0:00

I want to discuss about minimizing risk from fluoroscopy.

0:05

This is one modality where it's important to

0:08

discuss both the potential risks and also the radiation

0:12

protection principle for the staffs working around fluoroscopy.

0:17

Let's examine. Here is my outline for this particular part

0:21

of this. I'm going to speak on fluoroscopy exams,

0:25

biological effect of radiation,

0:27

factors affecting radiation exposure, radiation dose reduction

0:31

strategies,

0:33

scatter radiation patterns, finally, wrap it up with the

0:37

radiation protection principle.

0:40

The general fluoroscopy procedures performed in

0:43

radiology have lower risk for radiation injuries

0:47

because they are done in a very short period of time and without

0:51

any additional recording and other modes.

0:54

Therefore, these procedures have lesser risk for any

0:57

radiation injuries to the patient.

1:00

The main concern is the interventional fluoroscopy procedures.

1:04

These procedures have the tendency to have a

1:08

prolonged fluoroscopic exposure,

1:11

and if proper care is not taken care in terms of the

1:15

optimization of the equipment, nor understanding the principle of

1:19

radiation protection, that has the potential risk for causing

1:23

radiation injuries.

1:26

Here are the examples of fluoroscopy exams routinely

1:30

done in radiology. I listed on the left-hand side is the routine

1:34

procedures. Just to name a few, the most commonly

1:38

done in radiology departments are barium swallow, barium

1:41

enema studies, lumbar puncture, myelogram,

1:46

upper GI series, small bowel series, and so

1:49

forth. These procedure tend to be done

1:53

with the fluoroscopic exposure much smaller.

1:57

The maximum exposure time can be three to five minutes.

2:00

Beyond that, the procedure is done.

2:03

However, the one which I'm going to be talking more is the

2:07

interventional procedures. These are done by the

2:10

interventional radiologist, both for the body radiology procedure

2:15

and also for neuroradiology procedure.

2:18

Outside radiology, the fluoroscopy procedure which is done

2:22

under interventional type is mainly in cardiology,

2:26

especially cardiac stent placement,

2:30

electrophysiology procedure. There's a whole sort of procedures

2:34

done under the guidance of fluoroscopy, and we call it as interventional

2:38

cardiac procedures.

2:40

So is also the vascular surgery does fluoroscopy

2:43

procedure, which can be quite long and has the potential

2:47

for radiation in skin injuries. In addition,

2:51

other than these areas, the other area which is performing

2:55

fluoroscopy are in surgery, endoscopy,

2:59

orthopedics, urology, and neurosurgery.

3:02

Just to wrap it up, basically telling like these days, the advances

3:06

of fluoroscopy and the benefit of doing a fluoroscopy procedure

3:10

has really expanded the utilization of fluoroscopy around the

3:14

hospital.

3:16

Every surgical unit now have equipped with a fluoroscopy

3:19

system or have a mobile CRM ready to be

3:23

rolled into the surgery when they're doing a procedure.

3:27

So is the benefits of the fluoroscopy procedure.

3:30

So interventional fluoroscopy procedure that have the potential for high

3:34

skin doses are listed here. As you can see here, most of them

3:38

are very complicated procedure for like stent creation,

3:42

embolization, stroke therapy, cardiac ablation

3:46

procedure, carotid stent placement, angioplasty,

3:49

angiography. All these procedures are quite

3:53

complicated. Because of that, the physician doing this

3:57

procedure has to use fluoroscopic guidance for a long time.

4:01

When the long time means there's a lot of exposure to the skin surface,

4:05

that can lead to skin injury.

4:07

On the other hand, the benefit of this procedure far outweighs any of the

4:11

risk associated, because in the absence of these

4:15

procedures, the patient had to undergo open surgery,

4:19

which has lot more risk compared to these procedure, which are done on an

4:22

outpatient basis. The patient walks in, get the procedure done, and the

4:26

patient goes back home the same day, which has

4:30

minimal hospitalization, but also very comfortable for the

4:34

patient, but it also is a very life-saving procedure.