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RADIATION PROTECTION

 Effective measures employed by radiation workers to

RADIATION PROTECTION safeguard patient, personnel and the general public
from unnecessary exposure to ionizing radiation
 Deals with different techniques and procedures to
control radiation levels and reduce unnecessary
radiation exposure to the patient, radiation workers
and to the public
 X-rays:
 Use as diagnostic and therapeutic tool
 Can be beneficial and destructive

AIM OF RADIATION PROTECTION

 To limit human exposure to ionizing radiation to a

degree that is reasonable and acceptable in relation to
the benefit gained from the activities that involve the
exposure
 Reducing the likelihood of occurrence of somatic and
genetic effects
 To limit stochastic effects (e.g. cancer & genetic effects)
 To limit deterministic effects (e.g. cataracts, skin
erythema, sterility)

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RADIATION PROTECTION STANDARD

ORGANIZATION NAS/NRC-BEIR

 International Commission on Radiologic Protection

(ICRP)  National Academy of Sciences/National Research
 National Council on Radiation Protection and Council Committee on the Biological Effects of
Measurements (NCRP) Ionizing Radiation
 National Academy of Sciences/National Research  Organization that studies biological effects of ionizing
Council Committee on the Biological Effects of radiation and publishes resulting data
Ionizing Radiation (NAS/NRC-BEIR)
 Nuclear Regulatory Commission (NRC)

ICRP NCRP

 National Council on Radiation Protection and

 International Commission on Radiologic Protection Measurements
 Organization that publishes international radiation  Organization that publishes radiation protection
protection guidelines guidelines for the United States

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AGENCIES RESPONSIBLE FOR FORMULATING

NRC POLICIES AND STANDARDS OF RADIATION
PROTECTION

 Food And Drug Administration (FDA-DOH)

 Nuclear Regulatory Commission  Bureau of Food And Drugs (BFAD)
 Organization that enforces radiation protection  Bureau of Health Devices and Technology (BHDT)
standards at the federal level related to use of  Center For Device Regulation, Radiation Health And
radioactive material Research (CDRRHR)
 Philippine Nuclear Research Institute (PNRI )

PHILIPPINE REGULATORY AGENCIES PHILIPPINE REGULATORY AGENCIES

FDA-DOH BHDT
 Protects and promotes the right to health of the Filipino  Develops plans policies, programs and strategies for
people regulating health and health-devices technology
 Establish and maintain an effective health products
regulatory system CDRRHR
BFAD  Regulation of the use of radiation devices
 Has a regulatory functions over food, drugs, cosmetics,  Regulates the manufacture, import, export, distribution,
medical devices and household hazardous substances promotion, advertisement and sale of medical devices,
radiation devices and health-related devices

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PHILIPPINE REGULATORY AGENCIES SYSTEMS OF DOSE LIMITATION

PNRI  PRINCIPLES OF JUSTIFICATION

 Has a regulatory functions over radioactive materials in  PRINCIPLES OF OPTIMIZATION
the Philippines
 PRINCIPLES OF DOSE LIMITS

PRINCIPLES OF JUSTIFICATION RADIOGRAPHERS‘ RESPONSIBILITY

 Benefits vs Risk
 The potential benefits of
exposing the patient to  Protects the patient from unnecessary exposure
ionizing radiation must  Best accomplished by avoiding repeat exposures
far outweigh the
 Use smallest amount of radiation that produces a
potential risk of adverse diagnostic radiographic image
biologic effects

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RADIOLOGISTS/PHYSICIANS‘
PRINCIPLES OF OPTIMIZATION
RESPONSIBILITY

 Referred to as ALARA
 The exposure from a
justified application of
 Radiation safety of the patient radiation must be kept As
 Best accomplished by consultation Low As Reasonably
 Should not order unnecessary examinations Achievable (ALARA)
 Achieved By: application
of basic principles of
radiation protection

PRINCIPLES OF OPTIMIZATION PRINCIPLES OF DOSE LIMIT

 Maximum permissible
 Applied to keep radiation dose (MPD)
exposure and
 The dose of radiation that
consequent dose to the
would be expected to
lowest possible level
produce no significant
 Applied to prevent the radiation effects
stochastic effects of
 <DL: no response
radiation exposure (e.g.
cancer, leukemia &  >DL: with risk but small
genetic effects)

