The document discusses methods for reducing radiation risk for doctors performing fluoroscopy procedures. It describes the basic principles of radiation protection including minimizing exposure time, maximizing distance from the patient, and using protective equipment. Specific tips provided include collimating the x-ray beam, avoiding positions with high reflected radiation, and ensuring proper use of lead aprons and thyroid shields by all staff in the room. The document emphasizes optimizing image quality while minimizing unnecessary radiation dose for both patients and medical personnel.
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Radiation Protection Tips for Doctors Using Fluoroscopy
1. IAEA Training Course on Radiation Protection
for Doctors (non-radiologists, non-cardiologists)
using Fluoroscopy
Cum sa reduc riscul de iradiere?
2. 2
• Aspecte de reglementare in radioprotectie
• Metodele de baza in radioprotectie
• Factorii ce influenteaza dozele pentru personal
• Reguli practice
• Dispozitive de protectie
• Monitorizarea individuala a dozei
• Supravegherea medicala profesionala
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
Subiectele cheie
3. 3
Regulatory basis of radiation protection
Recommendations of the
International Commission of Radiological Protection (ICRP)
General – in 1990 and last in 2007
BSS= “International Basic Safety Standards for
Protection against Ionizing Radiation and for the Safety
of Radiation Sources, ” IAEA, Vienna 2011 (interim edition)
National regulations
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
4. 4
BSS – Responsabilitatile angajatorului
“Angajatorii sunt responsabili pentru asigurarea limitarii
expunerii la radiatii ionizante, optimizarea protectiei si
sigurantei, si organizarea programelor de radioprotectie cu
implementarea ulterioara a acestora”
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
5. 5
BSS – Dozele limita
For effective dose:
For equivalent dose:
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
*BSS interim edition
Urmatoarele limite nu se vor depasi pentru expunerea
profesionala la radiatii ionizante:
20 mSv pe an daca se activeaza 5 ani consecutiv sau 50 mSv intr-un
singur an;
pentru cristalin 20 mSv* pe an calculat pe 5 ani consecutiv; nu mai
mult de 50 mSv intr-un singur an.
Limita de doza pentru extremitati (miini si piciore) sau piele e de
500 mSv pe an.
6. 6
Bazele radioprotectiei
“Regulile de aur” :
• Timpul – minimizeaza expunerea
• Distanta – mareste distanta
• Dispozitive de protectie
• Factorii tehnici - e.g. collimation, pulse fluoroscopy,
magnification, filters, grids etc.
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
7. 7
Minimizeaza Timpul de Expunere
• Orice se face pentru minimalizarea expunerii va
micsora doza de radiatie!!
Minimizarea timpului fluoro si de achizitie
Oricind posibil iesirea din sala
Folosirea fluoroscopiei intermitente– minimizeaza
timpul in care tubul produce raze x.
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
8. 8
Maximizeaza Distanta – Legea patratului
invers ajuta sa te protejezi
“Legea patratului invers” – doza de radiatie variaza invers
proportional distantei
• Pacientul e principala sursa de radiatie secundara!!
0.5 m 1 m 1.5 m
dose rate
100
units
25
units
11
units
distance
• Deplasarea de la 0.5 m la 1 m (cu dublarea distantei)
doza scade de 4 ori sau cu 25%!!
patient
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
9. 9
Legea patratului invers te protejeaza
Stai cit mai departe de sursa cind este
ACTIVA, foloseste extensii pentru tuburi,
injector ghidat de la distanta, instrumente mai
lungi, etc.
Regula practica
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
10. 10
Factorii ce afecteaza doza pentru personal
• Sursa principala de radiatie pentru personal este
pacientul (radiatie secundara).
• Radiatia secundara nu
este uniforma in jurul
pacientului.
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
11. 11
• Radiatia secundara reflectata de la corp e mai pronuntata
de partea tubului;
• Peste jumate din radiatia reflectata se formeaza in primii
4 cm dupa ce raza x intra in pacient,
Factorii ce afecteaza doza pentru personal
• Doza de radiatie secundara
este mai mare in apropierea
suprafetei de intrare a
fascicolului primar in pacient.
