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Topic radiation safety

radiation safety

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Topic radiation safety

  1. 1. RADIATION SAFETY F2 Parach Sirisriro 7 Oct 2018
  2. 2. OUTLINE 1 TYPES OF RADIATION 2 BIOLOGIC EFFECTS OF RADIATION 3 EXPOSURE AND RECOMMENDED LIMITS 4 PRINCIPLES OF RADIATION PROTECTION 5 RADIATION SAFETY: ENDOVASCULAR PROCEDURES 6 RADIATION AND THE ENDOVASCULAR SURGEON
  3. 3. Rutherford's Vascular Surgery and Endovascular Therapy, Chapter 74, 3183-3221.e Textbook Journal - Meisinger, Q. C., et al. (2016). "Radiation protection for the fluoroscopy operator and staff." American Journal of Roentgenology 207(4): 745-754. - Ho, P., et al. (2007). "Ionizing radiation absorption of vascular surgeons during endovascular procedures." Journal of vascular surgery 46(3): 455- 459. - Kim, J. B., et al. (2017). "Radiation hazards to vascular surgeon and scrub nurse in mobile fluoroscopy equipped hybrid vascular room." Annals of surgical treatment and research 92(3): 156-163. REFERENCE
  4. 4. TYPES OF RADIATION • Ionizing radiation • Radiation capable of producing ions • Comes from x-ray machines, nuclear reactors, and radioactive materials • Non-Ionizing radiation • Comes from microwaves, sound waves, light, lasers, radiofrequency, electromagnetic fields, etc.
  5. 5. IONIZING RADIATION • Consists of alpha and beta particles, neutrons, and energetic photons (ultraviolet and above) • which contain sufficiently high energy to interact with atoms and produce biologic injury. • The most common forms of ionizing radiation used in medicine are x-rays, gamma rays, beta rays, and electrons
  6. 6. PENETRATING ABILITIES • ALPHA - very limited ability; short range in air, stopped by skin • BETA - function of originating energy; can penetrate skin • GAMMA - highly penetrating; can reach all body organs
  7. 7. FORMS OF IONIZING RADIATION (CONT.) • GAMMA • Deep penetrating • Need steel, lead, etc. to shield • X –Radiation • Commonly thought of as electromagnetic radiation produced by an x-ray machine • Penetration depends on wavelength and material being irradiated. • Often use concrete to shield
  8. 8. RADIOGRAPHIC UNITS & IMAGING TERMINOLOGY
  9. 9. - measured in C/kg or Roentgen(R) - amount of charge (electrons) liberated per kilogram of Air (Ionization)  1R = 2.58x10-4 C/Kg EXPOSURE
  10. 10. - measured in Gray (Gy) or Rad - amount of energy deposited/ absorbed per kilogram of tissue  1Gy = 1 Joule/Kg  100 Rad = 1 Joule/Kg  1Rad = 1/100 Gy ABSORBED DOSE
  11. 11. - measured in Sieverts (Sv) or Rem - amount of biological damage - gives a measure dose as if received by the whole body - used to equate dose to risk  1Sv = 1 Joule/Kg  100 Rem = 1 Joule/Kg  1Sv = 1/100 Rem EFFECTIVE DOSE
  12. 12. BIOLOGIC EFFECTS OF RADIATION •Classified as two types: •Deterministic effects •Stochastic effects.
  13. 13. DETERMINISTIC EFFECTS • Dose dependent and result in cell death • Occurs when a threshold level of radiation has been exceeded, and the higher the dose, the greater the injury
  14. 14. HUMAN RESPONSES TO IONIZATION RADIATION Acute Radiation Syndrome Hematologic Syndrome Gastrointestinal syndrome Central nervous system Local Tissue damage Skin Gonads Extremities Hematologic depression Cytogenic damage EARLY EFFECTS
  15. 15. Acute Radiation Syndrome Hematologic Syndrome Gastrointestinal syndrome Central nervous system Other malignant disease Bone cancer Lung cancer Breast cancer Leukemia Genetically significant dose Lifespan shortening HUMAN RESPONSES TO IONIZATION RADIATION LATE EFFECTS
  16. 16. Photograph of the patient’s back 6-8 weeks after multiple coronary angiography and angioplasty procedures. Photograph of the injury 16-21 weeks after the procedures. A small ulcerated area is present. DETERMINISTIC EFFECTS
  17. 17. Close-up of the lesion shown in C Photograph of the patient’s back 18-21 months after the procedures. Tissue necrosis is evident DETERMINISTIC EFFECTS
  18. 18. Photograph of the patient’s back after Grafting. DETERMINISTIC EFFECTS
