonged period without a large increase in ATP breakdown. 0000623274 00000 n Lead garments should be checked every six months to assure their integrity, and leaded aprons should be hung rather than folded to prevent cracking. 115) is provided in three interrelated Safety Guides (IAEA Safety Standards Series No. 0000621509 00000 n These devices should be worn by all hospital staff who encounter planned ionizing radiation. This essentially conveys that the risk of cancer increases approximately with dose, and risk exists even at the lowest doses. 0000092988 00000 n 0000624203 00000 n Fine tune radiation dose for different clinical indications and body regions. However, this is difficult to prove because it would require long-term follow-up through epidemiologic studies. 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