Entry #8: Practices for Exposure Reduction
When using fluoroscopy, the patient and employees involved in the exam receive greater doses of radiation than they would typically receive from a standard, conventional x-ray. This is because the radiation used in fluoroscopy is a continuous stream, not just a quick burst for a single image. Because of this, there is even more emphasis on protection from radiation. Here's a couple of tips on keeping safe while operating a fluoroscopic unit.
As with conventional x-ray, ALARA is always a must. Keeping the dose as low as reasonably achievable is always a top priority. Time, distance, and shielding are key. Something that makes fluoroscopy different from conventional radiography is that the x-ray tube is placed beneath the table with the image intensifier above (for MOST exams). By doing this, less radiation reaches the thyroid and lenses of the eye.
Limiting the beam through cones and cylinders will help keep the radiation focused only over the anatomy of interest. Collimation and other aperture diaphragms will assist in this as well. You can also control the strength of the beam by using filtration when needed. Operating under a more hardened beam will prevent excess absorption by the patient.
Ensure that you always maintain at least a 12 inch source-to-skin distance unless it is a special surgical case (like an extremity exam) that absolutely requires that the SSD be decreased to below 12 inches.
High-dose/ high level fluoroscopy (HLF) should only be used when the extra boost is needed to improve image detail. You exposure rate should never exceed 20 R/min.
If available, utilize a lead shield to stand behind when you are not needed immediately beside the C-arm. There is also a tethered switch that can be controlled from a distance-- another handy tool during long procedures where a tech will want to maximize their distance from the radiation source.
Pay attention to the signals and alarms on the fluoro unit. After 5 minutes of fluoro exposure there will be an alarm to let you know. To continue, the alarm will need to be reset. Be sure to annotate the length of exposure time for later dose calculations.
Lastly, be sure to wear your protective equipment! More info on these will be coming in the next post so stay tuned!
Mentice has produced a handy infographic with some basic information on radiation safety during fluoroscopy. Take a peek at it! (Here's a link to a larger version)
As with conventional x-ray, ALARA is always a must. Keeping the dose as low as reasonably achievable is always a top priority. Time, distance, and shielding are key. Something that makes fluoroscopy different from conventional radiography is that the x-ray tube is placed beneath the table with the image intensifier above (for MOST exams). By doing this, less radiation reaches the thyroid and lenses of the eye.
Limiting the beam through cones and cylinders will help keep the radiation focused only over the anatomy of interest. Collimation and other aperture diaphragms will assist in this as well. You can also control the strength of the beam by using filtration when needed. Operating under a more hardened beam will prevent excess absorption by the patient.
Ensure that you always maintain at least a 12 inch source-to-skin distance unless it is a special surgical case (like an extremity exam) that absolutely requires that the SSD be decreased to below 12 inches.
High-dose/ high level fluoroscopy (HLF) should only be used when the extra boost is needed to improve image detail. You exposure rate should never exceed 20 R/min.
If available, utilize a lead shield to stand behind when you are not needed immediately beside the C-arm. There is also a tethered switch that can be controlled from a distance-- another handy tool during long procedures where a tech will want to maximize their distance from the radiation source.
Pay attention to the signals and alarms on the fluoro unit. After 5 minutes of fluoro exposure there will be an alarm to let you know. To continue, the alarm will need to be reset. Be sure to annotate the length of exposure time for later dose calculations.
Lastly, be sure to wear your protective equipment! More info on these will be coming in the next post so stay tuned!
Mentice has produced a handy infographic with some basic information on radiation safety during fluoroscopy. Take a peek at it! (Here's a link to a larger version)
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