  19. 19. STOCHASTIC EFFECTS • Cause DNA damage to single cells -- mutation. • This is an all-or-none phenomenon, The severity of the effect of mutation is unrelated to the dose. • Mutations lead to  cancer  birth defects  genetic effects
  20. 20. EXPOSURE AND RECOMMENDED LIMITS
  21. 21. EXPOSURE AND RECOMMENDED LIMITS
  22. 22. Principles of Radiation Protection
  23. 23. A.L.A.R.A. policy Radiation exposure of personnel and the general public should be kept As Low As Reasonably Achievable.
  24. 24.  Correct exposure factors  Correct radiographic technique  Appropriate radiation protection  Appropriate development/viewing techniques  Appropriate radiographic positions for examination  Minimize repeat examinations  Continuing education A.L.A.R.A. policy
  25. 25. Qualifications for performing fluoroscopy Only a physician or a registered x-ray technologist under the direct supervision of a physician may perform fluoroscopy.
  26. 26.  Reduce of your exposure  Increase from the source  Make use of available TIME DISTANCE SHIELDING General Radiation Safety
  27. 27. • Minimize time in radiography or fluoroscopy rooms • Minimize time spent with patients who are undergoing therapy treatment • Know Your Protocol  Read the procedure through carefully  Understand the steps clearly or  Have the protocol displayed where you can see it  Do not depress the footswitch continually for long periods  Use pulsed fluoroscopy modes • Practice the technique beforehand Time
  28. 28. Distance
  29. 29. SCATTER RADIATION
  30. 30. Fluoro only when viewing monitor Use pulsed fluoroscopy when possible Use last image hold Methods to reduce dose to patients and personnel
  31. 31. Shielding Personal shielding  lead aprons - at least 3 - 5mm Pb equivalent provide up to 90% shielding.  thyroid / eye shielding during fluoroscopy  lead glove (5mm + Pb eq.) if hands are likely to be in the beam  Lead drape on fluoro tower provides an additional 90% protection of the remaining 10% from lead aprons above.
  32. 32. SHIELDING
  33. 33. COMMON STYLES OF LEAD PERSONAL PROTECTIVE APRONS.
  34. 34. COMMON STYLES OF LEAD PERSONAL PROTECTIVE APRONS.
  35. 35. SHIELDING
  36. 36. RADIATION DOSE MONITORING
  37. 37. Radiation safety Endovascular procedure
  38. 38. The distance between patient and image detector should be minimum and maximum between patient and the source. Position
  39. 39. TUBE ANGULATION Work practices • Steep angulations – LAO 45o CAU 35o • Demands more radiation for imaging • Increases staff dose • Increases patient dose
  40. 40. WORK PRACTICES • • Excessive use of image magnification increases radiation doses • Use image magnification modes judiciously
  41. 41. ENDOVASCULAR PROCEDURE Kim, J. B., et al. (2017). "Radiation hazards to vascular surgeon and scrub nurse in mobile fluoroscopy equipped hybrid vascular room." Annals of surgical treatment and research 92(3): 156-163.
  42. 42. ENDOVASCULAR PROCEDURE Kim, J. B., et al. (2017). "Radiation hazards to vascular surgeon and scrub nurse in mobile fluoroscopy equipped hybrid vascular room." Annals of surgical treatment and research 92(3): 156-163.
  43. 43. ENDOVASCULAR PROCEDURE Kim, J. B., et al. (2017). "Radiation hazards to vascular surgeon and scrub nurse in mobile fluoroscopy equipped hybrid vascular room." Annals of surgical treatment and research 92(3): 156-163.
  44. 44. RADIATION AND PREGNANCY Risk of • Spontaneous abortion (15%) • Genetic abnormalities (4%-10%) • Birth malformations (2%-4%)
  45. 45. RECOMMENDATIONS FOR PREGNANT WORKERS The National Nuclear Commission guideline : • No more than 5 mSv of equivalent dose exposure during the entire pregnancy • less than 0.5 mSv/mo.
  46. 46. CONCLUSION • Use radiation safety accessories when required. • Use personal monitoring devices • Follow the basic principles of radiation safety • Follow radiation dose reduction techniques • Radiation safety awareness and training program
  47. 47. THANK YOU

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