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Radiation safety and flouroscopy3 Radiation safety and flouroscopy3 Presentation Transcript

  • Radiation Safety and Fluoroscopy 1 PRESENTED BY K R I S H N AD AS B AN E R J E E P h D , FAC R , FA A P M Enduring Material Created from a live program JUNE 29, 2010 J A M E S O N H E A LT H S Y S T E M 1 AM A CME CREDIT upon completion of test and evaluation E x p i r e s Au g u s t 3 0 , 2 0 11
  • Radiation Safety and Fluoroscopy 2 Dr. Banerjee and the CME have no real or apparent conflicts of interest. Send exam and evaluation to Lori Graham – Library/CME or fax to 724-656-4267 (4267 internal) or email at lgraham@jamesonhealth.org Exam and evaluation are in two forms: 4 pages or slides number 45-52, either version can be turned in.
  • Radiation Safety and Fluoroscopy 3  Objectives:  At the conclusion of the presentation, the participant should be able to:  Summarize the basic properties, and units of measurement of radiation.  Review the sources of radiation and the methods of radiation protection.  Document the biological effects of radiation exposure.  Summarize the types of X-ray equipment, imaging recording and processing.  Recommend the proper patient exposure and positioning for a particular radiation related procedure.  Review the procedures, the Quality Assurance Program, and the related radiation safety regulations.
  • Radiation Safety and Fluoroscopy 4  The following topics will be covered in accordance to 25 PA Code 221.11  1. Basic radiation properties  2. Units of measurement  3. Sources of radiation  4. Methods of radiation protection  5. Biological effects  6. X-ray equipment  7.Imaging recording and processing  8. Patient exposure and positioning  9 Procedures  10. Quality Assurance Program  11. Regulations.
  • Radiation Safety and Fluoroscopy 5  Radiation terminology  Air Kerma: The kinetic energy or kerma per unit mass of air. Represented by the unit Gray (Gy).  C/Kg or R: Coulombs per kilogram, formerly R or roentgen, an SI unit representing exposure.  Dose: term used for the quantity of absorbed radiation per unit mass  “Dose equivalent”: term of quantity of absorbed dose in tissue as modified by certain risk factors dependent upon the type of radiation to which one is exposed.  Dose rate: Absorbed does delivered per unit of time.  Radiology Students.com Dictionary of Radiological Terms and Abbreviations. www.radiologoystudents.com accessed June 21, 2010
  • Radiation Safety and Fluoroscopy 6  Radiation terminology  RAD: Radiation Absorbed Dose. Unit of dose or energy absorbed per unit mass in materials including tissue.  International unit is the Gray (1 Gy = 100 rad)  REM: Roentgen Equivalent Man. Unit of effective dose that corrects absorbed rate for the risk from high energy particles .  International unit is the Sievert (1Sv = 100 rem)  Roentgen: The unit to measure ionization in air as a result of exposure to x- or gamma rays; there is no international equivalent term. Radiology Students.com Dictionary of Radiological Terms and Abbreviations. www.radiologoystudents.com accessed June 21, 2010
  • Radiation Safety and Fluoroscopy 7  What is Radiation?  Transfer of energy like a battery transfer energy to a ball.  Exist in bundles of electromagnetic waves.  Ionized Radiation  Some forms of radiation can create ions.  Radiation contains sufficient energy to break chemical bonds by removing electrons from an atom or molecule.  These ions has the potential to cause damage to the molecules in the human body.  Other types of radiation, like laser, ultrasound and microwave, do not ionize and are safe if used properly. Landauer basic radiation safety. Ver. 1.02. Glenwood, IL: Lauder, c1997.
  • Radiation Safety and Fluoroscopy 8  Common Ionizing Radiation Sources  X-Ray  Penetrating electromagnetic radiation usually generated by equipment.  Gamma Rays  Very penetrating electromagnetic radiation, emitted from the nucleus of atoms in radioactive materials.  Example: Cobalt -60 used in radiation therapy  Alpha particles  High mass, double charged with low penetrating power. Stopped by paper or skin thus the most dangerous  Example: Radium – 226 and Radon – 222 Gas Landauer basic radiation safety. Ver. 1.02. Glenwood, IL: Lauder, c1997.
