Staff and Patient Radiation Protection
In The Cath Lab
Andrés Sinisterra
Assistant Radiation Safety Officer for Medicine
Radiation vs. Radioactivity
RadiationEnergy in transit in the form of high speed particles and electromagnetic waves.
Ionizing RadiationRadiation with enough energy so that during an interaction with an atom, it can remove tightly bound electrons from their orbits, causing the atom to become charged or ionized.
RadioactivitySpontaneous transformation of an unstable atom and often results in the emission of radiation. This process is referred to as a transformation, a decay or a disintegration of an atom.
External vs. Internal Radiation Exposure
External Exposure – X-rays, Diagnostic Procedures.
Internal Deposition – Contamination from nuclear medicine patient undergoing a diagnostic or therapeutic procedure resulting in an ingestion of radioactive materials by the staff.
+
=T E D E
Units of Radiation Exposure
Roentgen Measure of electrical charge produced in air1,000 mr = 1R
Fluoro @ SSD ~3-10 R/min
Measure of energy absorbed, usually in tissue or bone.200 rad = transient erythema1 Gray = 100 Rad
Rad (Gray)
Units of Radiation Exposure
Rem (Sievert)
Measure of occupational risk (cancer) from radiation exposure1,000 mrem = 1 Rem1 Sievert = 100 Rem
1 R = 1 Rad = 1 Rem
A wave is a wave & nothing but a wave!
CAUTIONX-RAY
THIS EQUIPMENT PRODUCESX-RAYS WHEN ENERGIZED
TO BE OPERATED ONLY BYQUALIFIED PERSONNEL
CAUTION RADIATION
ROTOR
ROTATING ANODE
FILAMENT
TARGET
CATHODE
TUBE WINDOW
EVACUATED GLASS TUBE
Image Quality Vs Exposure
Area of Interest Collimation
Calcification of the vas deferens. These bilateral asymmetric calcifications occur in the lower to middle portion of the male pelvis
INCIDENT X-RAY
PHOTOELECTRON
Photoelectric effect occurs when an incident x-ray is totally absorbed during the ionization of the inner-shell electron. The incident photon disappears and the k-shell electron, now called a photoelectron, is ejected from the atom.
Compton effect occurs between moderate-energy x-rays and outer-shell electrons. It results in ionization of the target atom, change in photon direction and reduction of photon energy. The wavelength of the scattered x-ray is greater than that of the incident x-ray.
COMPTON ELECTRON
INCIDENT X-RAY
SCATTERED X-RAY
ANGLE OF DEFLECTION
<
INCIDENT ELECTRON
EJECTED ELECTRON LEAVES A HOLE TO BE FILLED
O Shell M Shell L Shell K ShellN Shell
Characteristic X-ray Photons(Characteristic Cascade)
Primary Primary BeamBeam
Scatter Scatter RadiationRadiation
Leakage Leakage RadiationRadiation
Scatter Scatter RadiationRadiation
Leakage Leakage RadiationRadiation
X-Ray X-Ray TubeTube
CaudalCaudal
Know Where Your Head Is At……!!!Know Where Your Head Is At……!!!
CoronalCoronal
Maximum Scatter
plus Leakage
Minimum Scatter
Head
and shoulders
knees
and toes !!!!!
Be aware of critically exposed areas
30-cm FOV
Image intensifier
70-cmSSD
1Medium conventional fluoroscopy2Setting C for fluorography3Floor kVp is 110
Dose = 50 rad
Pail of water
28-cm deep
55-cmSSD
1Medium conventional fluoroscopy2Setting C for fluorography3Floor kVp is 80
Dose = 140 rad
15-cm air gap
Pail of water
28-cm deep
23-cm FOV
Image intensifier
The effects of an air gap are significant, even if the image is properly collimated
The effects of an air gap are significant, even if the image is properly collimated
Know Where Your Head Is At……!!!Know Where Your Head Is At……!!!
The greater the distance the greater the scatter
The following Table illustrates the effect of changing Field-Of-View, or magnification modes, for a typical fluoroscopy
system
Mag Mode (Field-Of-View)
ESE (R/min) Increase Factor
Normal(9 inch)
1.2 1.0
Mag 1(6 inch)
2.9 2.4
Mag 2(4.5 inch)
5.2 4.3
Inverse Square Law (X-Rays & Gamma Rays)
For a point source, the intensity varies inversely as the square of the distance from the source.
