Medical Staff Radiation Exposure and Fluoroscopy Protection

03.01.21 | Monday | Nofit Amir

To avoid threats from radiation exposure, radiologists and their teams must use adequate radiation shielding and fluoroscopy protection. Though X-rays pose a minimal threat to patients, long-term exposure to medical staff can cause cataracts, cardiovascular disease, and even cancer.

Fluoroscopy

Fluoroscopy is an imaging technique that uses X-rays to obtain real-time moving images of an object’s interior. An X-ray beam passes through the body during a fluoroscopy procedure, and a continuous image transmits to a monitor. The monitor allows doctors to see the movement of a body part, an instrument, or contrast agent, like X-ray dye, during procedures. Fluoroscopy is used in a wide variety of examinations and procedures to diagnose or treat patients. Some examples are:

• Barium X-rays and enemas to view the gastrointestinal tract
• Catheter insertion and manipulation to direct the movement of a catheter through blood vessels, bile ducts, or the urinary system
• Placement of devices within the body, such as stents to open narrowed or blocked blood vessels
• Angiograms to visualize blood vessels and organs
• Orthopedic surgery to guide joint replacements and treatment of fractures

Radiation-Related Risks Associated with Fluoroscopy

Fluoroscopy carries some risks, as do other X-ray procedures. The radiation dose the patient receives varies depending on the individual procedure. Fluoroscopy can result in relatively high radiation doses, especially for complex interventional procedures, such as placing stents or other devices inside the body, requiring fluoroscopy to be administered for a long time. Radiation-related risks associated with fluoroscopy include radiation-induced injuries to the skin and underlying tissues, which occur shortly after the exposure, and radiation-induced cancers, which may occur sometime later in life.

Concerns about radiation-related injuries to patients and medical staff have increased since the mid-1990s due to the increasing complexity and radiation dose of some fluoroscopically-guided interventions. Recent studies have suggested that even much lower radiation dose levels (500 mSv) can still produce eye damage leading to cataracts.

Types of Fluoroscopy Protection

Fluoroscopy operators and staff can significantly reduce their radiation exposure by wearing correctly fitted protective garments, positioning protective devices to block scatter-radiation, and adhering to good radiation practices. A lead apron of at least 0.25 mm lead equivalence (0.5 mm is recommended) will reduce scattered x-rays by 95 percent for fluoroscopic procedures. Additionally, a thyroid collar and leaded eyewear (or “radiation glasses”) are recommended.

Lead Aprons– For reasons of weight, lead aprons generally have shielding equivalence equal to a 0.25–0.5 mm lead barrier and will only attenuate the radiation. Lead aprons absorb 90–95 percent of the scattered radiation that reaches them. “Wrap-around” lead aprons are helpful when medical personnel spend a lot of time with their backs turned away from the patient. Lead aprons can weigh up to 17 lbs and can cause orthopedic issues and fatigue. It is important to note that the head remains wholly exposed to radiation risks while wearing lead aprons alone.

Lead Glasses– To protect the eyes from harmful radiation, operators use protective eyewear made from lead. To maximize protection, radiation protection glasses should be used in tandem with scatter-shielding screens and additional lead protection on the body, neck, and head.

Radiation Shielding Screen– Typically, a large sheet made of iron or lead is used to protect from harmful radiation scatter. These can be large and cumbersome to navigate and position in the operating theater.

StemRad MD– This proprietary exoskeleton system marries lead aprons and radiation shields–eliminating the need for lead glasses. The exoskeleton supports 100 percent of the weight from the lead and comes with a thyroid collar to allow the user to wear their own prescription glasses. This collar also protects the head and face, unlike traditional lead aprons. Using the most advanced materials, StemRad MD utilizes bilayer technology of bismuth and antimony––the best protection on a weight basis. The StemRad MD system covers more of the body than the typical lead apron–protecting the user from dangerous scatter radiation.

When it comes to fluoroscopy protection, out-dated options, like the lead apron, compromise protection with materials as thin as 0.25 mm (0.33 lead equivalence). Methods of wrapping the front with 0.25 mm lead over 0.25 mm lead to reach 0.5 mm in overlap in the front still leave the sides exposed at 0.25 mm. The head and face are still vulnerable to radiation exposure.

A solution, like the StemRad MD and its zero-gravity technology, can take the weight off of the user without radiation compromise. Shielding the face and head, the StemRad MD system takes radiation protection to a whole new level. Reducing muscle fatigue and radiation dangers, radiologists can operate with confidence.

By understanding the essentials of radiation physics, protective equipment, and each imaging system’s features, operators and staff can capitalize on radiation protection opportunities while minimizing ergonomic strain. Practicing and promoting radiation safety can help fluoroscopy operators and staff enjoy long, productive careers.