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Introduction to Fluoroscopy & Radiation Safety. RTEC 124 - Week 10 Rev 2010. References: Merrills CH 16 & 17 Bushong – Ch 21. CONVENTIONAL FLUOROSCOPY INVENTED BY THOMAS EDISON. Early Fluoroscopy. Digital / Fluoro Equipment Check off. MUST BE COMPLETED PRIOR TO DOING ANY PATIENT EXAMS

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Introduction to fluoroscopy radiation safety

Introduction toFluoroscopy& Radiation Safety

RTEC 124 - Week 10

Rev 2010

References:

Merrills CH 16 & 17

Bushong – Ch 21


Conventional fluoroscopy invented by thomas edison
CONVENTIONAL FLUOROSCOPYINVENTED BY THOMAS EDISON

Early Fluoroscopy


Digital fluoro equipment check off
Digital / Fluoro Equipment Check off

  • MUST BE COMPLETED PRIOR TO DOING ANY PATIENT EXAMS

  • Fluoroscopy Procedures must ALWAYS be supervised – even after a check off

  • You MUST be a CRT to have a Fluoroscopy Lic to operated fluoro units

    in California (CDPH-RHB Title 17)


Fluoroscopy images in motion conventional digital fluoro principles

Fluoroscopy is a common technique used by clinical physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

Fluoroscopy: Images in MotionConventional & Digital Fluoro Principles


Objectives
Objectives physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

  • Differentiate fluoroscopic examinations from static diagnostic radiographic examinations

  • Describe a typical basic fluoroscopic image chain (RT 244 – detailed)

  • Explain difference between fluoroscopic operation and a diagnostic x-ray tube

  • Safety Principles


Types of equipment

C-arm physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

Under table/over table units

Conventional & Digital Units

Types of Equipment


Recording the fluoroscopic image
Recording the Fluoroscopic Image physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

  • Cassettes

  • 105 mm chip film

  • Digital fluoroscopy

    Dynamic Systems

  • Cine film (cardiac cath)

  • Videotape (OPMS)


Image intensificaiton photons are ampilfied multiplied
IMAGE INTENSIFICAITON physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.photons are ampilfied + multiplied

  • IMAGES ARE VIEWED ON A

    TV SCREEN/MONITOR


Image intensifier cassette loading
Image Intensifier & Cassette loading physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

Digital &

Conventional

Units


Image intensifier
Image Intensifier physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

Bushong – Ch 21


Important to limit the field of view (collimation) physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.


Conventional fluoro
Conventional Fluoro physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

X-ray tube located under the table


Digital fluoro
DIGITAL FLUORO physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

X-ray tube located under or over the table – remote controls


The role of the technologist

Provide Assistance physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

To the Patient

And Radiologist

Before, during and

after the procedure

Prep the room

Prep the contrast

Prep the patient

Get a history from the patient

Aftercare instructions

and clean up of supplies

The Role of the Technologist


Carlton ch 40 fluoroscopic uses functional studies xrays in motion

GI tract studies physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

Esophagus /OPMS

Upper GI

SMB

BE

ERCP

GU studies

- VCU's,

RT 255 The “OGRAMS”

Angiograms

Hysterosalpingograms

Venogram

Myelogram

Sialogram

Tube /Line placement

Fistulograms

ETC ETC

PAIN CLINIC (C-ARM)

Carlton – Ch. 40Fluoroscopic UsesFunctional studies – xrays in motion


Radiation safety and fluoroscopy

Radiation Safety physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.and Fluoroscopy

Time

Distance

Shielding

The Patient & Scatter


Radiation protection during fluoroscopy
Radiation Protection During Fluoroscopy physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

  • The patient

  • The radiographer and radiologist

  • Others


Radiation protection the patient is the largest scattering object
RADIATION PROTECTION physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.The Patient is the largest scattering object

  • Lower at a 90 DEGREE ANGLE from the patient + PRIMARY BEAM

    AT 1 METER DISTANCE -

  • 1/1000 OF INTENSITY PRIMARY XRAY or 0.1%


Room design
Room design physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

Remember to move the overhead tube out of the way!


Protective barriers
Protective Barriers physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.

  • Primary barrier – protection from Primary radiation (for the patient& technologist )

  • The II is a 2.0 mm pb eq barrier

  • Secondary barrier - protection from Secondary radiation (from the patient)

    - Protection for the technologists, etc


Iso exposure curves where is it safe
Iso Exposure Curves physicians to obtain real time images of moving body parts and internal structures of a patient compared to static radiographic examinations.Where is it SAFE??

Behind the lead shield and behind the Radiologist!


Patient entrance skin exposure (ESE) is higher when the fluoroscopic x-ray tube is too close to the tabletop.

  • Minimum source-to-skin distance

    • 12” for mobile equipment

    • 15” for stationary systems

  • Audible alarm at 5 mins.