1 1 cmcm
10,000 2 2
cmcm2,500
5 cm5 cm400
10 10 cmcm100
20 cm20 cm
25
Leakage Leakage RadiationRadiation
X-Ray X-Ray TubeTube
Scattered Scattered X-raysX-rays
Basic Radiation Safety Principles
TTimeime
DDistanceistance
CContaminationontamination ControlControl
SShieldinghielding
Whole Body Radiation Badge
Worn Underneath Pb
Apron
Collar Radiation Badge
Worn Outside Pb Apron At Neck
Level
BLACK ICON RED ICON
Extremity Radiation Badge
Worn on Primary Hand
Closest to Radiation Source
Radiation Exposure and Monitoring
Whole Body Whole Body Radiation Radiation
BadgeBadgeWorn Worn
Underneath Underneath Pb ApronPb Apron
Collar Collar Radiation Radiation
BadgeBadgeWorn Worn
OutsideOutside Pb Apron At Pb Apron At Neck LevelNeck Level
At Breast
~30 cm
At Thyroid
~45 cm
So what’s the big deal where I put my &#@% badges ? D’O
H !
Get The Lead Out but Watch Your Back !!
PROTECTIVE EQUIPMENTPROTECTIVE EQUIPMENT
AAs s LLow ow AAs s RReasonably easonably AAchievable chievable
ALARA Level IALARA Level I
> 10% of the maximum > 10% of the maximum quarterly exposure limit quarterly exposure limit
(125 mrem)(125 mrem)ALARA Level IIALARA Level II
> 30% of the maximum > 30% of the maximum quarterly exposure limit quarterly exposure limit
(375 mrem)(375 mrem)
ALARA Investigational Level IALARA Investigational Level I
Reducing Patient Dose During Fluoroscopy Reducing Patient Dose During Fluoroscopy (And Yours)(And Yours)
Get off the pedal!! – Fluoro intermittentlyGet off the pedal!! – Fluoro intermittently
Collimate and only expose clinical areaCollimate and only expose clinical area
Use larger fields when possibleUse larger fields when possible(Magnification increases patient dose)(Magnification increases patient dose)
Use distance of at least 30 cm for mobile Use distance of at least 30 cm for mobile units and 38 cm for fixed installationsunits and 38 cm for fixed installations
Use appropriate mA and KVpUse appropriate mA and KVp
Reducing Patient Dose During Fluoroscopy Reducing Patient Dose During Fluoroscopy (And Yours)(And Yours)
Remember the egg timer!!!Remember the egg timer!!!Be aware of the 5 minute timer (especially Be aware of the 5 minute timer (especially in high level mode)in high level mode)
Have sufficient beam filtrationHave sufficient beam filtration> 90 KVp requires 2.5 mm Al to 3.5 mm Al > 90 KVp requires 2.5 mm Al to 3.5 mm Al @ 130 KVp@ 130 KVp
Fluoro only when necessaryFluoro only when necessary
Schedule annual QA of equipmentSchedule annual QA of equipment
Radiation DoseThe amount of energy deposited in any substance by ionizing radiation per unit mass of the substance. It is expressed numerically in rads (traditional units) or grays (SI units).
Absorbed Dose Dose Equivalent Deep Dose Equivalent Eye Dose Equivalent Shallow Dose Equivalent Effective Dose Equivalent Committed Dose Equivalent Total Effective Dose Equivalent
Absorbed Dose - The amount of energy deposited in any substance by ionizing radiation per unit mass of the substance. It is expressed numerically in rads (traditional units) or grays (SI units).
Dose Equivalent - The dose equivalent (H) is the product of the absorbed dose in tissue, the quality factor and all other modifying factors at the location of interest. The unit is the rem (R) or the sievert (Sv).
Radiation Dose
Deep Dose Equivalent (Hd) - Applies to external whole body exposure, means the dose equivalent at a tissue depth of 1 cm or greater.
Eye Dose Equivalent - The external dose equivalent to the lens of the eye at a tissue depth of 0.3 cm.
Shallow Dose Equivalent (Hg) - Applies to the external exposure of the skin or extremity. The dose equivalent at a tissue depth of 0.007 cm averaged over an area of 1 cm2.
Radiation Dose
Committed Dose Equivalent (HE.50) - The dose equivalent (H) is a given organ or tissue that will be accumulated over 50 years following a single intake of radioactive material.
Effective Dose Equivalent (HE) - The sum of the products of the dose equivalent (HT) to each organ or tissue and the weighting factor (WT) applicable to each of the body organs or tissues that are irradiated (HE = ‡” WTHT).