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PRINCIPLES OF DOSE LIMIT PRINCIPLES OF DOSE LIMIT

 Upper boundary dose of

 No individual exposure
ionizing radiation that
should exceed the dose
can be absorbed in a
limit
single exposure or
 Exposure should be annually which results in
within the prescribed negligible risk of
dose limit  Bodily injury
 Hereditary damage

CLASSIFICATON OF EXPOSED CLASSIFICATION OF RADIATION

INDIVIDUALS WORKERS

 Radiation Workers  Occupationally exposed workers

 Those who incur, as an occupational risk, a certain  Individuals who have a significant potential for exposure
likelihood of exposure to ionizing radiation in the course to radiation in the course of their employment
of their normal duties  Occasionally exposed workers
 General Public  Individuals whose duties may occasionally bring them
 Those who are not classified as radiation workers into areas where radiation exposure may occur

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CLASSIFICATION OF WORKING AREA CONTROLLED AREA

 An area occupied primarily by radiology personnel &

patients
 CONTROLLED AREA  Occupied by persons trained in radiation safety and wearing
 UNCONTROLLED AREA personnel monitoring devices
 DL: <1 mSv/week (100 mrem/week)
 Based on the annual recommended occupational dose limit of
5000 mrem/yr or 50 mSv/yr

UNCONTROLLED AREA

 An area that can be occupied by anyone

 General public areas where personnel are not provided
radiation exposure monitors (dosimeters) or radiation
safety training should be shielded
 DL: <20 μSv/week (2 mrem/week )
 Based on the annual recommended dose limit for the public of
100 mrem/yr or 1 mSv/yr
 Protective Barrier: it should ensure that no individual will
receive more than 2.5 mrem/hr or 25 µSv/hr

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CARDINAL PRINCIPLES OF
MINIMIZE TIME
RADIATION PROTECTION
 Reduce the amount of time spent in the vicinity of the
radiation source while it is operating
 Shortening the length of time spent in a room where
 Simplified rules designed to ensure safety in radiation x-radiation is produced
areas for occupational workers  The time of exposure should be kept to a minimum
 STD:  Radiography: to reduce motion blur
 SHIELDING  Fluoroscopy: to reduce patient & personnel exposure
 TIME  5-minute Reset Timer:
 DISTANCE  Reminds the radiologist that a considerable amount of
fluoroscopic time has elapsed

MAXIMIZE DISTANCE MAXIMIZE DISTANCE

 Standing at the greatest distance possible from an • Two steps back

energized x-ray beam • Exposure Rate: 5 mR/hr
 Increase the distance between the radiation and the (50 μGya/hr)
individual protected • Behind the radiologist
 Effective method to reduce exposure to radiation • Zero exposure
 Inverse Square Law: radiation dose is inversely
related to the distance between the source & the
patient

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ISOEXPOSURE LINES USE SHIELDING

 Interposing a radiation-absorbent shielding

• Lines that represent
 material between the radiographer and the
positions of equal
radiation exposure in the  source of radiation
fluoroscopy room  Insert shielding material between the radiation
source and the exposed person
• Exposure Rate in Normal
 Greatly reduces the level of radiation exposure
Position: 300 mR/hr (3
mGya/hr)  Composition: lead
 HVL & TVL: estimate the amount that a protective
barrier reduces radiation intensity
 1 TLV = 3.3 HVL

USE SHIELDING

 Protective Apron: 0.5 mm Pb

 Equivalent to 2 HVLs
 Reduce occupational exposure to 25% (actual = 10% only)
 Note:
 Structural shielding for x-ray imaging facilities are
designed in accordance to NCRP Report No. 49
 Thickness recommendations for lead devices have been
determined by NCRP Report No. 102

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DOSE LIMITS
EFFECTIVE DOSE LIMIT RECOMMENDATION
OCCUPATIONAL EXPOSURES
- Effective Dose Limits
Annual 50 mSv (5 rem)
 Radiation Worker: 50 mSv/yr (5 rem/yr ) Cumulative 10 mSv x age (1 rem x age)

 General Public: Tissues & Organs Annual Dose Limits

Lens of eye 150 mSv (15 rem)
 5 mSv/yr (0.5 rem/yr )
Skin, hands & feet 500 mSv (50 rem)
 For infrequent exposure
PUBLIC EXPOSURES
 1/10 DL for radiation worker
Types of Exposure Annual Dose Limit
 1 mSv/yr (0.1 rem/yr)
Continuous/Frequent Exposure 1 mSv (0.1 rem)
 For continuous exposure
Infrequent Exposure 5 mSv (0.5 rem)
 1/50 DL for radiation worker

