ICRP Publication 117
Radiological Protection in Fluoroscopically Guided Procedures outside the Imaging Department
Recommended citation
ICRP, 2010. Radiological Protection in Fluoroscopically Guided Procedures outside the Imaging Department. ICRP Publication 117, Ann. ICRP 40(6).
Authors on behalf of ICRP
M.M. Rehani, O. Ciraj-Bjelac, E. Vaño, D.L. Miller, S. Walsh, B.D. Giordano, J. Persliden
Abstract - An increasing number of medical specialists are using fluoroscopy outside imaging departments, but there has been general neglect of radiological protection coverage of fluoroscopy machines used outside imaging departments. Lack of radiological protection training of those working with fluoroscopy outside imaging departments can increase the radiation risk to workers and patients. Procedures such as endovascular aneurysm repair, renal angioplasty, iliac angioplasty, ureteric stent placement, therapeutic endoscopic retrograde cholangio-pancreatography, and bile duct stenting and drainage have the potential to impart skin doses exceeding 1 Gy. Although tissue reactions among patients and workers from fluoroscopy procedures have, to date, only been reported in interventional radiology and cardiology, the level of fluoroscopy use outside imaging departments creates potential for such injuries.
A brief account of the health effects of ionising radiation and protection principles is presented in Section 2. Section 3 deals with general aspects of the protection of workers and patients that are common to all, whereas specific aspects are covered in Section 4 for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology, gastroenterology and hepatobiliary system, and anaesthetics and pain management. Although sentinel lymph node biopsy involves the use of radio-isotopic methods rather than fluoroscopy, performance of this procedure in operating theatres is covered in this report as it is unlikely that this topic will be addressed in another ICRP publication in coming years. Information on radiation dose levels to patients and workers, and dose management is presented for each speciality.
Issues connected with pregnant patients and pregnant workers are covered in Section 5. Although ICRP has recently published a report on training, specific needs for the target groups in terms of orientation of training, competency of those who conduct and assess specialists, and guidelines on the curriculum are provided in Section 6.
This report emphasises that patient dose monitoring is essential whenever fluoroscopy is used.
It is recommended that manufacturers should develop systems to indicate patient dose indices with the possibility of producing patient dose reports that can be transferred to the hospital network, and shielding screens that can be effectively used for the protection of workers using fluoroscopy machines in operating theatres without hindering the clinical task.
© 2012 Published by Elsevier Ltd on behalf of ICRP.
Keywords: Radiological Protection; Fluoroscopy; Radiation; Dose.
1 The term ‘worker’ is defined by the Commission in Publication 103 (ICRP, 2007) as ‘any person who is employed, whether full time, part time or temporarily, by an employer, and who has recognized rights and duties in relation to occupational radiological protection’. In this document, both terms are used: ‘worker’ in the context as above and ‘staff’ where use of ‘worker’ appears inappropriate.
AUTHORS ON UTHORS ON BEHALF OF EHALF OF ICRP M.M. REHANI, O. CIRAJ-BJELAC, E. VANO˜ ´ , D.L. MILLER, S. WALSH, B.D. GIORDANO IORDANO, J. PERSLIDEN ERSLIDEN
Reference
ICRP, 2007. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann. ICRP 37 (2–4).
Key Points
An increasing number of medical specialists are using fluoroscopy outside imaging departments, and expansion of its use is much greater today than at any time in the past.
There has been general neglect of radiological protection coverage of fluoroscopy machines used outside imaging departments.
Lack of radiological protection training of workers using fluoroscopy outside imaging departments can increase the radiation risk to workers and patients.
Although tissue reactions among patients and workers from fluoroscopy procedures have, to date, only been reported in interventional radiology and cardiology, the level of fluoroscopy use outside imaging departments creates potential for such injuries.
Procedures such as endovascular aneurysm repair, renal angioplasty, iliac angioplasty, ureteric stent placement, therapeutic endoscopic retrograde cholangio-pancreatography, and bile duct stenting and drainage have the potential to impart skin doses exceeding 1 Gy.
Radiation dose management for patients and workers is a challenge that can only be met through an effective radiological protection programme.
Patient dose monitoring is essential whenever fluoroscopy is used.
Medical radiation applications on pregnant patients should be justified and tailored to reduce fetal dose.
Termination of pregnancy at fetal does of <100 mGy is not justified based upon radiation risk.
The restriction of a dose of 1mSv to the embryo/fetus of a pregnant worker after declaration of pregnancy does not mean that it is necessary for a pregnant woman to avoid work with radiation completely, or that she must be prevented from entering or working in designated radiation areas.
Pregnant medical workers may work in a radiation environment provided that there is reasonable assurance that the fetal dose can be kept below 1mSv during the course of pregnancy. It does, however, imply that the employer should review the exposure conditions of pregnant women carefully.
Every action to reduce patient dose will have a corresponding impact on occupational dose, but the reverse is not true.
Recent reports of opacities in the eye of workers who use fluoroscopy have draw attention to the need to strengthen radiological protection measures for the eyes.
The use of radiation shielding screens for protection of workers using x-ray machines in operating theatres in recommended, wherever feasible.
A training programme in radiological protection for healthcare professionals has to be oriented towards the type of practice in which the target audience is involved.
A worker’s competency to carry out a particular function should be assessed by individuals who are suitably competent themselves.
Periodic quality control testing of fluoroscopy equipment can provide confidence in equipment safety.
Manufacturers should develop systems to indicate patient dose indices with the possibility of producing patient dose reports that can be transferred to the hospital network.
Manufacturers should develop shielding screens that can be effectively used for the protection of workers using fluoroscopy machines in operating theatres without hindering the clinical task.