  • Radiation Safety and Fluoroscopy 9  Common Ionized Radiation Sources  Beta particles  Low mass, single charge electrons having more penetration than Alpha. Stopped by light shielding material.  Example: Phosphorus-32  Neutrons  No change (neutral), medium mass atomic particles, emitted from the nucleus of an atom, which can easily penetrate many materials.  Example: Americium -241 : Berylium as used in moisture gauges, or as stray radiation created by high energy linear accelerators used in therapy. Landauer basic radiation safety. Ver. 1.02. Glenwood, IL: Lauder, c1997.
  • Radiation Safety and Fluoroscopy 10  Sources of Radiation Exposure  Exposure to primary x-ray beam  X-ray fields near a bare x-ray tube are very intense. • For this reason, regulations do not allow the use of instruments without a protective tube housing or shield. • The x-ray tube housing contains one or more ports which provide a narrow beam of useful x-rays. The x-ray dose rate at the beam port may be several thousand rad per second (several tens of gray per second). Inadvertent placement of fingers at the beam port for even a second can result in serious burns. • As a further precaution, current regulations require a shutter for all beam ports on the tube housing. The shutters must automatically close unless a collimator, camera, or other equipment is attached to the beam port. Use of a beam collimator greatly increases safety of analytical x-ray equipment on two ways. Appendix A: Radiation Hazards of Analytical X-Ray Equipment. Arizona State University. Office of Radiation Safety. http://www.asu.edu/radiationsafety/x-ray/appn_A.html accessed June 18, 2010.
  • Radiation Safety and Fluoroscopy 11  Sources of Radiation Exposure  Exposure to primary x-ray beam  The dose rate at the hand of 10 cm collimator is reduced to several thousand rad per minute (several tens of gray per minute).  In addition, the dimensions of the collimated beam are usually on the order of 1 mm2  The possibility of receiving a high dose to any portion of the skins is unlikely under these conditions. Natural movement of the hand will ensure that the same 1 mm2 area of the skin is not irradiated for any significant amount of time.  The intensity of the x-ray beam decreases very rapidly as the distance from the tube increases. The dose rate as a function of the distance from the tube follows the well known inverse square relationship. Appendix A: Radiation Hazards of Analytical X-Ray Equipment. Arizona State University. Office of Radiation Safety. http://www.asu.edu/radiationsafety/x-ray/appn_A.html accessed June 18, 2010.
  • Radiation Safety and Fluoroscopy 12  Sources of Radiation Exposure  The intensity of the x-ray beam decreases very rapidly as the distance from the tube increases. The dose rate as a function of the distance from the tube follows the well known inverse square relationship.  Possible Radiation Intensity Near Analytical X-Ray Equipment. Location Dose Rate Primary beam at beam port Several tens of gray per second. Primary beam at end of 10 cm Several tens of gray per minute . collimator Scattered radiation near sample several milligray per hour Scattered radiation near table 1 milligray per hour edge Appendix A: Radiation Hazards of Analytical X-Ray Equipment. Arizona State University. Office of Radiation Safety. http://www.asu.edu/radiationsafety/x-ray/appn_A.html accessed June 18, 2010.
  • Radiation Safety and Fluoroscopy 13  Sources of Radiation Exposure  Scattered Radiation  A hazard may also exist from exposure to scattered radiation. Scattered radiation is produced when the primary beam strikes collimators, samples, beam stops or shielding. The intensity of the scattered radiation is a couple of orders of magnitude less than that of the primary beam. It is possible for these scattered radiation fields to result in exposures, which exceed regulatory limits, however. • Scattered Radiation may exceed regulatory exposure limits.  Leakage Radiation  Are x-ray photons that escape through the protective housing. They result in unnecessary exposure to the patient and technologist, and do not contribute any diagnostic information to the resultant image. Appendix A: Radiation Hazards of Analytical X-Ray Equipment. Arizona State University. Office of Radiation Safety. http://www.asu.edu/radiationsafety/x-ray/appn_A.html accessed June 18, 2010.