DESIGN OF RADIOLOGIC FACILITIES

EFFECTIVE DOSE LIMIT RECOMMENDATION
EDUCATION AND TRAINING EXPOSURES
- Dose Limit
Annual 1 mSv (0.1 rem)
Tissue & Organs Dose Limit
 RADIOGRAPHIC PROTECTION FEATURES
Lens of eye 15 mSv (1.5 rem)
 FLUOROSCOPIC PROTECTION FEATURES
Skin, hands & feet 50 mSv (5 rem)
EMBRYO-FETUS/PREGNANCY EXPOSURES  DESIGN OF PROTECTIVE BARRIERS
Monthly Dose Limit 0.5 mSv (0.05 rem)
Entire Gestational Period 5 mSv (0.5 rem)

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X-RAY IMAGING SYSTEM

RADIOGRAPHIC PROTECTION
 DESIGNED TO IMPROVE RADIOGRAPHIC QUALITY
FEATURES
 DESIGNED REDUCE PATIENT RADIATION DOSE

RADIOGRAPHIC PROTECTION
PROTECTIVE X-RAY TUBE HOUSING
FEATURES

 Protective X-ray Tube  Beam Alignment

Housing  Filtration  Required to protect
 Control Panel  Reproducibility patient & RT
 Source-to-Image  Linearity  Restricts emission of x-
Receptor Distance  Operator Shield ray to the area of useful
Indicator beam
 Mobile X-ray Imaging
 Collimation System  Reduces leakage & off-
 Positive-Beam Limitation focus radiations

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PROTECTIVE X-RAY TUBE HOUSING CONTROL PANEL/CONSOLE

 Selects and displays exposure factors

 Confines the HV entering  Location: behind the protective barrier with window
the tube  Must indicate the conditions of exposure
 Prevents electric shock  Must positively indicate when the x-ray tube is
 Requirement: lead-lined energized
 Leakage:  Must indicate when the x-ray beam is energized and
 <100 mR/hr (1 mGya/hr) at terminated (visible or audible signals)
1m  Use of kVp & mA indicators

SID INDICATOR

 Must be provided
 Tape measure or lasers attached to the collimators or
tube housing
 Manually measures the distance from the anode focal
spot to the IR
 Centering Indicators: accurate within 1% of SID
 Distance Indicators: accurate within 2% of SID

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APERTURE DIAPHRAGM BEAM RESTRICTION

 Accomplished by
providing light-localized,
variable-aperture
 Simplest
rectangular collimators
 Fixed lead opening
 Others:
designed
 Aperture diaphragm
 For fixed IR size
 Cones
 For constant SID
 Cylinders

VARIABLE-APERTURE COLLIMATOR VARIABLE APERTURE COLLIMATOR

 Most common used

beam restricting device
 PBL: automatic collimator

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BEAM ALIGNMENT FILTRATION

 Absorbs low energy, long

wavelength or soft x-rays
 Reduces exposure to the
patient’s skin and
 X-ray tube should be provided with a mechanism to superficial tissue
ensure proper alignment of the x-ray beam and IR  Increases mean energy or
quality (beam hardening)
 Decreases overall
intensity or x-ray quantity

FILTRATION TOTAL FILTRATION

 Inherent filtration plus
 Types: added filtration
 Inherent = 1.5 mm Al  2.5 mm Al:
 Glass envelope  Fixed x-ray unit (>70 kVp)
 Insulating oil  Mobile & Fluoroscopy
 Glass window  1.5 mm Al:
 Mirror  Fixed x-ray unit (50-70
 Added = 1.0 mm Al kVp)
 Extra sheet of Al  0.5 mm Al: <50 kVp
 Fixed x-ray unit (<50 kVp)

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COMPENSATING FILTER COMPENSATING FILTER

 Makes the remnant
beam more uniform  Examples:
 Inserted between the  Wedge filter
x-ray source and the  Trough filter
patient  Aluminum step wedge
 Composition: filter
 Aluminum  Conic filter
 Lead-acrylic  Bowtie filter