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
12. 12
Reflectii intense
EVITA ACEASTA POZITIE DACA E POSIBIL
Operatorul trebuie sa se afle de partea intrensificatorului de
imagine dupa posibilitate
Factorii de afecteaza dozele pentru personal
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
13. 13
Doza reflectata e
mai mare linga
suprafata prin
care fascicolul
de raze X intra in
pacient
0.3 mGy/h
0.6 mGy/h
0.8 mGy/h
100 kV
11x11 cm
1m patient distance
patient thickness 18 cm
1 mA
DEPENDENTA DE UNGHI
Factorii ce afecteaza doza pentru personal
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
14. 14
Doza reflectata
e mai mica cu
cresterea
distantei
100 kV
11x11 cm
1 mA
mGy/h at 1m
mGy/h at 0.5m
VARIATIA DISTANTEI
Factorii ce afecteaza doza pentru personal
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
15. 15
Tubul in pozitie -sub masa- minimizeaza doza catre
ochii operatorului
over-couch tube under-couch tube
1.3 (59%)
2.0 (91%)
2.2 (100%)
100 kV
20x20 cm
1m patient distance
1 m
1 Gy/h
(17mGy/min)
mGy/h
1.2 (55%)
1.3 (59%)
1.2 (55%)
1.2 (55%)
100 kV
20x20 cm
1m patient distance
1 m
1 Gy/h
(17 mGy/min)
mGy/h
2.2 (100%)
Factorii ce afecteaza doza pentru personal
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
16. 16
Doza e mai
mare de partea
tubului
Factorii ce afecteaza doza catre personal
Proiectii laterale
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
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17. IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
17
Variatii a ratei de expunere dependent de
proiectie
anthropomorphic phantom (average-sized) measurements
Proiectii oblice,
mai multa
radiatie
secundara.
18. 18
IMAGE INTENSIFIER
Active Field-of-View (FOV)
RELATIVE PATIENT
ENTRANCE DOSE RATE
FOR SOME UNITS
12" (32 cm) 100
9" (22 cm) 177
6" (16 cm) 400
4.5" (11 cm) 711
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
19. 19
Oricind posibil colimeaza fascicolul de raze X
spre locul de interes
Reguli practice
Colimarea
•reduce doza pentru personal
•reduces doza pentru pacient
•imbunatateste calitatea imaginei
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
20. 20
Dozele pentru personal si pentru pacient sunt
legate partial
Acestea sunt in functie de:
sistemul de raze X
starea reala a sistemului
cum este folosit sistemul
Dispozitivele de radioprotectie disponibile
numarul si tipul de proceduri efectuate
nivelul de experienta a personalului
protocolul de operare folosit
Factorii ce afecteaza dozele pentru personal
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
21. 21
DACA SE
MARESTE
DIMENSIUNEA
PACIENTULUI
DOZA LA PIELE A
PACIENTULUI SI
RADIATIA SECUNDARA
CRESTE SEMNIFICATIV
Factorii ce afecteaza doza pacientului si
personalului
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
22. 22
Influienta grosimii pacientului
Cresterea de la 16 la 24 cm,
Rata dozei reflectate poate creste cu un
factor de 5 (10 mSv/hr x 5=50 mSv/hr)
Factorii ce afecteaza doza pacientului si
personalului
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
23. 23
SCHIMBAREA
DE LA REGIMUL
NORMAL LA CEL
HIGHDOSE AL
FLUROSCOPIEI
CRESTE RATA
DOZEI CU UN
FACTOR DE 2 SI
MAI MULT
Factorii ce afecteaza doza pacientului si
personalului
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
24. 24
Sfaturi practice pentru protectia
personalului
• Mareste distanta de la pacient.
• Minimizeaza folosirea floroscopiei si foloseste
regimul lowdose.
• Achizitioneaza doar numarul necesar de frameuri
per scena si cit mai putine scene.
• Colimeaza fascicolul catre suprafata de interest.
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
25. 25
• Foloseste sistemele cu tubul sub masa.
• Ia in considerare dimensiunea pacientului si
pozitia C-armului (angularea C-armului).
• A se pozitiona de partea intensificatorului de
imagine cit mai departe de pacient posibil.
• Foloseste ecranul suspendat, perdelutele, si
celelalte dispozitive de protectie in dotare.
Sfaturi practice pentru protectia personalului
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
26. 26
Optimizarea Radioprotectiei
• Asigura calitatea adecvata a imaginei prin
optimizarea ratei dozei.
• Trebuie de optimizat doza pentru pacient si de a o
minimalizat pentru personal
• Minimizarea dozei pentru pacient si personal nu
trebuie sa fie scop in sine.
Daca calitatea imaginii nu este
adecvata, orice doza de radiatie
resulta in plus!
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
27. 27
Echipamentul individual de protectie
• Angajatorul va asigura personalul cu echipament
individual de protectie adecvat si pe marime care va
corespunde cerintelor si standartelor (BSS).
Dar este responsabilitatea personalului
de a folosi echipamentul corect!
Oricum imbracamintea de protectie nu trebuie sa
inlocuiasca masurile de protectie.
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
28. 28
Echipament de protectie individuala
• Echipamentul de protectie include sortul,
scutul tiroid, ochelarii.
