Radiological Protection in Fluoroscopically Guided Procedures outside the Imaging Department
ICRP Publication 117Ann. ICRP 40(6), 2010
M.M. Rehani, O. Ciraj-Bjelac, E. Vaņo, D.L. Miller, S. Walsh, B.D. Giordano, J. Persliden
Abstract - An increasing number of medical specialists are using fluoroscopy outside imaging departments, but there has been general neglect of radiological protection coverage of fluoroscopy machines used outside imaging departments. Lack of radiological protection training of those working with fluoroscopy outside imaging departments can increase the radiation risk to workers and patients. Procedures such as endovascular aneurysm repair, renal angioplasty, iliac angioplasty, ureteric stent placement, therapeutic endoscopic retrograde cholangio-pancreatography, and bile duct stenting and drainage have the potential to impart skin doses exceeding 1 Gy. Although tissue reactions among patients and workers from fluoroscopy procedures have, to date, only been reported in interventional radiology and cardiology, the level of fluoroscopy use outside imaging departments creates potential for such injuries.
A brief account of the health effects of ionising radiation and protection principles is presented in Section 2. Section 3 deals with general aspects of the protection of workers and patients that are common to all, whereas specific aspects are covered in Section 4 for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology, gastroenterology and hepatobiliary system, and anaesthetics and pain management. Although sentinel lymph node biopsy involves the use of radio-isotopic methods rather than fluoroscopy, performance of this procedure in operating theatres is covered in this report as it is unlikely that this topic will be addressed in another ICRP publication in coming years. Information on radiation dose levels to patients and workers, and dose management is presented for each speciality.
Issues connected with pregnant patients and pregnant workers are covered in Section 5. Although ICRP has recently published a report on training, specific needs for the target groups in terms of orientation of training, competency of those who conduct and assess specialists, and guidelines on the curriculum are provided in Section 6.
This report emphasises that patient dose monitoring is essential whenever fluoroscopy is used.
It is recommended that manufacturers should develop systems to indicate patient dose indices with the possibility of producing patient dose reports that can be transferred to the hospital network, and shielding screens that can be effectively used for the protection of workers using fluoroscopy machines in operating theatres without hindering the clinical task.