ALUMINUM STEP WEDGE

 For serial radiography of

the abdomen and lower
extremities

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WEDGE FILTER TROUGH FILTER

 For radiography of the  For radiography of the

foot chest

EXPOSURE REPRODUCIBILITY EXPOSURE LINEARITY

 A consistency in output in radiation intensity at any

 A consistency in output in radiation intensity for selected kVp settings when generator settings are
identical generator settings from one individual changed from one mA and time combination
exposure to subsequent exposures  Checking:
 Verification: use same technical factors to make of  Constant mA x Adjusted time = Constant mAs
repeated series radiation exposure  Constant time x Adjusted mA = Constant mAs
 Tolerance: 5% or less  Tolerance: 10% or less

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OPERATOR SHIELD

 Fixed Protective
Barrier:
 Console Booth
 RT stands behind this
barrier during the
exposure

OPERATOR SHIELD

LEAD ACRYLIC
 Protective Apparel: SECONDARY
must be worn when BARRIER
the RT is inside the
exposure room

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OPERATOR SHIELD

LEAD ACRYLIC  Exposure Control:

must be fixed to the
SECONDARY operating console
BARRIER and not a long cord

OPERATOR SHIELD MOBILE X-RAY IMAGING SYSTEM

 Exposure Control:  Lead Apron:

must be fixed to the  Should be assigned on
operating console each x-ray unit
and not a long cord  If mobile barrier is
unavailable
 Exposure Switch/Cord:
 At least 2 m or 6 ft long

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MOBILE X-RAY IMAGING SYSTEM

 Useful Beam: must be

directed away from the
RT
 Least scatter: 90-degree
angle from the patient
 = 1/1000 or 0.1% of the
primary beam intensity at
1m

FLUOROSCOPIC PROTECTION
FEATURES

FLUOROSCOPIC PROTECTION
 Source-to-Skin Distance  Bucky Slot Cover
FEATURES  Primary Protective Barrier  Protective Curtain
 Filtration  Cumulative Timer
 Collimation  Dose Area Product
 Exposure Control

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SOURCE-TO-SKIN DISTANCE (SSD) PRIMARY PROTECTIVE BARRIER

 Fluoroscopic IR assembly:
 Source-to-tabletop distance  Provides barrier to primary radiation
 Portable Radiography: minimum of at least 12  2 mm Pb equivalent
inches SSD  Not activated when the II is in parked position
 Stationary/Fixed Fluoroscopes: Not less than  Fluoroscopic C-arm: RT should stand on the II
38 cm or 15 in. side during lateral or oblique projections
 Mobile/Portable Fluoroscopes: not less than  Note: II tube should be as close as possible to
30 cm or 12 in. the patient (ALARA)

TOTAL FILTRATION

 Must be equivalent to 2.5

mm Al

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COLLIMATION EXPOSURE CONTROL

 Tight collimation of the beam

 Collimation should be no larger than the size of the  Must be dead-man type
image receptor being used
 No pressure = exposure automatically
 PBL responds when an image receptor is placed in the
terminates
tray containing sensors that measure its size
 Accuracy of the collimator is subject to strict quality  Examples:
control standards  Conventional foot pedal
 Pressure switch

BUCKY SLOT COVER PROTECTIVE CURTAIN/PANEL

 Should be position
 Bucky Tray: moved at the end of the table between
during fluoroscopy fluoroscopist &
 Result: leaving an opening in the side of the table patient
approximately 5 cm wide at gonadal level  Equivalent: at least
 Opening: should be covered with at least 0.25 0.25 mm Pb
mm Pb equivalent equivalent

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CUMULATIVE TIMER TABLETOP EXPOSURE RATE

 Fluoroscopic timer
 5-minute reset timer  For each mA operation at 80 kVp:
 Audible sound > 5 mins (300 secs)  Not exceed 2.1 R/min (21 mGya/min)
 Reminds the radiologist about the x-ray beam-  No Optional High-Level Control:
 <10 R/min (100 mGya//min )
on time
 For normal operation
 Should not be reset  With Optional High-Level Control:
 RT: record total beam-on time  <20 R/min (200 mGya/min)
 For interventional procedures
 Note: >30 mins causes skin injury
 Cineradiography/Videography: no limit

ALARA IN FLUOROSCOPY DOSE AREA PRODUCT (DAP)

 A quantity that reflects not only the dose but

 II tube should be as close as possible to the also the volume of tissue irradiated
patient  Better indicator of the risk than dose
 Pulsed or intermittent fluoroscopy or low-  Measured using DAP meter
dose modes should be used when possible  Expressed in: cGy-cm2 (R-cm2)
 Last-image hold feature  Directly proportional to the field size
 Smaller Field Size:
 Less DAP
 Less risk

