Training for Medical Personnel involved in Fluoroscopic Procedures

Introduction

Many patients at Strong Memorial Hospital are exposed to x-rays for diagnosis and also as part of their medical care. The Food and Drug Administration and the State of New York, Department of Health strictly regulate the use of radiation producing machines for medical care. In addition to these regulations, the Radiation Safety office has developed policies and procedures to ensure regulatory compliance and to protect the health and safety of the patients and hospital staff and much as possible.

The primary possible health effect from working with radiation and radioactivity is very slightly elevated risk of cancer. This risk is no greater than that due to other occupational hazards for personnel adhering to regulatory dose limits.

1. Personnel Dosimetry
• Instruments to monitor occupational exposure (Film Badge)
• Proper Handling of Dosimeters
  1. Location to wear badge
     • One badge – outside lead apron on the collar
     • Two badges – one badge outside lead apron on the collar (CL), second badge underneath the lead apron at waist level (TR).
     • Ring badges – should be worn underneath gloves and can be worn while hands are scrubbed.
  2. Storage of dosimeter
     • Ideal is to have the badge placed on a control board – same location daily
     • Non-radiation area
  3. Evaluation of badges
     • Monthly analysis – notification if ALARA limits are exceeded (set by the Radiation Safety Committee)
     • Charge for late or unreturned badges
     • Late devices – results may be overestimated, since a control may not be subtracted
  4. Record keeping requirement
     • Determination of accumulated dose – inform Radiation Safety of prior work experience involving radiation (i.e. prior dose history)


2. Maximum Permissible Occupational Dose - Yearly

Total Effective Dose Equivalent	5000 mRem
Eye Dose Equivalent	15000 mRem
Shallow Dose Equivalent to skin or extremity	50000 mRem
Declared Pregnant Worker*	500 mRem per pregnancy, 50mrem/month
Minors(< 18 years old)	500 mRem per year – written notification
General Public	100 mRem per year


* When a woman voluntarily declares pregnancy, in writing, Radiation Safety shall review past exposure history and provide exposure counseling. When necessary, the pregnant worker’s supervisor may have to adjust working conditions to comply with the limits listed above. Declaration of pregnancy is a voluntary act. If a declaration is not made, then the limits do not apply.



3. ALARA – As Low As Reasonably Achievable
1. Assumption that personnel exposure are ALARA is doses are ≤10% of Maximum Permissible Dose
• 500 mRem per year- Whole Body
2. ALARA investigation
• Participant will receive a letter stating that ALARA levels have been exceeded during a specific quarter
• Level I – greater than 125 mrem per quarter
• Level II – greater than 375 mrem per quarter
• Level II exposure requires an interview with the RSO and must respond in writing.


4. General Radiation Safety Practices
1. Time – the less time spent in a radiation field, the less exposure one receives.
2. Distance – radiation exposure from a radiation source varies inversely with the square of the distance from the source, hence by doubling the distance one decreases his/her exposure by a factor of four (4). At 1.0 meter (3 feet) the dose rate is approximately 0.1% of the patient’s entrance skin exposure.
3. Shielding – shielding material between the radiation source and the individual being exposed attenuates the radiation and reduces exposure.
4. All personnel involved with the procedure should wear lead aprons while the fluoro unit is in operation.
5. Only personnel involved with the procedure should be present in a fluoroscopic room while the unit is operating. Otherwise, exit the room while the fluoroscopy unit is in operation.


5. Practices for Reducing Radiation Exposure to Fluoroscopist, Ancillary Staff and Patients
1. The image intensifier should be as close to the patient as possible
• Decreases entrance skin exposure rate
• Reduces scatter – hence reduces staff exposure
2. Collimation should always be used to target only the area of interest
• Reduces scatter to ancillary staff
• Reduces patient exposure by targeting a specific volume of tissue
3. Use distance
• Increase distance when at all possible, for staff (for example, the dose rate at 2 feet is 25% of that at 1 foot)
4. Use shielding
• Wearing a lead apron will provide shielding and reduce exposure
5. Size of the patient- the larger the patient the higher technique needed
• Increase dose to personnel and the patient
6. The X-ray tube should be as far from the patient as possible
• Minimize entrance skin dose rate to the patient
7. Beam time – keep to a minimum
• Best way to reduce exposure to all, staff and patient
• Use machine options (i.e. pulsed fluoro, 5-minute timer and image hold options) to reduce patient and staff exposure


6. Authorization to order or use fluoroscopy:
1. Only professional practitioners (licensed physicians, podiatrists, dentists or chiropractors), physician’s assistants working under the authority of a credentialed physician, or a certified nurse practitioner working under a practice agreement with a credentialed physician may order fluoroscopy.
2. Professional practitioners must be specifically credentialed by Strong Memorial Hospital for fluoroscopy.
3. Only a credentialed professional practitioner or a licensed radiologic technologist may position the patient, select the technique (kVp, mA, time), acknowledge the 5 minute warning timer and / or operate the fluoroscopy unit.

Click the link below to start the Fluoroscopy Refresher Training:
Go to Fluoro Refresher Training