  • Radiation Safety and Fluoroscopy 14 Effective Doses for X-Ray and Nuclear Medicine Procedures Radiographs Doses in Mrem Abdomen (KUB) 53 Chest (2 views) 4 Pelvis (AP) 70 Dental -- biteview 0.4 Mammogram 13 CT – Abdomen 1000+ Nuclear Bone Scan 400 Tumor Localization 1220 Nuclear renal scan 310-520 Barium Enema 700 Medical procedures and X-ray doses. Global Dosimetry Solutions, 2003. (pamphlet sheet)
  • Radiation Safety and Fluoroscopy 15  Methods of radiation protection  Time, distance, and shielding (measures minimize your exposure to radiation in much the same way as they would to protect you against overexposure to the sun .)  Time: For people who are exposed to radiation in addition to natural background radiation, limiting or minimizing the exposure time reduces the dose from the radiation source.  Distance: Just as the heat from a fire is less intense the further away you are, so the intensity and dose of radiation decreases dramatically as you increase your distance from the source. Minimize your exposure. United States Nuclear Regulation Commission. http://www.nrc.gov/about- nrc/radiation/protects-you/protection-principles.html accessed June 21, 2010.
  • Radiation Safety and Fluoroscopy 16  Methods of radiation protection  Shielding: Barriers of lead, concrete, or water provide protection from penetrating radiation such as gamma rays and neutrons. This is why certain radioactive materials are stored under water or in concrete or lead-lined rooms, and why dentists place a lead blanket on patients receiving x-rays of their teeth. Similarly, special plastic shields stop beta particles, and air stops alpha particles. Therefore, inserting the proper shield between you and a radiation source will greatly reduce or eliminate the dose you receive. Minimize your exposure. United States Nuclear Regulation Commission. http://www.nrc.gov/about- nrc/radiation/protects-you/protection-principles.html accessed June 21, 2010.
  • Radiation Safety and Fluoroscopy 17  Methods of radiation protection  Collimation Effects  X-ray beam collimation for radiography and fluoroscopy projection imaging is important for patient dose and image quality reasons. Actively collimating to the volume of interest reduces the overall integral dose to the patient and thus minimizes the radiation risk. Less volume irradiated will result in less x-ray scatter incident on the detector. This results in improved subject contrast and image quality. Collimation effects. UPSTATE Medical University. http://www.upstate.edu/radiology/rsna/fluoro/collimation/ accessed June 21, 2010
  • Radiation Safety and Fluoroscopy 18  Methods of radiation protection  Collimation Effects  X-ray field collimation differs from the use of electronic magnification in that the acquired field of view remains constant, and there is no improvement in the resultant spatial resolution performance . However, the use of collimation will normally reduce the image brightness, and require a corresponding increase in radiation entrance skin dose to the patient, although not to the level when electronic magnification is used, because the minification gain is unchanged. Collimation effects. UPSTATE Medical University. http://www.upstate.edu/radiology/rsna/fluoro/collimation/ accessed June 21, 2010
  • Radiation Safety and Fluoroscopy 19  Methods of radiation protection  Filtration  Increasing beam quality and reducing the patient dose by removing low energy x-rays from the useful beam with aluminum or an aluminum equivalent. Radiology Students.com Dictionary of Radiological Terms and Abbreviations. www.radiologoystudents.com accessed June 21, 21010
  • Radiation Safety and Fluoroscopy 20  Methods of radiation protection  ALARA = As Low As Reasonably Achievable  It is known the lower the dose = lower the risk  Badge Monitoring  Measures the amount of radiation exposed to at the workplace
  • Radiation Safety and Fluoroscopy 21  LIMITING YOUR EXPOSURE: You do the math!  Doubling your distance from the X-ray tube reduces your exposure by a factor of four.  Doubling that distance from the X-ray tube reduces your exposure by a factor of sixteen!
  • Radiation Safety and Fluoroscopy 22  Occupational Radiation Limits by exposure and annual limit for Adults (10 CFR 20.1201 Occupational Dose Limits for Adults and 20.1208 Dose equivalent to an embryo/fetus) Total effective dose equivalent 5 rem/year Sum of deep-dose equivalent and the committed dose equivalent of any individual organ or tissue except lens of eye 50 rem/year Lens of eye 15 rem/year Shallow –dose equivalent to the skin of the whole body or skin of any extremity 50 rem/year Fetus/embryo , dose equivalent 0.5rem/year 10 CFR 20.1201 and 20.1208 http://www.ncr.gov/reading-rm/doc-collections/cfr accessed June 18, 2010.