Total Effective Dose Equivalent - The sum of the deep dose equivalent for external exposures and the committed effective dose equivalent for internal exposures.
Radiation Dose
Radiation Exposure Limits
Whole body; head and trunk; active blood-forming organs; lens of eyes, or gonads.
Hands and forearms; feet and ankles.
Skin of whole body.
1.25
18.75
7.5
((1,250 mrem)(5.0 rem/yr)
(18,750 mrem)(75 rem/yr)(7,500 mrem)(30 rem/yr)
Rem Per Calendar Rem Per Calendar QuarterQuarter
Type of Exposure Type of Exposure
(State of Connecticut Administrative Regulations Sect. 19-24-5) (State of Connecticut Administrative Regulations Sect. 19-24-5)
FetusFetus 500 mrem Total Gestation500 mrem Total Gestation(0.5 rem)(0.5 rem)
Radiation Exposure Limits
The total effective dose equivalent. 5.0 (0.05 Sv)
Rem Per Calendar Rem Per Calendar YearYear
Type of Exposure Type of Exposure
(USNRC 10CFR20 (USNRC 10CFR20 - § 20.1201- § 20.1201 ) )
The sum of the deep-dose equivalentand the committed dose equivalent toany individual organ or tissue otherthan the lens of the eye
50 (0.5 Sv)
Radiation Exposure Limits
Rem Per Calendar Rem Per Calendar YearYear
Type of Exposure Type of Exposure
(USNRC 10CFR20 (USNRC 10CFR20 - § 20.1201- § 20.1201 ) )
In Utero exposure to the FetusIn Utero exposure to the Fetus 0.5 rem Total Gestation0.5 rem Total Gestation(500 mrem & <50/mo) (500 mrem & <50/mo)
An eye dose equivalent
and
A shallow dose equivalent to the skin or to any extremity.
15 rem ( 0.15 Sv )
50 rem ( 0.50 Sv )
Conditions For Exceeding Quarterly Doses To Whole Body
< 3.0 rem< 3.0 rem
Total Whole Body DoseTotal Whole Body Dose <= 5 (N-18) rem<= 5 (N-18) rem
All Previous Whole Body DosesAll Previous Whole Body Doses
PlusPlus N = N = Your Your Age Age In Years In Years
Prior Dose Must Be On a Clear RecordPrior Dose Must Be On a Clear Record
! ! ! ! ALARA PROGRAM EXISTS ! ! ! !! ! ! ! ALARA PROGRAM EXISTS ! ! ! !
Total Dose For Any Quarter
Confidential Declaration of Pregnancy
NRC requires a signed declaration of pregnancy
for occupational workers to limit exposures
to 500 mrem/9months or 50 mrem in any one
month.
The United States Nuclear Regulatory Commission requires in the Code of Federal Regulations
Title 10, Chapter I, Part 20.1208, that special consideration be given to limitation of embryo/fetus
radiation exposure only in those instances where a woman has declared the pregnancy to the
appropriate representative of the employer (the UCHC). In cases where a pregnancy is not declared
in writing, the larger occupational exposure limit for the working mother is used as a maximum
permissible dose limit. The purpose of this form is to officially notify the employer, through the
Medical Director of Employee Health Services, that dose limitation to your embryo/fetus is
requested. The information contained on this form will be treated as confidential, and only those
directly involved in assessing the potential for embryo/fetal exposures will be informed. Please
sign the form where indicated and forward to:
PREGNANCY DECLARATIONConfidential Document
Marcia Trape-Cardoso, M.D., Medical Director Employee Health ServicesMC-6210
I, _________________________________ ______ , formally declare my pregnancy and request
dose limitation to my embryo/fetus such that my total radiation exposure during the gestational
period does not exceed 500 mrem, and if exposed, received at a uniform rate of no more than 50 mrem
per month. As required by the Nuclear Regulatory Commission, my approximate date of conception
was __________________.
Signed: Date:
Department:
Telephone #:
c:\flw\pregwrk.pre ( rev. 10/2000 )
A question of riskA question of risk
Radiation Exposures From ?