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LEAD EQUIVALENT DESCRIPTION

Mininum lead equivalent
required
0.25 mm Pb Fluoroscopic protective
curtain
Bucky slot shield
Protective lead apron
RADIATION MONITORING
0.50 mm Pb
Thyroid shield
1.5 mm Pb Control booth window
2.0 mm Pb Fluoroscopic IR assembly
1/16-in Pb Primary barrier
1/32-in Pb Secondary barrier
0.8 mm Pb
X-ray room door
(1/32-in Pb)

MONITORING PERSONNEL
FILM BADGE
EXPOSURE

 Consist of plastic case, x-ray film, and filters

 Film used is similar to dental x-ray film
 FILM BADGE  Dose Measurement: as low as 100 μGya
 TLD  <100 μGya reported as minimal
 OSL  Sensitive to environmental factors
 POCKET DOSIMETER  Changed monthly
 Filters: measure the intensity of radiation

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TLD OSL
 Lithium fluoride crystals
 Used mainly in ring badges worn by nuclear medicine  Aluminum oxide
technologists  Dose measurement: as low as 10 μGya
 Dose measurement: as low as 50 μGya  <10 μGya reported as minimal
 <50 μGya reported as minimal  Unaffected by temperature and humidity
 Insensitive to environmental factors  Can be worn 3 months at a time
 Can be worn for longer periods than film badges  Can be reanalyzed multiple times, if necessary
 Expensive (TLD and TLD reader)

POCKET DOSIMETER AREA MONITORING

 Uses quartz fiber

 Look like large pens or flash drives  PORTABLE IONIZATION CHAMBER
 Provides immediate personal dosimetry  PROPORTIONAL COUNTER
 Useful in IR laboratories  GEIGER-MUELLER DETECTOR
 Waiting several months for readings is not reasonable

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PORTABLE IONIZATION CHAMBER ION CHAMBER DOSIMETER

 Used to measure radiation in
an area
 Fluoroscopic room, storage
areas for radioisotopes,
 Doses traveling through  Used for accurate
barriers
measurement of useful
 Patients who have
beams
radioactive sources within
them
 Radionuclide generators
and syringes
 As low as 10 μGya per hour (1
mR/hr)

DOSE CALIBRATOR PROPORTIONAL COUNTER

 Laboratory
instrument
 Used in nuclear medicine  Assay of small
to measure accurately
quantities of
quantities of radioactive
material radionuclides
 Ability to distinguish
between alpha and
beta radiation

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GEIGER-MUELLER COUNTER GEIGER-MUELLER COUNTER

 Used to detect radioactive

particles in nuclear medicine  Sounds audible alarm when struck
facilities by radiation, with Sound
 Used to detect the presence of increasing as radiation becomes
radioactive contamination on more intense
work surfaces and laboratory  Not useful as dosimeter
apparatus  Difficult to calibrate
 Limited to 1 mGya per hour
 Meter reads in counts per minute

DESIGN OF PROTECTIVE BARRIER

 CATEGORIES OF RADIATION SOURCES

DESIGN OF RADIATION  PRIMARY RADIATION
 SECONDARY RADIATION
FACILITIES  SCATTER
 LEAKAGE
 TYPES OF BARRIER
 PRIMARY BARRIER
 SECONDARY BARRIER

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DESIGN OF PROTECTIVE BARRIER PRIMARY RADIATION

 FACTORS THAT AFFECT BARRIER THICKNESS  Useful or direct

 DISTANCE radiation
 OCCUPANCY  Emerges directly from
 CONTROLLED the x-ray tube
 UNCONTROLLED
collimator
 WORKLOAD
 USE FACTOR  The most intense,
hazardous & difficult
to shield

SECONDARY RADIATION

 Scatter Radiation:
 Results when the useful
beam intercepts any
objects causing some x-
rays to be scattered
 Leakage Radiation:
 Radiation emitted from
the x-ray tube housing in
all directions other than
that of the useful beam

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PRIMARY BARRIER PRIMARY BARRIER

 Protective barrier designed to shield areas

from primary radiation  Composition:
 1⁄16-inch lead equivalent  Lead bonded to dry wall or wood panelling
 Located where primary beam may strike the  Concrete, concrete block or brick
wall or floor  May be used instead of lead
 Height: 7 feet from the floor  Note: primary barrier requirements are always
much less for fluoroscopic x-ray beams than
for radiographic x-ray beams