  • Radiation Safety and Fluoroscopy 23  Dose records  Evaluation of cumulative dosage records for mandatory reports to individuals  10 CFR 19.13(b): licensees must provide an annual report to each individual monitored of the dose received in that monitoring year if: • (1) the individual's occupational dose exceeds 1 millisievert (mSv) (100 millirem (mrem)) TEDE or 1 mSv (100 mrem) to any individual organ or tissue; or • (2) the individual requests his or her annual dose report.  The criterion of 1 mSv (100 mrem) applies to the whole body, to any individual organ or tissue, to the lens of the eye, to the skin of the whole body, and to the skin of the extremities. If the dose to any one of these exceeds the criterion during a monitoring year, then the licensee must provide a dose report to the individual for that year. The agency will also revise NRC Form 3, "Notice to Employees," to reflect the changes to the requirements for reporting doses to individuals. 10 CFR 19. 13 http://www.ncr.gov/reading-rm/doc-collections/cfr accessed June 18, 2010.
  • Radiation Safety and Fluoroscopy 24  Dose records  Maintenance of the cumulative dose records  Jameson Health System’s policy. • Personnel monitoring devices (film badges, TLD rings, pocket chambers, etc.) are required to be provided to any individual whose occupational exposure to sources of ionizing radiation has the potential to exceed 1/10 of the MPD (Maximum Permissible Dose) of 5000 millirem annually. • The Health System’s Radiation Protection Plan is modeled under the ALARA (As Low As Reasonably Achievable) concept. Thresholds for investigational levels are as follows: 1. Whole body ALARA I = 125 millirem per quarter 2. Whole body ALARA II = 375 millirem per quarter • Annual Occupational Exposure Limits: Whole Body : 5000 millirem Extremities: 50,000 millirem Medical Imaging Procedure Manual. Personnel monitoring Dept 54. http://radmanual.jameson/Department/DEPT-54.htm
  • Radiation Safety and Fluoroscopy 25  Dose records  Maintenance of the cumulative dose records  Jameson Health System’s policy • As an employer, Jameson Health System Inc. is required to be compliant with a Radiation Protection Plan consistent with 10 CFR 10.1101 provisions for monitoring occupational dose. • When an individual exceeds the ALARA II investigational level, that person receives a written notice and is interviewed by Radiation Safety Officer to determine factors contributing to the excessive dose rate. Suggestions will be offered to reduce the dose rate in the future. • When the limit of 5000 mrem limit is exceeded, the individual will no longer be able to practice the remaining of that calendar year. This is in compliance with PA DEP Bureau of Radiation Protection. Medical Imaging Procedure Manual. Personnel monitoring Dept 54. http://radmanual.jameson/Department/DEPT-54.htm accessed June 21, 2010
  • Radiation Safety and Fluoroscopy 26  Personal Dosimetry  Jameson Health System’s policy – position of dosimeters  For your guidance in the issuance and selection of appropriate dosimeters, the following criteria have been established.  1.Whole body film badges should be worn by all persons working with medical or dental x-ray and gamma-ray equipment (diagnostic or therapeutic). • a. For support personnel, monitoring requirements are based on the radiation dose they are likely to receive (see above). • b. Persons wearing lead aprons should wear the badge at collar level outside the apron (to estimate eye exposure). A second badge may be considered to monitor exposure of areas covered by the apron. • c. Persons whose hands might be placed unprotected in a direct x-ray beam should wear finger dosimeters.  [2]. 3. Personnel working with radionuclides should wear whole body badges when working with gamma-emitting sources. Extremity badges for beta and gamma-emitting radionuclides should be used. Medical Imaging Procedure Manual. Personnel monitoring Dept 54. http://radmanual.jameson/Department/DEPT-54.htm accessed June 21, 2010
  • Radiation Safety and Fluoroscopy 27  Personal Dosimetry  Types  Clip on’s – many shapes and sizes • Rectangle used at Jameson  Ring -- for on your finger  Wrist
  • Radiation Safety and Fluoroscopy 28  Biological effects of Radiation Biological Effects  Effects of Radiation – two types  Threshold Effects or Deterministic Effects  Effects that will occur given enough exposure  Examples include: • Cataracts in the eyes • Skin erythema (skin reddening) • Hair loss  Chance Effects or Stochastic Effects  Effects that have higher chance of occurring as you receive higher amounts of exposure  Examples include: • Cancer • Genetic mutations • Effects on the embryo or fetus Landauer basic radiation safety. Ver. 1.02. Glenwood, IL: Lauder, c1997.