Smoking a pack and a Smoking a pack and a half of cigarettes a day half of cigarettes a day
will add about 1,300 will add about 1,300 mrem/year to one's mrem/year to one's
effective doseeffective dose
Flying from New York to Flying from New York to London results in the absorption London results in the absorption
of an extra of an extra 2-3 mrem of cosmic radiation2-3 mrem of cosmic radiation6-8 mrem from NY to Japan 6-8 mrem from NY to Japan
Risks which Increase Chance of Death by 1 Risks which Increase Chance of Death by 1 in 1 millionin 1 million aa
Drinking Miami drinking water for 1 year Cancer from chloroform
Drinking 30, 12 oz. cans of diet soda Cancer from saccharin
Living 5 years at site boundary of a typical nuclear power plant in the open
Cancer from radiation
Drinking 1000, 24 oz. soft drinks from banned plastic bottles Cancer from acrylonitrile monomer
Living 20 years near PVC plant Cancer from vinyl chloride (76 standard)
Living 150 years within 20 miles of a nuclear power plant Cancer from radiation
Eating 100 charcoal broiled steaks Cancer from benzopyrene
Risk of accident by living within 5 miles of a nuclear reactor for 50 years
Cancer from radiation
Eating 40 tablespoons of peanut butter Liver cancer from aflatoxin B
a B.L. Cohen and I.S. Lee, “Catalog of Risks Extended and Updated”, Health Physics, Vol. 61, Sept. 1991.
Estimated Loss of Life Expectancy Estimated Loss of Life Expectancy from Health Risks from Health Risks
Health Risk Average Days of Life Expectancy Lost
Smoking 20 cigarettes/day 2370 (6.5 years)Overweight (by 20%) 985 (2.7 years)All accidents combined 435 (1.2 years)Auto accidents 200Alcohol consumption 130Home accidents 95Drowning 41Natural background radiation 8Medical diagnostic x-rays 6All catastrophes (fire, flood, etc.) 3.51,000 mrem (1 rem) occupational radiation dose 11,000 mrem (1 rem)/yr for 30 years 30
Note: Average U.S. occupational radiation dose is estimated at 0.34 - 0.65 rem/year.
PROGRAM FOR IMPLEMENTING PROGRAM FOR IMPLEMENTING
PATIENT INFORMED CONSENTPATIENT INFORMED CONSENT
AND AND
FOLLOW UPFOLLOW UP REGARDING HIGH DOSE SPECIAL REGARDING HIGH DOSE SPECIAL
X-RAY PROCEDURESX-RAY PROCEDURES
There are certain x-ray guided procedures There are certain x-ray guided procedures that could result in the delivery of a radiation that could result in the delivery of a radiation dose to an area of a patient’s skin of dose to an area of a patient’s skin of sufficient magnitude to produce clinical sufficient magnitude to produce clinical symptoms.symptoms.
This program was developed to inform patients of this potential risk prior to such procedures, determine if a procedure may lead to a large skin dose and to follow up with the patient if there is a possibility of a skin reaction.
Purpose:Purpose:
This program is applicable to following x-ray This program is applicable to following x-ray guided proceduresguided procedures::
Policy:Policy:
Percutaneous Transluminal AngioplastyPercutaneous Transluminal AngioplastyRadiofrequency Cardiac Catheter Ablation Radiofrequency Cardiac Catheter Ablation Vascular Embolization Vascular Embolization Stent and Filter Placement Stent and Filter Placement Thrombolytic & Fibrinolytic Procedures Thrombolytic & Fibrinolytic Procedures Percutaneous Transhepatic Cholangiography Percutaneous Transhepatic Cholangiography and/or Biliary Drainage and/or Biliary Drainage
Any other x-ray guided procedure that could Any other x-ray guided procedure that could expose the expose the same area of the skin for more area of the skin for morethan 30 minutesthan 30 minutes
Policy (continued):Policy (continued):Endoscopic Retrograde Endoscopic Retrograde
Cholangiopancreatography Cholangiopancreatography Transjugular Intrahepatic Portosystemic Shunt Transjugular Intrahepatic Portosystemic Shunt Percutaneous Nephrostomy Percutaneous Nephrostomy Urinary/Biliary Stone Removal Urinary/Biliary Stone Removal
Or
For such cases, the patient must be For such cases, the patient must be informed in writing prior to the informed in writing prior to the procedure of the risks associated with procedure of the risks associated with large x-ray skin doses. large x-ray skin doses.
Appropriate follow up must be made, if Appropriate follow up must be made, if after completion of a procedure, a large after completion of a procedure, a large skin dose is possible. skin dose is possible.
Policy (continued):Policy (continued):
Connective tissue diseases (e.g. scleroderma, lupus erythematosus, mixed connective tissue disease), diabetes mellitus, hyperthyroidism and the homozygous form of ataxia telangiectasia have been associated with an increased sensitivity to radiation. Some chemotherapy agents are also known to increase radiation effects.
