RADIATION EXPOSURE

AND
SAFETY
 CORE PRINCIPLE

► There is no amount of radiation that is good for

 You…
 Or for your patients…
 Or for your staff!

Unless you already have cancer!

 Characteristics of X-Radiation
► Gamma ray photons
 Photon energy 65 -125 kev
 Less energetic than most clinically used radionucleides
 Cause tissue injury by ionizing atoms in molecules

► Peak kilovoltage(kVp)
 Determines X-ray photon penetrating power
 kVp = penetration image contrast
► Miliamperage(ma)
 Determines the number of X-ray photons produced per unit time
► Pulse width (msec)
 The duration of the X-ray pulse associated with an image frame
(typically 5-8 msec)
 Determines image motion blurring
 Factors Affecting Radiation Dose
► Equipment Design and Settings ► Physician Procedure Conduct
 Movement capabilities of C-arm, X-  Positioning of image intensifier
ray source, image intensifier and X-ray source relative to the
 Field-of-view size patient
 Collimator position  Beam orientation and movement
 Beam filtration  Detector field-of-view size
 Fluoroscopy pulse rate and acquisition
frame rate
 Collimation
 Fluoroscopy and acquisition input  Fluoroscopy pulse rate
dose rates  Acquisition frame rate
 Automatic dose-rate control including  Total fluoroscopy time
beam energy management options
 Total acquisition time
 X-ray photon energy spectra
 Use of variable beam filtration
 Software image filters
 Preventative maintenance and  Acquisition and fluoroscopic
calibration technique factors on some units
 Quality control

► Patient Factors
 Patient body weight and habitus
How patients and we get Exposed
 THE INVERSE SQUARE LAW
Vertical Plane Scattered Radiation Isodose Curves
Horizontal Plane Scattered Radiation
Isodose Curves
 EFFECTS OF X-RAY EXPOSURE

► Deterministic Effects (predictable, dose-related)

 Skin injury and hair loss (most common)

►Hand skin burns at Acute threshold dose 7 Gy

 Eyes (Cataract – 1 to 2 Gy, latent period 1 year)

 Other organs
Threshold Skin Entrance Doses
for Different Skin Injuries
 Stochastic Effects (probabilistic, no relationship to dose)
► Neoplasm
► Risk of fatal cancer estimated to be 4% per Sv for long-term exposure.
Lifetime risk of fatal cancer is 20%.
Lifetime risk if exposed to 1 Sv = 24%
Background radiation is 1 mSv/year @ sea level.
Typical patient dose for interventional procedure: 26 mSv
Incremental cancer risk ≈ 0.3% / procedure

 Minimum latent period - leukemia 2 years & solid cancers 5 yrs.

 Newborns are estimated to be 10 to 30 times more sensitive.
 Females are more susceptible than males, because of greater breast and
thyroid sensitivity.
 Pelvic procedures deliver significant doses to the reproductive cells.
The risk for radiation induced heritable effects is approximately 0.01%
affected offspring per 10 mGy (1 rad) absorbed to the gonads.
 Pregnancy
► In Utero Effects
 Deterministic Effects
► Central nervous system functional effects
► Malformations
 Stochastic Effects
► Neoplasm, heritable
► Gestation dependence

► The risk for childhood cancers (principally leukemias) from in utero exposure is about
0.06% per 10 mSv (1 rem), but the risk for long-term adult development of induced
cancers is not known.

► Doses to the conceptus in excess of 50 to 100 mGy place the child at risk for growth
retardation, malformation, resorption, or miscarriage

► Procedures that involve structures above the diaphragm are unlikely to deliver doses
capable of inducing deterministic effects. Uterus only receives scattered radiation and
this is typically much less than 2%.