  • Radiation Safety and Fluoroscopy 29 Somatic Effects  Effects of radiation limited to the exposed individual, as distinguished from genetic effects, that may also affect subsequent unexposed generations.  Prompt – Skin burns & Cataracts (below 5,000 rad and 500 rad)  Delayed – Cancer Electronic Reading Room > Basic References > Glossary > Somatic effects of radiation http://www.nrc.gov/reading-rm/basic-ref/glossary/somatic-effects-of-radiation.html Accessed June 22, 2010
  • Radiation Safety and Fluoroscopy 30 Genetic effects  High radiation doses tend to kill cells, while low doses tend to damage or alter the genetic code (DNA) of irradiated cells. High doses can kill so many cells that tissues and organs are damaged immediately. This in turn may cause a rapid body response often called Acute Radiation Syndrome. The higher the radiation dose, the sooner the effects of radiation will appear, and the higher the probability of death.  Genetic effects and the development of cancer are the primary health concerns attributed to radiation exposure. The likelihood of cancer occurring after radiation exposure is about five times greater than a genetic effect (e.g., increased still births, congenital abnormalities, infant mortality, childhood mortality, and decreased birth weight).  Genetic effects are the result of a mutation produced in the reproductive cells of an exposed individual that are passed on to their offspring. These effects may appear in the exposed person's direct offspring, or may appear several generations later, depending on whether the altered genes are dominant or recessive. Fact Sheet on Biological Effects of Radiation. USNRC. 2004. http://www.nrc.gov/reading-rm/doc-collections/fact- sheets/bio-effects-radiation.html accessed June 22, 2010.
  • Radiation Safety and Fluoroscopy 31 Genetic effects
  • Radiation Safety and Fluoroscopy 32 Relative tissue radiosensitivities
  • Radiation Safety and Fluoroscopy 33 Dose-effect relationships
  • Radiation Safety and Fluoroscopy 34 Special considerations  Dental  Radiographic, fixed, portable, mobile units  Fluoroscopy  All fluoroscopy equipment transforms x-rays exiting the patient into real- time visual images. This transformation is made possible by either an image intensifier or a flat panel digital detector.
  • Radiation Safety and Fluoroscopy 35 Special considerations  Mobile fluoroscopy  Cine fluoroscopy  Digital fluoroscopy  CT/CT fluoroscopy
  • Radiation Safety and Fluoroscopy 36 X-ray Equipment and Minimizing Patient Exposure  Exposure factors  kVp  mAs  Shielding  Rationale for usage  Types of devices  Placement of devices
  • Radiation Safety and Fluoroscopy 37 X-ray Equipment and Minimizing Patient Exposure  Beam restriction  Purpose of primary beam restriction  Effects on scatter  Types  Filtration  Effect on skin and organ exposure  Effect on average beam energy
  • Radiation Safety and Fluoroscopy 38  The intensity of light (or X-ray beam) observed from a source of constant intrinsic luminosity falls off as the square of the distance from the object. This is known as the inverse square law for light intensity.  Thus, if I double the distance to a light source the observed intensity is decreased to (1/2)2 = 1/4 of its original value. Generally, the ratio of intensities at distances d1 and d2 are Inverse-square law . Wikpedia. http://en.wikipedia.org/wiki/Inverse-square_law accessed June 30, 2010. Intensity: the Inverse Square Law. http://csep10.phys.utk.edu/astr162/lect/light/intensity.html accessed June 30, 2010.
  • Radiation Safety and Fluoroscopy 39 Inverse-square law . Wikpedia. http://en.wikipedia.org/wiki/Inverse-square_law accessed June 30, 2010. Intensity: the Inverse Square Law. http://csep10.phys.utk.edu/astr162/lect/light/intensity.html accessed June 30, 2010.