To avoid injuries when using an oblique or lateral beam projection, the patient's arm must be secured away from the primary beam. Direct exposure of the female breast, especially entrance-beam exposure, must also be avoided.
Policy (continued):Policy (continued):
Radiation Biology
Radiosensitivity of Cells 1
As cells mature they become less sensitive to radiation
As metabolic rate increases cells become more sensitive to radiation
As reproductive rate increases cells become more sensitive to radiation
Cell types that are most sensitive to radiation include lymphocytes and stem cells
Cell types that are least sensitive to radiation include muscle and ganglion cells
1 Adapted from The 1906 Law of Bergonie and Tribondeau
Various degrees of sensitivity to radiation exist due to the type of tissue which receives the
exposure
RadiosensitiveRadiosensitive RadioresistantRadioresistant
Breast tissueBreast tissue Heart tissueHeart tissue
Bone marrow cellsBone marrow cells Large arteriesLarge arteries
Mucosa lining of small intestinesMucosa lining of small intestines Large veinsLarge veins
Sebaceous (fat) glands of skinSebaceous (fat) glands of skin Mature blood cellsMature blood cells
Immune response cellsImmune response cells NeuronsNeurons
All stem cell populationsAll stem cell populations Muscle cellsMuscle cells
LymphocytesLymphocytes
Radiation Induced Skin InjuriesRadiation Induced Skin Injuries
SKIN EFFECT Single-Dose Threshold rad (Gy) Time to Onset
Early transient erythema 200 (2) Hours
Main Erythema 600 (6) ~10 d
Temporary epilation 300 (3) ~3 wk
Permanent epilation 700 (7) ~3 wk
Dry desquamation 1400 (14) ~4 wk
Moist desquamation 1800 (18) ~4 wk
Secondary ulceration 2400 (24) >6 wk
Late erythema 1500 (15) ~6 – 10 wk
Ischemic dermal necrosis 1800 (18) >10 wk
Dermal atrophy (1st phase) 1000 (10) >14 wk
Dermal atrophy (2nd phase) 1000 (10) >1 yr
Induration (Invasive Fibrosis) 1000 (10) >1 yr
Telangiectasia 1000 (10) >1 yr
d: day(s); wk: week(s); yr: year(s)
Stochastic Effects (by chance)
Health effects that occur randomly. Effects that occur by chance, generally occurring without a threshold level of dose, whose probability is proportional to the dose and whose severity is independent of the dose. .
(examples: cancer incidence and genetic effects)
1,000,000 persons buy a lottery ticket for $1,00 each.
999,999 persons will not get the large prize. Only one will win the BIG ONE.
Return on scratch tickets is not certain.
Stochastic Effects (by chance)
Nonstochastic (Deterministic) Effects
Health effects that can be induced upon reaching an apparent threshold, and their severity varies with the radiation dose.
examples:
cataract in the lens of the eye, non- malignant damage to the skin
100 persons invest $1,000 at 5% interest
Each person will receive $1,050.00
Return is certain
Nonstochastic (Deterministic) Effects
So....., how really dangerous is this so called
“RADIATION??”
Radiation Injuries - Cases
Industrial Radiation AccidentIndustrial Radiation Accident
An example of a skin injury attributable to x-rays from An example of a skin injury attributable to x-rays from
fluoroscopy is shown in Figure 2. fluoroscopy is shown in Figure 2.
This case, patient A in Table 2, is that of a 40-year-old This case, patient A in Table 2, is that of a 40-year-old
male who underwent coronary angiography, coronary male who underwent coronary angiography, coronary
angioplasty and a second angiography procedure due angioplasty and a second angiography procedure due
to complications, followed by a coronary artery by-to complications, followed by a coronary artery by-
pass graft, all on March 29, 1990. pass graft, all on March 29, 1990.
Source:Thomas B. Shope, Ph.D. (HFZ-140)FDA/Center for Devices and Radiological Health
Figure 2(a).Figure 2(a). Condition of patient's Condition of patient's back six to eight weeks back six to eight weeks following multiple following multiple coronary angiography coronary angiography and angioplasty and angioplasty proceduresprocedures
Source:Thomas B. Shope, Ph.D. (HFZ-140)FDA/Center for Devices and Radiological Health
Figure 2(b).Figure 2(b).