► Shielding a pregnant woman’s abdomen and pelvis will be ineffective for procedures
in which the chest or head are the principally exposed body regions.
 Recommended Dose Limits
► How to estimate your actual dose:
 TLD badge
►Worn outside the lead apron on collar
►Under-apron at the waist

► National Council on Radiation Protection maximum permissible

doses:
 In one year: 50 mSv
 Eye : 150 mSv/year
 Skin: 500 mSv/year
 Operator exposure goal < 0.1 mSv/ case
500 cases per year to exceed maximum permissible dose
30 year career exposure: 1.5 Sv
 What Can be done To Protect
Patients, Staff
and Ourselfs ?

2 - 5% radiation is transmitted through 0.5 mm lead

 Minimizing Exposure
► ALARA principle
As Low As Reasonably Achievable

► The Inverse Square Law is Your Protection!

Keep your distance from the beam!

► Reduce Fluoroscopy time

Keep it brief!

► Barriers
 The Ceiling-Mounted Glass Shield
(Reduces Your upper body exposure by 90%)
How You Position Your System Affects
the Dose to your Patient and to You
Collimator Affects the Dose to the
Patient and to You
 Minimizing Radiation exposure
► Minimize beam-on time, both for fluoroscopy and acquisition.
 Never irradiate the patient unless the primary operator’s eyes are on the monitor
 The last image hold feature can be used to study anatomic details without the
need for ongoing radiation exposure

► Position the X-ray source and image receptor optimally

 Distance from the patient to the image detector is minimized
 Position the patient’s heart near the imaging system’s isocenter

► Use least degree of image magnification required for accurate interpretation

 Systems that use conventional image intensifiers, the dose increases
substantially with increasing magnification
 Flat-panel detector systems have a smaller dose increment with magnification

► Understand and utilize the X-ray dose-reduction features provided

 Use the slowest fluoroscopy pulse rate and the lowest fluoroscopy dose rate that
will produce satisfactory images
 Employ beam-hardening filters whenever feasible.
► Vary the site of the radiation entrance port
 Procedures that require long fluoroscopy times, if clinically feasible, change the
radiographic projection so as to minimize the dose to any particular portion of
entrance port skin.

► Record the estimated dose delivered to the patient

 For older units that do not provide this function, the total fluoroscopy and
acquisition times should be recorded

► Maintain X-ray equipment in good repair and calibration

 Aging image intensifiers have reduced light output for a given X-ray input dose.
Thus, an aging image intensifier will automatically require the X-ray system to
deliver an increased dose. Such image intensifiers should be replaced.

► Select X-ray units with sophisticated dose-reduction and monitoring features

ACC Recommendations for Reducing Radiation Exposure
► Equipment factors—incorporate as many as possible
 Pulsed progressive fluoroscopy
 Additional copper filters
 Digital-only cine acquisition
 Last image hold feature
 Image looping
 High frequency generator

► Operator-dependent functions
 Minimize patient exposure
 Limit number and length of cine runs
 Use least amount of fluoroscopy time possible
 Minimize use of magnification
 Use proper collimation of primary beam
 Utilize appropriate shielding: side table, ceiling mounted, mobile “door” shields
 Maintain distance from primary beam
 Keep image intensifier as close to patient as possible
 Maintain source to entrance distance as long as practical (recommended 50 cm)
 Select highest kv that provides the needed contrast
 Avoid use of “boost” or high dose modes
► Laboratory maintenance
 Conduct periodic inspections and testing of X-ray unit(s)
 Inspect X-ray lead shields and lead aprons/thyroid shields at least annually

► Operator shielding
 Wear two-piece lead apron that wraps around body, covering back to protect
from scattered X-rays
 Select proper-fitting lead aprons: minimize armhole openings, cover entire
torso, extend to midthigh
 Wear thyroid shield
 Wear eye protection: leaded eyeglasses with temple shields

► Monitoring
 Wear two badges: under apron at waist and outside lead shields at collar level
 Consider use of a sterilizable ring on arm closest to X-ray tube
 Regularly review personal exposure
 Record fluoroscopic and cine times for each case
Radiation need not be feared
But it must command Your
Respect

THANK YOU