  • Radiation Safety and Fluoroscopy 40  Example math: A source is producing an intensity of 456 R/h at one foot from the source. What would be the distance in feet to the 100, 5, and 2 mR/h boundaries. 1. Convert Rem per hour to mRem per hour 456R/h x 1000 = 456,000 mR/h 2. Rework the equation to solve for D2 Plug in values and solve: Answer: D2= 67.5 feet  Using this equation the 100mR/h boundary would be 68 feet, the 5mR/h boundary would be 301.99 feet, and the 2mR/h boundary would be 477.5 feet. Radiographic Inspection - Formula Based on Newton's Inverse Square Law. NDT Education Resource Center, Brian Larson, Editor, 2001-2010, The Collaboration for NDT Education, Iowa State University, www.ndt-ed.org. http://www.ndt-ed.org/GeneralResources/Formula/RTFormula/InverseSquare/InverseSquareLaw.htm Accessed June 30, 2010
  • Radiation Safety and Fluoroscopy 41 X-ray Equipment and Minimizing Patient Exposure  Solid-state image receptors  Image Processing  Processing efficiency as related to patient dose  Film artifacts and corrective actions  Image quality as related to patient exposure
  • Radiation Safety and Fluoroscopy 42 Procedures also exist for and you should be familiar with:  Operation of Equipment  Identification of controls  Function of each control  Technique chart usage  Radiation Emergency (part of the HEICS plan) available on the Jameson Portal page potentially have to treat individuals who are injured, contaminated, or both.  Quality Assurance Program activities performed by QC Technologist Annual survey by Radiation Health Physicist.
  • Radiation Safety and Fluoroscopy 43 Continuing Education in Radiation Safety  Annual requirements – Pennsylvania  Physicians and Dentists in the Low Risk Category:  4 contact hours, every 4 years.  Physicians in the High Risk Category:  3 contact hours, every 3 years. DEP Technical guidance of medical X-ray procedures operator training guide 25 Pa Code 221.11 “ Document No. 291-4200-001, FINAL February 7, 2009 PA DEP. Bureau of Radiation Protection. Pg. 3.
  • Radiation Safety and Fluoroscopy 44 General Resources: DEP Technical guidance of medical X-ray procedures operator training guide 25 Pa Code 221.11 “ Document No. 291-4200-001, FINAL February 7, 2009 PA DEP. Bureau of Radiation Protection. http://www.dep.state.pa.us/dep/subject/advcoun/rpac/2006/10-18-06%5C291- 4200-001%20Medical%20X- ray%20Procedures%20Operator%20Training%20Guide%20-%20augmented.pdf Pennsylvania. Department of Environmental Protection. Bureau of Radiation Protection. http://www.dep.state.pa.us/brp/Nuclear_Safety_Division/Nuclear_Safety_Homepage.htm United States Nuclear Regulatory Medicine Commission http://www.ncr.gov THE NEXT SLIDES 45-52 ARE THE TEST AND EVALUATION. ONLY THE SLIDES 45-52 OR THE 4 PAGE TEST AND EVALUATION NEED TURNED IN FOR CREDIT. COMPLETED FORMS SEND TO: LORI GRAHAM
  • Radiation Safety and Fluoroscopy 45 Radiation Safety and Fluoroscopy Enduring Material Please indicate your answers as clearly. Name (Please print): Date: 1. What is the method of radiation protection that is recommended and most effective? a. Limiting the time of exposure b. Using lead shielding. c. Distancing oneself from the radiation source. d. All the above. 2. REM is the unit effective dose that corrects absorbed rate for the risks from high energy particles. a. True b. False 3. What is the annual exposure limits according to the Pennsylvania Dept. of Environmental Protection, Bureau of Radiation? a. 5000 millirem whole body per calendar year b. 500 millirem whole body per calendar year c. 50,000 millirem extremities per calendar year d. 5000 millirem extremitites per calendar year e. Both a and c
  • Radiation Safety and Fluoroscopy 46 4. All but one is a biological effect of radiation exposure. Select the one that is not a biological effect of radiation exposure. a. Cataracts in the eyes b. Skin reddening and burning c. Eczema d. Hair loss 5. Where can the Radiation Emergency Procedure for Jameson Memorial Hospital be found? a. Located in the Physician’s Lounge b. Online Manual page on the Jameson Portal under Radiation Manual c. Online by searching Google.com d. On the PA DEP’s website 6. What does ALARA stand for? a. As Low As Reasonably Achievable b. As Low As Requirement Allows c. As Low As Registration Allows d. As Low As Restrictions Allow