Executive Summary: Not included in this publication
ICRP, 2010. Radiological Protection in Fluoroscopically Guided Procedures outside the Imaging Department. ICRP Publication 117, Ann. ICRP 40(6).
Authors on behalf of ICRP
M.M. Rehani, O. Ciraj-Bjelac, E. Vaño, D.L. Miller, S. Walsh, B.D. Giordano, J. Persliden
Abstract - An increasing number of medical specialists are using fluoroscopy outside imaging departments, but there has been general neglect of radiological protection coverage of fluoroscopy machines used outside imaging departments. Lack of radiological protection training of those working with fluoroscopy outside imaging departments can increase the radiation risk to workers and patients. Procedures such as endovascular aneurysm repair, renal angioplasty, iliac angioplasty, ureteric stent placement, therapeutic endoscopic retrograde cholangio-pancreatography, and bile duct stenting and drainage have the potential to impart skin doses exceeding 1 Gy. Although tissue reactions among patients and workers from fluoroscopy procedures have, to date, only been reported in interventional radiology and cardiology, the level of fluoroscopy use outside imaging departments creates potential for such injuries.
A brief account of the health effects of ionising radiation and protection principles is presented in Section 2. Section 3 deals with general aspects of the protection of workers and patients that are common to all, whereas specific aspects are covered in Section 4 for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology, gastroenterology and hepatobiliary system, and anaesthetics and pain management. Although sentinel lymph node biopsy involves the use of radio-isotopic methods rather than fluoroscopy, performance of this procedure in operating theatres is covered in this report as it is unlikely that this topic will be addressed in another ICRP publication in coming years. Information on radiation dose levels to patients and workers, and dose management is presented for each speciality.
Issues connected with pregnant patients and pregnant workers are covered in Section 5. Although ICRP has recently published a report on training, specific needs for the target groups in terms of orientation of training, competency of those who conduct and assess specialists, and guidelines on the curriculum are provided in Section 6.
This report emphasises that patient dose monitoring is essential whenever fluoroscopy is used.
It is recommended that manufacturers should develop systems to indicate patient dose indices with the possibility of producing patient dose reports that can be transferred to the hospital network, and shielding screens that can be effectively used for the protection of workers using fluoroscopy machines in operating theatres without hindering the clinical task.
© 2012 Published by Elsevier Ltd on behalf of ICRP.
Keywords: Radiological Protection; Fluoroscopy; Radiation; Dose.
1 The term ‘worker’ is defined by the Commission in Publication 103 (ICRP, 2007) as ‘any person who is employed, whether full time, part time or temporarily, by an employer, and who has recognized rights and duties in relation to occupational radiological protection’. In this document, both terms are used: ‘worker’ in the context as above and ‘staff’ where use of ‘worker’ appears inappropriate.
AUTHORS ON UTHORS ON BEHALF OF EHALF OF ICRP M.M. REHANI, O. CIRAJ-BJELAC, E. VANO˜ ´ , D.L. MILLER, S. WALSH, B.D. GIORDANO IORDANO, J. PERSLIDEN ERSLIDEN
Reference
ICRP, 2007. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann. ICRP 37 (2–4).
Key Points
An increasing number of medical specialists are using fluoroscopy outside imaging departments, and expansion of its use is much greater today than at any time in the past.
There has been general neglect of radiological protection coverage of fluoroscopy machines used outside imaging departments.
Lack of radiological protection training of workers using fluoroscopy outside imaging departments can increase the radiation risk to workers and patients.
Although tissue reactions among patients and workers from fluoroscopy procedures have, to date, only been reported in interventional radiology and cardiology, the level of fluoroscopy use outside imaging departments creates potential for such injuries.
Procedures such as endovascular aneurysm repair, renal angioplasty, iliac angioplasty, ureteric stent placement, therapeutic endoscopic retrograde cholangio-pancreatography, and bile duct stenting and drainage have the potential to impart skin doses exceeding 1 Gy.
Radiation dose management for patients and workers is a challenge that can only be met through an effective radiological protection programme.
Patient dose monitoring is essential whenever fluoroscopy is used.
Medical radiation applications on pregnant patients should be justified and tailored to reduce fetal dose.
Termination of pregnancy at fetal does of <100 mGy is not justified based upon radiation risk.
The restriction of a dose of 1mSv to the embryo/fetus of a pregnant worker after declaration of pregnancy does not mean that it is necessary for a pregnant woman to avoid work with radiation completely, or that she must be prevented from entering or working in designated radiation areas.
Pregnant medical workers may work in a radiation environment provided that there is reasonable assurance that the fetal dose can be kept below 1mSv during the course of pregnancy. It does, however, imply that the employer should review the exposure conditions of pregnant women carefully.
Every action to reduce patient dose will have a corresponding impact on occupational dose, but the reverse is not true.
Recent reports of opacities in the eye of workers who use fluoroscopy have draw attention to the need to strengthen radiological protection measures for the eyes.
The use of radiation shielding screens for protection of workers using x-ray machines in operating theatres in recommended, wherever feasible.
A training programme in radiological protection for healthcare professionals has to be oriented towards the type of practice in which the target audience is involved.
A worker’s competency to carry out a particular function should be assessed by individuals who are suitably competent themselves.
Periodic quality control testing of fluoroscopy equipment can provide confidence in equipment safety.
Manufacturers should develop systems to indicate patient dose indices with the possibility of producing patient dose reports that can be transferred to the hospital network.
Manufacturers should develop shielding screens that can be effectively used for the protection of workers using fluoroscopy machines in operating theatres without hindering the clinical task.
Executive Summary: Not included in this publication
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