RADIATION SAFETY: IS MY CATH LAB DOING ENOUGH? Radiation Protection Pavilion E. Vano (Madrid/ES) Monday 28 th Sept 2015 12:30 12:45 1
CONTENT 1. Knowledge of the X-ray and imaging system. 2. Availability and knowledge of the radiation protection tools (patients and staff). 3. Audit of patient dose values and comparison with DRLs. 4. Audit of staff dose values and comparison with dose limits. 5. Are optimization actions necessary? 2
1. KNOWLEDGE OF THE X-RAY AND IMAGING SYSTEM Operation modes available (e.g. fluoroscopy, cine, DSA, roadmap, stent enhacement, CBCT, etc). Image quality and patient dose for the different modes. Radiation dose information during the procedures (patient and staff doses, if available). Radiation dose reports (RDSR in DICOM) and interpretation. Radiation dose registries (patients and staff if available). Alarm settings for high doses (need of follow-up). 3
2. AVAILABILITY AND KNOWLEDGE OF THE RADIATION PROTECTION TOOLS (PATIENTS AND STAFF) Active and passive strategies. RP tools offered by the X-ray system (e.g. specific low dose protocols, wedge filters, virtual collimation, etc). Ceiling suspended screens and protective curtains. Disposable protective patient drapes. Personal protective devices: aprons, thyroid shield, glasses, gloves, etc. Importance of occupational dosimetry (and real time information). 4
3. AUDIT OF PATIENT DOSE VALUES AND COMPARISON WITH DRLS No limits for patient doses, but Diagnostic Reference Levels (DRLs) should be used (and are required by the European regulations) for optimization and clinical audit. DRLs are a form of investigation level, applied to an easily measured quantity. Intended for use as a simple test for identifying situations where the levels of patient dose are unusually high or low. Objective of DRLs - avoid radiation dose to the patient that does not contribute to the clinical purpose of a medical imaging task (ICRP 105). 5
4. AUDIT OF STAFF DOSE VALUES AND COMPARISON WITH DOSE LIMITS A single standard personal dosimeter worn under the apron may not be enough for interventionists considering the new occupational dose limit for the lens of the eyes. ICRP and CIRSE-SIR recommend the use of double personal dosimetry for a proper evaluation of occupational risk for interventionists. Measurement (or estimation) of occupational doses in some non-protected organs or tissues need to be audited to avoid deterministic effects (e.g. cataracts). Active electronic dosimeters with real time information are excellent tools for optimization. 6
5. ARE OPTIMIZATION ACTIONS NECESSARY? Optimization actions are required by European regulations and recommended by most of the international organizations. Optimization actions should be included in the quality assurance programme of any IR unit. The periodic evaluation of image quality (diagnostic information), patient doses and staff doses, are the key aspects of any radiation safety programme for interventional radiology. 7
RADIATION SAFETY: IS MY CATH LAB DOING ENOUGH? (SCORING SHEET MAX. 5 POINTS) 1. Do you know the patient dose values for the different operation modes of your X-ray system?. 2. Are you using all the RP tools (active and passive) available in your catheterization laboratory?. 3. Do you audit periodically the patient dose values and compare them with DRLs?. 4. Do you know your occupational monthly doses under and over the protective apron?. 5. Are you reviewing periodically your working procedures to implement optimization actions if appropriate?. 8
THANK YOU! 9 (Next slides contain some useful references)
The CIRSE Executive Committee and the SIR Executive Council endorsed the document 10 10
SIR AND CIRSE GUIDELINES FOR PATIENT RADIATION DOSE MANAGEMENT Quantities and units used for patient dose measurement (including peak skin dose). Pre-procedural planning. Individual training Equipment Patient consent Procedure planning Intra-procedural management (with dose management and minimization techniques) Post-procedural care (with dose documentation, patient follow-up and quality assessment) Appendices 11
Also published in: J Vasc Interv Radiol. 2010 May;21(5):607-15. Guidelines approved by the members of the CIRSE Standards of Practice committee and the SIR Safety and Health Committee The CIRSE Executive Committee and the SIR Executive 12 Council endorsed the document 12
SIR AND CIRSE GUIDELINES FOR OCCUPATIONAL RADIATION PROTECTION Quantities and units used for occupational exposure. Occupational dosimetry in the interventional laboratory. Dosimeter use. Dose limits and risk estimates. Evaluation of personal dosimetric data. Radiation protection tolos. Practical advice to reduce or minimize the occupational radiation dose (including training). Management responsibilities. 13
To Published in: J Vasc Interv Radiol 2012; 23:19 32 Guidelines approved by the members of the SIR Safety and Health Committee and CIRSE Standards of Practice committee, represent experts in a broad spectrum of interventional procedures from both 14 the private and academic sectors of medicine
SIR AND CIRSE GUIDELINES FOR RADIATION MANAGEMENT DURING PREGNANCY Quantities, units, biological effects and risk of ionizing radiation during pregnancy. Role of Qualified Medical Physicist or Medical Physics Expert. Clinical management of pregnant patients. Practical actions to control dose to the pregnant patient and conceptus (fluoroscopy and CT). Counseling pregnant patients. Estimation radiation dose to conceptus and recording dose in patient medical record and folloup evaluations. Recommendations. 15
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