  • Radiation Safety and Fluoroscopy 47 7. Skin burns and cataracts can occur below 5,000 rad and 500 rad. a. True b. False 8. According to the inverse square law, if one doubles the distance from the source, the intensity of the source is ¼ or (½)2. a. True b. False 9. When working with radiation equipment, which of the following procedures should you be familiar with? a. Operation of the equipment b. Radiation Emergency of the Institution c. Functions of each control d. Shielding for the operator and patient specific to the equipment e. All of the above 10. Genetic effects occurs when low doses of radiation damage or alter the genetic code, whereas, Acute Radiation Syndrome is a rapid body response from high radiation doses. a. True b. False
  • Radiation Safety and Fluoroscopy 48 Evaluation must be completed and turned in for certificate. Program Title: Radiation Safety and Fluoroscopy Enduring Material Creator, Consulting and Reviewing Physician : Dr. Banerjee Date/Time: June 29, 2010 Expiration: August 31, 2011 Learning Objectives: At the conclusion of the presentation, the participant should be able to: a. Summarize the basic properties, and units of measurement of radiation. b. Review the sources of radiation and the methods of radiation protection. c. Document the biological effects of radiation exposure. d. Summarize the types of X-ray equipment, imaging recording and processing. e. Recommend the proper patient exposure and positioning for a particular radiation related procedure. f. Review the procedures, the Quality Assurance Program, and the related radiation safety regulations.  Please rate the following… Excellent Good Fair Poor  Overall activity…      Clarity of session content…      Relevance of content to you…      Quality of visual aids/handouts…   
  • Radiation Safety and Fluoroscopy 49 Evaluation must be completed and turned in for certificate Statement of changes this program has made on your practice. Some questions allow for more than one answer. 1. This activity will assist in improvement of:  Competence  Performance  Patient Outcomes  Patient Safety 2. I plan to make the following changes in my practice by:  Modifying treatment plans.  Changing my screening/prevention practice.  Incorporating different diagnostic strategies into patient evaluation.  Using alternate communication methodologies with patient and families.  Other. Please state:  None. This activity validated current practices. 3. What is your level of commitment to making the changes stated above?  Very committed  Somewhat committed  Not very committed  Do not expect to change practice
  • Radiation Safety and Fluoroscopy 50 Evaluation must be completed and turned in for certificate Statement of changes this program has made on your practice. Some questions allow for more than one answer. 4. What are the barriers you face in your current practice setting that may impact patient outcomes?  Lack of evidence-based guidelines  Lack of applicability of guidelines to current practice or patients  Lack of time  Organizational or Institutional  Insurance or Financial  Patient Adherence or Compliance  Treatment related to adverse events  Other: Explain 5. This activity supported achievement of the learning objectives.  Strongly Agree  Agree  No Opinion  Disagree  Strongly Disagree
  • Radiation Safety and Fluoroscopy 51 Evaluation must be completed and turned in for certificate Statement of changes this program has made on your practice. Some questions allow for more than one answer. 6. The material was organized clearly for learning to occur.  Strongly Agree  Agree  No Opinion  Disagree  Strongly Disagree 7. The content learned from this activity will impact my practice.  Strongly agree  Agree  No Opinion  Disagree  Strongly Disagree 8. The activity was presented objectively and free of commercial bias.  Strongly agree  Agree  No Opinion  Disagree  Strongly Disagree
  • Radiation Safety and Fluoroscopy 52 Evaluation must be completed and turned in for certificate Statement of changes this program has made on your practice. Some questions allow for more than one answer. If you answered Disagree or Strongly Disagree to any of the statements above, please explain your disagreement with the statement(s) in space below. Any other comments about today’s program can be made here also. Name Specialty Be sure that both evaluation and test are turned in. Slides 45-52 or the 4 page paper version. Be sure to send inner office to Lori Graham – Library /CME, or FAX 724-656-4267 or EMAIL: lgraham@jamesonhealth.org