0:01

In general, any medical X-ray imaging

0:05

will use a principle called ALARA principle.

0:08

ALARA principle basically stands for to use radiation

0:12

as low as reasonably achievable.

0:16

That is very important because reasonably achievable means

0:20

there are a variety of factors sometimes, but in general, this is a

0:24

principle. So minimize the radiation dose as low as reasonably

0:27

achievable. Having discussed the patient

0:31

radiation reduction strategies and also discussed about

0:35

the implication of the scatter radiation from the field size

0:39

and the position of the patient to the patient's size, I

0:43

want to now discuss about radiation protection principle.

0:48

This is generally generic to every radiation, but more specific

0:52

here in fluoroscopy. The three main pillars of

0:55

radiation protections are time, distance, and shielding.

1:01

If one follows the principle of time, distance, and shielding, they

1:05

will have the maximum protection required to work around a

1:08

fluoroscopy suite.

1:10

What I meant is time is to minimize the time of exposure.

1:15

Shorter exposure time will yield lower patient dose

1:19

and lower scatter radiation.

1:22

But it is also equally important to remember to maximize the

1:26

image quality while minimizing the radiation dose.

1:29

If we decrease the radiation dose unilaterally, that can have

1:33

impact on image quality, which may

1:36

result in repeating the procedure, which should be avoided at all

1:40

cost. So the radiation utilized is just enough

1:44

to see what the physician is trying to look

1:48

for, diagnosis.

1:51

Distance is the second principle of radiation protection,

1:55

and the reason is it utilizes the principle called

1:58

inverse square law.

2:01

Means further away you stand from a radioactive source,

2:05

lesser you're going to get exposed to that particular radiation.

2:08

To show you an example here, here is a radioactive source.

2:12

At two feet, if you're measuring here, 90 MR per

2:16

hour.

2:18

If you double the distance, this will not go down by

2:22

50%, it'll go by one-fourth time. So

2:26

instead of 90 MR per hour, now this goes to

2:29

22.5 MR per hour. And if you go further another

2:33

foot, this will go up to 10 MR per hour.

2:36

So inverse square law works very conveniently,

2:40

and it can be used, it should be used for radiation protection

2:43

principle.

2:46

The third principle of radiation protection principle is shielding,

2:50

and that can be used for radiation, the scatter radiation protection shielding.

2:54

This is by regulation, it is required anybody working around

2:57

fluoroscopy to wear an apron. And this apron,

3:01

lead apron of 0.25 to 0.5 millimeter thick,

3:05

attenuates scatter radiation X-rays by 20 times.

3:10

Because of that, I also try to show that there is no need to

3:14

wear a double apron or a

3:18

special lead band around the abdomen during

3:21

pregnancy. I have seen instances where the nurses are very

3:24

nervous and they end up wearing two layers, which is not

3:28

necessary, or even purchase this abdominal

3:32

belt type to wear on top of the apron, which is basically

3:36

we have demonstrated it is not that effective except it's going

3:40

to impact,

3:41

have caused a lot more abdominal or shoulder pain.

3:45

So the radiation shields comes in aprons which are wrapped

3:49

around in one or two pieces. There are also thyroid shield, which is

3:53

recommended for interventional fluoroscopy procedure.

3:56

There is also leaded glasses, field shield.

3:59

And on top of it, most of the fluoroscopy suite or in the surgery,

4:03

there is ceiling and floor-mounted shields

4:08

which we recommend to use.

4:10

There is a fourth one category, which I have striked off, is called the leaded

4:13

surgical gloves, which is they are very thin

4:17

gloves with a thin layer of lead. However, they do

4:21

not actually protect so much as they claim,

4:25

because if the hand is out of the primary beam,

4:28

of course, it can protect the scatter, block scatter radiation.

4:32

But the purpose of the intervention is you're working with the patient, so

4:36

your hand may be exposed to primary radiation.

4:39

That actually has been shown to have exposed the hand even for

4:43

more than without the gloves. So we call them the

4:47

emperor's gloves when you talk about leaded surgical gloves.

4:52

These are example of lead apron,

4:55

both two-piece or one-piece. Most of the interventional

4:58

fluoroscopy, they use a two-piece basically to distribute the weight of

5:02

the apron that they need to carry around.

5:06

The minimum number is 0.25 to 0.5 millimeter lead,

5:10

and usually it is also covered in the back because the reason is a lot of the

5:14

time we are turning around talking to the students or anybody else, so the

5:18

back is also protected.

5:20

These days, there are special additions can be stitched to the apron

5:24

to protect the arm and also the breast, because

5:28

large-breasted women, because the whole can get exposed to low radiation,

5:32

that can be avoided by having a customized apron which will

5:36

cover this left side attached to the arm, so that way the whole

5:40

arm is covered. And so is also the, any gap shown

5:44

is covered. So these devices, typically

5:48

0.25 to 0.5 millimeter lead or lead

5:51

equivalent. These days, there is also lightweight apron which can be utilized in

5:55

fluoroscopy, which will block radiation 90% to

5:58

95% attenuation.

6:01

Caution is these aprons have to be checked on an annual

6:05

basis for any defect, such as hole or tear

6:09

pattern, and that needs to be documented.

6:12

And a lot of the time, the Joint Commission, when they come for inspection, they

6:16

ask for the documentation.

6:18

Regarding eye protection, I'm showing here a variety of eye protection.

6:22

For those who are doing interventional fluoroscopy, we recommend them to

6:26

wear eye protection. And if they are wearing eye protection, we

6:30

also want to make sure that their side is also covered, so it's

6:34

not left out open for any low radiation to enter.

6:39

The idea of utilizing the materials in the room.

6:42

This is a ceiling-mounted acrylic shield.

6:45

It's a lead shield. If it is brought properly closer to the

6:49

procedure area. Here it's showing me doing the measurement on a

6:53

interventional fluoroscopy system.

6:56

I brought this inside, means my uncovered portion of the body,

6:59

the head and neck, hardly get any scatter radiation now.

7:04

And there is also lead skirts in the table, which is again very helpful

7:09

for any protection for scatter radiation hitting the persons.

7:13

So the

7:15

understanding the application of radiation protection principle and adopting

7:19

on a regular basis will really certainly help for long-term

7:23

exposures, long-term working in this area.

7:27

This is the image of the leaded surgical gloves, which I was

7:31

against it, basically showing those who are wearing it, if the hand

7:35

is in the primary beam, they can see the finger,

7:39

and basically the finger might got a lot of radiation because of the nature of

7:42

these very thin gloves.

7:45

Then there are also mobile barriers available in the

7:49

surgical suite, and I like this product.

7:52

I highly recommend having this in the radiology area,

7:56

especially in the interventional area, because these can be

8:00

moved. They are made of lead with an

8:03

acrylic shield equivalent to lead attenuation power.

8:07

With the wheels, they can be moved anywhere.

8:10

When they move anywhere inside the suite, it creates a shadow area

8:14

for anybody to work behind it, and

8:17

that will minimize their X-radiation exposure.