SECONDARY BARRIER

 Protective barrier designed to shield areas

from secondary radiation
 1⁄32-inch lead equivalent
 Less thick than primary barriers
 Lead is not required (computed: <0.4 mm Pb)
 Composition: gypsum board, glass or lead acrylic
 e.g. control booth barrier

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SECONDARY BARRIER

 WALLS
 Four thicknesses of 5/8 in. gypsum board
 OPERATING CONSOLE BOOTH
 Four thicknesses of 5/8 in. gypsum board and
½-inch plate glass
 ½-1 inch glass walls

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FACTORS THAT AFFECT BARRIER

WORKLOAD (W)
THICKNESS

 WORKLOAD
 USE FACTOR  The level of radiation activity in the room
 Product of the maximum mA & the number of x-ray
 OCCUPANCY
examinations performed per week
 CONTROLLED  Expressed in: mAmin/week or mAs/week
 UNCONTROLLED  Greater number of examination per week
 DISTANCE  Requires thicker shielding
 Busy, General Purpose X-ray Room: 500 mAmin/week
 Private Office: <100 mAmin/week

SAMPLE PROBLEM SOLUTION

A radiographic x-ray suite is in W = (300 mA x 0.1 sec) x (5 days/wk) x (20

operation 5 days per week. The average patients/day) x (3 images/patient)
number of patients per day is 20, and the
average number of images per patient is W = 9000 mAs/wk
3. The average technical exposure factors W = 150 mA-min/wk
are 90 kVp, 300 mA, and 0.1 sec. Find the
weekly workload.

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USE FACTOR (U) USE FACTOR (U)

 Beam direction factor

 The percentage of time during which the x-ray  Walls: ¼
beam is on & directed toward a particular  Floor: 1
protective barrier  Room for Chest
 Represents the portion of beam-on time that Radiography: 1
x-ray beam is directed at the barrier  Others: 0
U=½  Secondary radiation:
 Involves in 50% of the x-ray examination during the always 1
week

OCCUPANCY FACTOR

 The use of the area that is being protected

 Used to modify the shielding requirement for a particular
barrier
 TIME OCCUPANCY FACTOR (T)
 Length of time that the area being protected is used
 Often Occupied:
 40 hours per week
 More shielding is required
 Examples: office & laboratory
 Rarely Occupied:
 <40 hours per week
 Less shielding is required
 Examples: storeroom & closet

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OCCUPANCY FACTOR DISTANCE

 Depends on the distance between the source of

 Who occupies a given area radiation & the barrier
 Uncontrolled Area:  The distance to the adjacent room not to the inside of
 Areas occupied most frequently by the general the wall of the x-ray room
public  Walls near the x-ray imaging system
 2 mrem/week  Requires more shielding
 Other walls of the room
 Controlled Area:
 Requires less shielding
 Areas occupied by the occupational workers
 X-ray Imaging System: must be position in the middle
 1 mSv/week of the room

MONITORING RADIATION
kVp
EXPOSURE

 Used as the measure of penetrability  Used as the measure of penetrability

 General Radiography: 100 kVp  General Radiography: 100 kVp
 Mammography: 30 kVp  Mammography: 30 kVp
 Modern X-ray Imaging System: 150 kVp  Modern X-ray Imaging System: 150 kVp
 Most Examination: 75 kVp  Most Examination: 75 kVp

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PERSONNELS WHO ARE REQUIRED TO

WEAR AN OCCUPATIONAL RADIATION
MONITOR
PROTECTION OF RADIATION
WORKER, PATIENT,  Radiologic technologist
 Anyone who is required to immobilize or hold
GENERAL PUBLIC patients
 Personnel who regularly operate C-arm
fluoroscope
 Personnel who regularly in the immediate
vicinity of C-arm fluoroscope

FLUOROSCOPY REMOTE FLUOROSCOPY

 Contributes to the highest occupational exposure of  Results in low personnel exposures

diagnostic x-ray personnel
 Rationale: personnel are not in the x-ray
 Personnel exposure is related directly to the x-ray
beam-on time examination with the patient
 X-ray Tube Over The Table  Note: it is best to position the x-ray tube
 Advantage: better image quality under the patient during mobile & C-arm
 Disadvantage: higher personnel exposures
 Rationale: higher levels of scatter & leakage radiation
fluoroscopy

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INTERVENTIONAL RADIOLOGY MAMMOGRAPHY