Appearance of skin Appearance of skin injury approximately injury approximately 16 to 21 weeks 16 to 21 weeks following the following the procedures with small procedures with small ulcerated area ulcerated area present.present.
Source:Thomas B. Shope, Ph.D. (HFZ-140)FDA/Center for Devices and Radiological Health
Figure 2(c).Figure 2(c).
Appearance of skin Appearance of skin injury approximately injury approximately 18 to 21 months 18 to 21 months following procedures, following procedures, evidencing tissue evidencing tissue necrosis.necrosis.
Source:Thomas B. Shope, Ph.D. (HFZ-140)FDA/Center for Devices and Radiological Health
Figure 2(d).Figure 2(d).
Close-up view of lesion Close-up view of lesion shown in 2(c).shown in 2(c).
Source:Thomas B. Shope, Ph.D. (HFZ-140)FDA/Center for Devices and Radiological Health
Figure 2(e).Figure 2(e). Appearance of Appearance of patient's back patient's back following skin grafting following skin grafting procedure.procedure.
Source:Thomas B. Shope, Ph.D. (HFZ-140)FDA/Center for Devices and Radiological Health
Transjugular Intrahepatic Portosystemic Shunt
Source:Koening, Wagner, et al., University of Texas Health Science Center
6 month7.5 month10 month22 month23 month
This patient received 3 TIPS procedures within a week
Radiofrequency Cardiac Catheter Ablation
Source:Koening, Wagner, et al., University of Texas Health Science Center
Tissue necrosis 5 months after procedure, and deep ulceration with exposure of the humerus at 6.5 months
Both patients with Discoid Lupus Erythematosis received skin doses believed insufficient to cause such effects in normal skin.
Reproduced with permission from Gironet et al, 1998, Ann Dermatol Venerol, 125, 598 - 600
Reproduced with permission from Wagner et al, 1999, Radiology, 213, 773 - 776
Radiation-sensitive patientsRadiation-sensitive patients
In right photo, G = graft, R = ribCourtesy of IAEA
Lessons from injured patients
Case #1:Electrophysiological and ablation procedure
Three attempts in 4 months, each with more than 100 minutes of fluoroscopy.
After first attempt erythema observed by patient, but not recognized as due to procedure.
Erythemas on back healed. Arm lesion required grafting.
Material used here previously copyrighted by Louis K Wagner 2004 or Partners in Radiation Management LTD Company 2004 and used here by permission.
Courtesy of IAEA
Lessons from injured patients
If cause of initial erythemas was correctly identified, injury would likely have been avoided because failures of initial ablations would not have been blamed on faulty equipment.
Erythemas on back healed. Arm lesion required grafting.
Material used here previously copyrighted by Louis K Wagner 2004 or Partners in Radiation Management LTD Company 2004 and used here by permission.
Courtesy of IAEA
Lessons from injured patients
Case #2: PTCA and stent placement of RCA. Involved 63 minutes of fluoroscopy and nearly 5000 frames of cine in LAO orientation with cranial tilt.
Lesion required grafting.
Material used here previously copyrighted by Louis K Wagner 2004 or Partners in Radiation Management LTD Company 2004 and used here by permission.
Courtesy of IAEA
Lessons from injured patients
Case #2: Dose buildup due to long fluoroscopy and fluorography with steep angle through thick chested patient not recognized
Lesion required grafting.Material used here previously copyrighted by Louis K Wagner 2004 or Partners in Radiation Management LTD Company 2004 and used here by permission.
Courtesy of IAEA
Lessons from injured patients
Case #2: Cause of injury initially misidentified as pressure wound due to defibrillator pad.
Lesion required grafting.Material used here previously copyrighted by Louis K Wagner 2004 or Partners in Radiation Management LTD Company 2004 and used here by permission.
Lessons from injured patients
Case #3: PTCA : 51 minutes high-dose fluoroscopy, 74 seconds cine in 141 kg man. Dose estimated retrospectively at 22 Gy.
Lesion required grafting.
Courtesy of IAEA
Lessons from injured patients
Case #3: Cumulative buildup of dose for steeply angled high-dose beam through large patient not recognized Lesion required grafting.
Courtesy of IAEA
If you use too much radiation …you will get your ass in trouble
RULE 1
Courtesy of IAEA
RULE 2
Excess radiationcan sneak up on you and catch youunaware
A fluoroscope can be a dangerous beast
Courtesy of IAEA
Rule 3
Use all protective
measures at your disposal to
minimize risk
The EndThe End