What are the methods of minimizing radiation exposure during fluoroscopy?

Concerns over radiation safety are valid. Understanding and maintaining safe administration helps patients understand the potential risks during endovascular procedures.

Methods

X-ray production, units of radiation exposure, and forms of direct and indirect exposures are discussed.

Results

Positioning of the image intensifier as close to the patient as practical, moving the x-ray tube as far from the patient as possible, and using pulse fluoroscopy are all ways to help decrease the radiation dose. Collimation, achievable without the use of fluoroscopy, improves image quality while decreasing the radiation dose. Time, distance, and shielding are the three most productive means of reducing radiation exposure.

Conclusion

The best defense against radiation injury to both patient and staff is to minimize the total fluoroscopy time, keep the image intensifier close to the patient, collimate to the region of interest, and use appropriate radiation shielding and monitoring.

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Competition of interest: none.

The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.

Time is one of the three basic safety measures to reduce external radiation exposure. It is important for healthcare personnel to limit the amount of time spent in close proximity to the radiation source when exposure to the radiation source is possible. Reducing the time of an exposure reduces the effective dose (radiation) proportionally. Consequently, the less time you are around the equipment, the smaller your exposure will be.

2. Notification by Radiation Equipment Operator

Before any treatment or procedure, it is the responsibility of the trained and certified radiation equipment operator to notify healthcare personnel in the x-ray or treatment room prior to the activation of radiation producing equipment (RPE).

Any piece of equipment in which x-rays are produced electrically are classified as radiation producing equipment or RPE. These tools are used in a variety of medical applications including radiography, mammography, computed tomography, and fluoroscopy.

3. Fluoroscopic Procedures

Healthcare personnel performing fluoroscopic procedures must ensure that the patient is kept as close as possible to the image intensifier side of the fluoroscopic unit and away from the tube side of the unit. All healthcare personnel involved in the fluoroscopic procedure must stand on the image intensifier side of the fluoroscopic unit, whenever possible, to reduce the radiation exposure. Standing on the the same side as the image intensifier radiation intensity is decreased.

4. Avoid Direct Beam Exposure

Healthcare personnel assisting with radiological procedures must avoid holding the patient manually during a radiographic study due to the risk of direct beam exposure.  Any individual holding or supporting a person during radiation exposure should wear protective gloves and apron with a minimum of 0.25 millimeters lead equivalent. Under no circumstances should individuals holding or supporting a person’s part of their body be directly in the primary beam. Healthcare personnel must avoid exposing any body parts to direct x-ray beam exposure.

5. Utilize Shielding

Whenever possible, appropriate shielding should be used to provide attenuation of the radiation being delivered to the healthcare personnel who are potentially exposed. Healthcare personnel must keep all body parts out of the direct x-ray beam. There are a variety of shielding options available and may include, but are not limited to:

• Walls, windows, control booths, and doors
• Mobile rigid shields on wheels for transport to various areas
• Ceiling-suspended transparent barriers
• Flexible (lead or lead equivalent) aprons, vests, and skirts
• Thyroid collars/shields
• Lead Gloves
• Leaded safety eye glasses with side shields

Specific Shielding Applications

Healthcare personnel who may have to stand with their backs exposed to the radiation beam must wear wrap-around aprons to decrease the risk of radiation exposure.

Bone and Bone Marrow Protection

When healthcare personnel are in close proximity to the radiation beam they should wear an appropriate lead or lead equivalent apron of sufficient length to shield the upper legs and protect the long bones and bone marrow from increased doses of radiation.

Thyroid Protection 

Healthcare personnel must wear a thyroid collar to protect the thyroid whenever the likelihood of the procedure places them at a higher risk of increased exposure.

Female Healthcare Personnel 

Female healthcare personnel must protect their breasts from radiation exposure by utilizing an apron that completely covers the area.

Healthcare personnel must shield the lens of the eye by using leaded eyeglasses with wrap-around side shields or leaded face shields to reduce scatter radiation when it is anticipated that increased fluoroscopic time may be necessary.

Limiting Radiation Exposure 

Reducing radiological exposure in healthcare settings is important for both occupational workers as well as patients. The following guidelines are based on the radiation safety principles of time, distance, and shielding. By following these guidelines, you can reduce your occupational exposure to radiation.

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Note: This information included in this post is intended for general reference information only. The information provided is not a substitute for professional advice and should not be relied upon in the absence of such professional advice.