 Personnel receive higher exposures  Personnel exposures are low

 Rationale: less scatter radiation due to low kVp
 Longer fluoroscopic x-ray beam-on time operation
 Frequent absence of a protective curtain on the  Personnel Protection:
image-intensifier tower  Long exposure cord
 Use of cineradiography  Conventional or window wall
 Dose Limit: 500 mSv/yr (50 rem/yr)  Does not require protective shielding
 Rationale: mammographic x-ray units have personnel
protective barriers

COMPUTED TOMOGRAPHY SURGERY

 Personnel exposures are low

 Rationale:  Occupational exposure for nursing
 CT x-ray beam is finely collimated personnel & other working in the
 Only secondary radiation is present in the
operating room & intensive care unit is
examination room near zero
 Not necessary to provide occupational
radiation monitors for such personnel

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PROTECTION OF RADIATION
MOBILE RADIOLOGY
WORKER

 Contributes to the highest occupational exposure of

diagnostic x-ray personnel  CARDINAL PRINCIPLES
 Dose Limit: 50 mSv/yr (5000 mrem/yr)  PROTECTIVE BARRIER
 Smaller Hospitals, Emergency Centers & Private  PROTECTIVE DEVICES
Clinics: rarely exceeds 5 mSv/yr (500 mrem/yr)  PATIENT HOLDING
 Average Exposures: <1 mSv/yr (100 mrem/yr)  POSITION
 In most facilities

PROTECTION OF PATIENT
PROPER TECHNIQUE SELECTION

 COMMUNICATION  High kVp/low mAs technique must be utilized

 POSITIONING  Note: increasing kVp alone does not reduce the patient dose
 GONADAL SHIELDING
 EQUIPMENT

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PROPER COLLIMATION FILTRATION

 Absorb low-energy (low frequency/long wavelength)
 Essential to good radiographic technique photons
 X-ray beam should always be restricted to the area of clinical  Directly proportional to technical factors
interest  Composition: aluminum
 X-ray beam should never exceed the size of the IR  Minimum Total Filtration:
 Advantages:  2.5 mm Al for >70 kVp
 Reduced effective dose  1.5 mm Al for b/n 50-70 kVp
 Improved image quality  0.5 mm Al for <50 kVp
 Enhance contrast resolution  Note: the overall dose to the patient is decreased despite
the need to increase factors

IMAGE RECEPTOR PATIENT POSITIONING

 The fastest speed–screen-film combination consistent with  Patient scheduled for upper extremity or breast
the nature of the examination should be used examination should be placed in lateral position (seated)
 Rare earth and other fast screens should be used when with a protective apron
possible  Rati0nale: so that the useful beam should not intercept the
gonads
 General Radiography: 400-speed system
 PA Projection: less radiation dose to the lens of the eyes or
 Digital Radiography: uses faster IR than screen-film breast
 AP Projection: less radiation dose to the ovaries

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RESPONSIBLE FOR REPEAT

REPEAT EXAMINATION EXAMINATION
 Poor radiographic technique (primary)
 Repeat Rate:
 Motion
 All examination – 10%  Improper collimation
 Busy Hospital – should not exceed 5%  Dirty screens
 Highest Repeat Rate Examination: lumbar & thoracic spine,  Use of improperly loaded cassettes
 Light leaks
chest & abdomen
 Chemical fog
 Caused By:  Artifacts
 Radiologic technologist error  Wrong projection
 Most common  Improper patient preparation
 Grid errors
 Equipment malfunction
 Multiple exposures

GRIDS GONADAL SHIELDING

 The lowest possible grid ratio should be utilized
 Used to protect gonads from unnecessary radiation
 Rationale: to keep patient dose ALARA exposure.
 8:1 to 10:1 Grid: used in general-purpose x-ray imaging  Used whenever they do not obstruct the area of clinical
system interest
 4:1 to 5:1 Grid:  Reduce female gonad dose by up to 50%
 Specially designed grids  Reduce male gonad dose by up to 95%
 Indicated when a particularly sensitive tissue or organ is in
 Used for mammography or near (4-5 cm) the useful beam
 5:1 Grid: reduces approximately 85% of the scatter radiation  Lens of the eye
 16:1 Grid: reduces approximately 97% of the scatter radiation  Breast
 Gonads

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GONADAL SHIELDING FLAT CONTACT SHIELD

 Three Types:  Placed between the patient’s gonads and the source of
 Flat contact shield radiation
 Shaped contact shield  Need to be secured in place
 Shadow shield  Made of lead-impregnated vinyl

