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Ten tips for reducing radiation exposure during interventional procedures
HOLLYWOOD, Fla. — At the International Symposium on Endovascular Therapy, Lindsay Machan, MD, provided 10 tips for protecting yourself in a career with interventional fluoroscopy.
Lindsay Machan
1. Education
“The main source of exposure to [physicians performing interventional procedures] and staff is scatter radiation,” Machan, associate professor in the department of radiology, associate member of the division of vascular surgery and associate member of the department of urologic sciences at the University of British Columbia, Vancouver, said during a presentation. Scatter radiation is even greater when treating patients with elevated BMI.
Scatter radiation comes from two main places: the interface between the patient’s body and the table, and from the edge of the image intensifier, he said. “Be very aware of where your face is in relation to the image intensifier,” he said. Also, it is important to be mindful of automated dose control.
2. Understand the effects of angulation
Standing to the right of the patient carries a much higher risk for radiation exposure to the face.
3. Limit fluoroscopy time
Machan recommended limiting fluoroscopy time during endovascular procedures only to observe objects in motion. Instead, use the last image hold or fluoroscopy loops, he said. Consider digital magnification when reviewing images; take a nonmagnified image and ask a technician to digitally magnify the image.
4. Lower intensity
Another strategy is to use the lowest fluoroscopy dose that yields an adequate image or to use the lowest digital acquisition rate that provides necessary information. “You might be imaging two or four frames per second, when one or two [frames] is adequate,” he said.
5. Store images
Physicians performing endovascular procedures can store fluoroscopy images for posterity. For example, “when doing an inferior vena cava retrieval, you don’t need a perfect high-definition image, you just need to store it and show that you did snare it on the hook,” Machan said.
6. Only use magnification when needed
Increasing image magnification can increase radiation dose by up to 74%, depending on the type of machine, according to Machan. “The most common reason I see my partners using magnification is because the screen is too far away and [they] can’t see [it],” he said. “Moving the screen closer to where you are may help.”
7. Avoid exposure
Increasing the distance from fluoroscopy may limit the exposure rate. “One of the biggest increases in dose [exposure] that people have been incurring recently is that they are now standing in the room for digital acquisitions. If you don’t need to be in there, get out,” he said.
8. Protection is key
Machan utilizes floor-to-ceiling protection during endovascular procedures. Other methods for protection include the ZeroGravity Radiation Protection System (CFI Medical Solutions) and eye protection with glasses or a face shield. “In 2016, eye protection is mandatory. It is important to choose the right kind of leaded eye protection for the practice you have,” he said.
9. Cross-sectional imaging is recommended
Use of cross-sectional imaging may decrease fluoroscopy time. Machan recommended using it also during procedure planning.
10. Park your ego
“’Park your ego’ is by far the most important tip,” he said. Don’t expose yourself to more fluoroscopy just because you don’t want to miss a case, he said. – by Katie Kalvaitis
Reference:
Machan L. Session I: Town Hall – Managing the Lifetime Risks of Being an Interventionalist. Presented at: International Symposium on Endovascular Therapy; Feb. 6-10, 2016; Hollywood, Fla.
Disclosure: Machan reports financial ties with various medical device companies.