26 Jun RADPAD DAILY DOSE NEWSLETTER
HIGH BMI AND I
High BMI patients and dangerously high radiation doses.
OCCUPATIONAL RADIATION EXPOSURE
Serious risks and safety solutions by Dr. Mina S. Makary M.D.
While the radiation doses utilized in image-guided procedures are generally considered low, recent studies have demonstrated significant effects of chronic low-dose radiation exposure to the procedural staff.
Effects of chronic low-dose radiation exposure:
• Alarming incidence of brain cancer
• Higher incidence of skin, thyroid, breast cancers, and melanomas
• Higher incidence of stroke and atherosclerotic disease
• Increased risk of developing cataracts
• Decreased memory and verbal fluency
• Higher frequency of chromosomal abnormalities
The deleterious effects of radiation exposure are not only related to dose thresholds of specific exposures, but they are also a function of the cumulative doses over one’s lifetime exposure. These risks prompt increased awareness and education, improved radiation protection techniques, and further research efforts.
Risk reduction techniques – ALARA (As Low As Reasonably Achievable):
• Use intermittent fluoroscopy whenever possible
• Minimize the pulse rate for standard fluoroscopy
• Minimize the frame rate for digital angiography/digital subtraction angiography
• Avoid magnification if feasible
• Utilize the “last image hold” function rather than obtaining new unwarranted images
Next, capitalizing upon the nature and distribution of scatter radiation, which is the primary source of occupational exposure, further reduces one’s dose.
Capitalize on the nature of radiation to reduce dose:
• Step back as far as possible from the radiation source
• Angulate the tube towards the operator when oblique views are desired to avoid back scatter
• Utilize shielding
• Personal aprons
• Thyroid shields
• Table shields
• Mounted side shields
• Patient drape shields
• Monitor amount of radiation by utilizing personal dosimeter and equipment data.
In addition to protecting the procedural team, good radiation safety habits are good patient care. With the growth of both diagnostic imaging and imaging-guided procedures that require ionizing radiation, patient exposures have significantly increased at an alarming rate over the past three decades, and it is estimated that medical imaging contributed to 48 percent of the public’s radiation exposure in 2006 compared to only 15 percent in the 1980s.
Good radiation safety habits equals good patient care:
• Minimizing fluoroscopy time reduces patient exposure
• Collimation improves image contrast and quality in addition to reducing the dose
• Using non-ionizing radiation for procedural guidance, such as ultrasound and MRI, as much as possible
• Maximizing pre-procedural imaging for planning to minimize procedural time
• Avoiding unnecessary procedures
Occupational radiation safety is critical for many reasons. It protects our proceduralists and staff, as well as our patients while also ensuring the patient receives the best care possible. The risks are real. The benefits are real.
Radiation safety is both an occupational safety issue, as well as a patient care issue. It is not a luxury, and chronic low-dose radiation does matter. The time is now to prioritize radiation safety in our daily practice.
Dr. Makary’s article in its entirety is available at https://rb.gy/lzewjs. For queries/questions, he can be reached via social media/twitter at @MinaMakaryMD
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