FLAT AND SHAPED CONTACT

CONTACT SHIELD SHIELDS

 Cup-shaped shield designed to enclose the male gonads

 Provides maximum protection
 Shapes: hearts, diamonds, triangles & squares
 Examples:
 Lens shield
 Gonads shield
 Breast shield
 During scoliosis examination

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SHADOW SHIELD
 Shield that is suspended over the region of interest
 Casts a shadow over the patient’s reproductive organs
 More acceptable for use with adult patients
 Improper positioning:
 Repeat examinations
 Increased patient dose
 Useful in surgery
 Requires sterile procedure

UNNECESSARY EXAMINATION HOSPITAL ADMISSION

 Routine examination should not be performed when  Chest x-ray examinations should not be performed
there is no precise medical indication for routine hospital admission when no clinical
indication of disease is found

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PREEMPLOYMENT PHYSICAL
PERIODIC HEALTH EXAMINATIONS
EXAMINATION

 Chest & lower back x-ray examination as part of a  X-ray examinations should not be conducted on an
preemployment physical examination are not justified asymptomatic patient, especially fluoroscopic
examination

WHOLE-BODY MULTISLICE SPIRAL

EMERGENCY DEPARTMENTS
CT SCREENING

 Overutilization of CT examination must be controlled  This should not be done because the radiation dose is
too high

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PREGNANT RT PREGNANT RT

 Should notify her supervisor  Should not be terminated or given an involuntary

 Should be provided with a second personnel leave of absence
monitoring device positioned under the protective  Should be reassigned to areas where exposure is
apron likely to be lower
 Red: collar badge  Disadvantage: places additional radiation exposure
 Above the protective apron burden on fellow workers
 Yellow: waist level  Should not be advised to participate in brachytherapy
 Under the protective apron applications
 Indicates exposure to the fetus

PREGNANT RT PREGNANT RT

 Should be provided with a wrap-around aprons

 0.5 mm Pb  Should handle only small quantities of radioactive
 90% attenuation at 75kVp material
• Additional or thicker lead aprons normally are  Should not elute radioisotope generators or inject
not required millicurie quantities of radioactive material
 Should be provided with a radiation monitor during
pregnancy

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PREGNANT RT NOTE

 Back problems during pregnancy constitute a greater

 Maternal Tissues: reduces fetal dose to hazard than radiation exposure
approximately 30% of the abdominal skin dose (30 µSv  The dose at waist level under a protective apron is
or 3 mrem) less than 10% of the collar dose
 Some RT: received >5 mSv/yr  The DL during pregnancy refers to the fetus not to
 Most RT: received <1 mSv/yr (100 mrem/yr) the radiologic technologist

DOSE LIMIT FOR EMBRYO PREGNANT PATIENT

 The potential pregnancy status of all female patients

ENTIRE GESTATIONAL PERIOD
EVERY MONTH
(9-MONTH PERIOD)
of childbearing age should always be determined
0.5 mSv 5 mSv  He/she should not be examined unless a documented
0.05 rem 0.5 rem decision to do so has been made
50 mrem 500 rem
 Examination should be done with precisely
collimated beams & use high-kVp technique
 Examination should be done with properly positioned
protective shields

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ADMINISTRATIVE PROTOCOLS 10-day RULE

 A guideline used to minimize the possible exposure to

 Used to ensure that we do not irradiate pregnant an embryo in the earliest days of a pregnancy
patients  The practice of waiting 10 days after the women’s
menstrual flow to conduct a x-ray examination
 Types:
 Considered obsolete
 Elective booking
 Rationale:
 Patient questionnaires  Because the egg for the next cycle reaches maximum
 Posting sensitivity during the 10-day period
 The application of this has always proven difficult

ELECTIVE BOOKING INFORMATION FORM

 Elective scheduling
 The most direct way to ensure against irradiation of  Must be completed before undergoing examination
an unsuspected pregnancy  Example: x-ray consent or patient questionnaires
 Requires that clinician, radiologist or radiologic
technologist determine the time of the patient’s
previous menstrual cycle

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POSTING
 Posting signs of caution in the waiting room
“Are you pregnant or could you be? If so, inform the
radiologic technologist,” or “Warning—special -THE END-
precautions are necessary if you are pregnant,” or
“Caution—if there is any possibility that you are
pregnant, it is very important that you inform the
radiologic technologist before you have an x-ray
examination.”

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