• Sortul trebuie sa fie echivalent:
cel putin 0.25 mm Pb daca se lucreaza cu
pina la 100 kV si
0.35 mm Pb daca se lucreaza cu peste 100
kV
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
29. 29
0.25 mm lead
60 kV; 100% 2 - 3 %
100 kV; 100% 8 - 15 %
Atenuarea plumbului
Courtesy of Prof. E. Vano
Echipament de protectie individuala
Mai mare kV, mai mica protectia
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
30. IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
30
0.50 mm lead
60 kV; 100% < 1 %
100 kV; 100% 3 - 7 %
Echipament de protectie individuala
Atenuarea plumbului
Courtesy of Prof. E. Vano
Mai mare kV, mai mica protectia
31. 31
• Protectia cu plumb reduce doza la 5% or
less(1-15%)
• Ecranizarea se face intre pacient si persoana
care trebuie protejata.
Daca operatorul e cu spatele la pacient,
protejarea spatelui este esentiala.
• Toti in sala trebuie sa poarte sortul de
protectie.
Echipament de protectie individuala
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
32. 32
Vest-Skirt Combination distribuie 70% din greutatea totala pe
solduri, lasind numai 30% pe umeri.
Optiunea cu material usor reduce greutatea cu peste 23%
asigurind protectie 0.5 mm Pb la 120 kVp
Echipament de protectie individuala
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
33. 33
Echipament de protectie individuala
Agata sortul! Nu le indoi!
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
34. 34
Sort usor scump de protectie trimis la curatatorie fara instructiuni
adecvate
Echipament de protectie individuala
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
35. 35
Expensive light protective apron sent to Laundry
Before
After cleaning
…$1000 loss!
Echipament de protectie individuala
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
36. 36
Scut tiroidian
Echipament de protectie individuala
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
37. 37
Ochelari de protectie
Equiv Pb: 0.75mm in fata si
siprotectie laterala;
Greutate: 80 grame.
Echipament de protectie individuala
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
38. DETERMINISTIC
LENS THRESHOLD
AS QUOTED BY
ICRP
OPACITIES
THRESHOLD
>0.1 Sv/year
CONTINUOUS
ANNUAL RATE
>0.15 Sv/year
CONTINUOUS
ANNUAL RATE
CATARACT
38
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L02. Understanding radiation units
39. 39
Radioprotectia minilor
Cea mai eficace metoda de protectie a miinilor:
Nu pune mina in fascicolul primar!!!
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
40. 40
Echipament de protectie
• Utilaje de protectie adaugatoare trebuie sa fie
prezente in sala:
• Ecrane de protectie suspendate.
• Jaluzele de plumb montate la masa.
• Scut pe rotile
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
41. 41
Under-couch tube
Head level
Without
protection
With
protection Pb
Head level
Height from the floor
Jaluzele de protectie
Height from the floor
Over-couch tube
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
42. (GOOD Practice) (BAD Practice)
Detector cit mai aproape de
pacient, tubul departe de
pacient patient
Detectorul departe de
pacient, tubul aproape
de patient
From: J American College of Cardiology 2004; 44(11): 2259-82
Doza la intrare in pacient vs. geometria
imaginii
42
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L02. Understanding radiation units
43. 43
Monitorizarea individuala a dozei
• Folosirea dozimetrului individual
• Se poarta la nivelul pieptului
• Inelul dozimetru
• Dozimetru la nivelul ochiului
• Dozimetrie electronica cu monitorizare in timp
real
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
44. 44
Monitorizarea dozei individuale
• Perioada de monitorizare sa nu depaseasca 3 luni,
preferabil o luna.
• E important procesarea sa se efectueze la timp.
• Intirzierea evaluarii dozimetrelor poate duce la pierderea
informatiei stocate.
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
45. 45
Dispensarizarea personalului
• Examenele medicale conform dispozitiei
autoritatilor regulatoare.
• Monitorizarea femeilor fertile sau gravide
In special implicate in radiologia interventionala.
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
46. 46
Protection of the
embryo or foetus
• The female worker should, on becoming aware that she is
pregnant, notify the employer in order that her working
conditions may be modified if necessary.
• The pregnancy shall not be considered as a reason to
exclude a female worker from work,
• But it is the responsibility of the employer to adapt the
working conditions in respect of occupational exposure so
as to ensure that the embryo or foetus is afforded the same
broad level of protection as required for members of the
public (< 1 mSv equivalent dose to the foetus to the end of
the pregnancy period”
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
47. 47
POSITIA TUBULUI
POZITIA FATA DE PACIENT
VOLUMUL PACIENTULUI IRADIAT (CIMPUL DE
VEDERE)
kV, mA and timpul (NUMARUL SI CARACTERUL
PULSURILOR)
FOLOSIREA EFECTIVA A ECHIPAMENTULUI
DE PROTECTIE
Factorii ce determina doza personalului
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
48. 48
O recomandare finala generala
Aveti in vedere radioprotectia pacientului,
astfel marind radioprotectia profesionala
individuala.
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?
49. Multumesc pentru atentie
49
IAEA Training Course on Radiation Protection for Doctors (non-radiologists, non-cardiologists) using Fluoroscopy
L05. How do I reduce my radiation risk?