radiation safety

1. RADIATION SAFETY
F2 Parach Sirisriro
7 Oct 2018

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. 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. 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. 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. 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. 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. RADIOGRAPHIC UNITS
&
IMAGING TERMINOLOGY

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. - 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. - 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. BIOLOGIC EFFECTS OF RADIATION
•Classified as two types:
•Deterministic effects
•Stochastic effects.

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. 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. 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. 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. 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. Photograph of the patient’s
back after Grafting.
DETERMINISTIC EFFECTS

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. EXPOSURE AND RECOMMENDED LIMITS

21. EXPOSURE AND RECOMMENDED LIMITS

22. Principles of
Radiation Protection

23. A.L.A.R.A. policy
Radiation exposure of personnel
and the general public should be kept
As Low As Reasonably Achievable.

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. Qualifications for
performing fluoroscopy
Only a physician or a registered
x-ray technologist under the direct
supervision of a physician may
perform fluoroscopy.

26.  Reduce of your exposure
 Increase from the source
 Make use of available
TIME
DISTANCE
SHIELDING
General Radiation Safety

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. Distance

30. SCATTER RADIATION

31. Fluoro only when viewing monitor
Use pulsed fluoroscopy when possible
Use last image hold
Methods to reduce dose
to patients and personnel

32. 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.

33. SHIELDING

34. COMMON STYLES OF LEAD PERSONAL
PROTECTIVE APRONS.

35. COMMON STYLES OF LEAD
PERSONAL PROTECTIVE APRONS.

36. SHIELDING

37. RADIATION DOSE MONITORING

38. Radiation safety
Endovascular procedure

39. The distance between
patient and image
detector should be
minimum and
maximum between
patient and the source.
Position

40. TUBE
ANGULATION
Work practices
• Steep angulations – LAO
45o CAU 35o
• Demands more radiation
for imaging
• Increases staff dose
• Increases patient dose

41. WORK PRACTICES
• • Excessive use of
image
magnification increases
radiation doses
• Use image
magnification modes
judiciously

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. 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. 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.

45. RADIATION AND PREGNANCY
Risk of
• Spontaneous abortion (15%)
• Genetic abnormalities (4%-10%)
• Birth malformations (2%-4%)

47. 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.

48. 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

49. THANK YOU