  • Same rules for collimation


Patient exposure
PATIENT EXPOSURE fluoroscopic x-ray tube is too close to the tabletop.

KEEP I.I. CLOSE TO PATIENT

  • REDUCE DISTANCE OF IMAGE INTESIFIER

  • INCREASE DISTANCE FROM THE TUBE

Patient entrance skin exposure (ESE) is ALSO higher when the IMAGE INTENSIFIER is too FAR to from the patient.


Over vs under the table fluoro tubes scatter
Over vs Under the table fluoroscopic x-ray tube is too close to the tabletop.fluoro tubes & Scatter


Under table tube vs Over table tube (remote units) fluoroscopic x-ray tube is too close to the tabletop.Digital & Conventional Fluoro


Fluoroscopic x ray tubes
Fluoroscopic X-Ray Tubes fluoroscopic x-ray tube is too close to the tabletop.

  • mA range: 0.5 – 5.0 mA

  • KVP: 70 – 110

    • depending on exam and contrast used

  • 15” minimum SOD in fixed fluoroscopic equipment

  • Foot switch (dead man)


Isoexposure curves where is it safe
IsoExposure Curves fluoroscopic x-ray tube is too close to the tabletop.Where is it SAFE??

VCUG


Fluoroscopic positioning previewing
Fluoroscopic Positioning Previewing fluoroscopic x-ray tube is too close to the tabletop.

  • Radiographers are trained in positioning

  • Unnecessary radiation exposure to patient is unethical

  • Fluoroscopic equipment should not be used to preview patient’s position


Principles of Personnel Exposure Reduction fluoroscopic x-ray tube is too close to the tabletop.

  • Time

  • Distance

  • Shielding

    • Protective barriers

    • Protective devices


Important to keep the curtain in place fluoroscopic x-ray tube is too close to the tabletop.


Protection of radiographer and radiologist
Protection of Radiographer and Radiologist fluoroscopic x-ray tube is too close to the tabletop.

  • Lead apron

    • 0.25 mm Pb/eq

  • Highest energy scatter

    • Same level as radiographer /radiologist’s gonads (135o under table)

    • OR for eyes (over table 45o) see diagrams

    • 90o angle to the incident beam (lowest)

      • (without shield – still high

      • see isoexposure curves)


Protection of Radiographer and Radiologist

  • Single step away from the table

  • decreases exposure exponentially (inverse sq law)

  • Bucky slot cover

  • Lead rubber drape

  • Radiologist as shielding


Shielding

PATIENT fluoroscopic x-ray tube is too close to the tabletop.–

WHEN NOT IN AREA OF INTEREST

REMEMBER WHERE THE SOURCE OF

THE XRAY BEAM IS

COMING FROM!

.5MM FOR GONADS

TECHNOLOGIST

.25 MM LEAD APRON

THYROID SHEILD

Shielding

What is the pb eq?

Can this be used for gonads?


Whats wrong
WHATS WRONG? fluoroscopic x-ray tube is too close to the tabletop.


Patient protection
Patient Protection fluoroscopic x-ray tube is too close to the tabletop.

  • Tabletop exposure rate

    • Maximum 10 R/min

    • Typically 1 – 3 R/min

  • Typical exposure rates

    • Cinefluorography

      • 7.2 R/min

    • Cassettes

      • 30 mR/exposure

    • 105 mm film

      • 10 mR/exposure


Alara as low as reasonably achievable
ALARA: As Low As Reasonably Achievable fluoroscopic x-ray tube is too close to the tabletop.

  • Radiologic personnel are responsible for minimizing radiation exposure to patients

  • Achieved through thoughtful approach and application of radiation protection practices

Procedure dose to patient


Protection of others
Protection of Others fluoroscopic x-ray tube is too close to the tabletop.

  • Radiographer’s responsibility to inform others in the room to wear lead apron

  • Do not initiate fluoroscopy until all persons have complied


Protection of personnel during fluoroscopy
Protection of Personnel fluoroscopic x-ray tube is too close to the tabletop.during FLUOROSCOPY

  • Radiologic personnel should not hold patients for exposures

  • Student SHALL not hold patient during radiation exposure

  • Family or friend better choice

  • Immobilization devices best choice


Bucky slot cover
Bucky Slot Cover fluoroscopic x-ray tube is too close to the tabletop.


Table movement

TABLE MOVEMENT fluoroscopic x-ray tube is too close to the tabletop.


Always make sure the foot fluoroscopic x-ray tube is too close to the tabletop.

Board is correctly in place

BEFORE standing a pt on the table

Check weight limit for table


BASIC PROCEDURES fluoroscopic x-ray tube is too close to the tabletop.

For FLUOROSCOPY

Note – do not allow pt to place Cup on the II - Table will move from vertical to horizontal!


Depending on the study – the patient may begin in the upright position

The Radiologist may then place the patient and table recumbant to finish the fluoro study


Overheads taken after dr leaves room
OVERHEADS upright positiontaken afterDR leaves room

Depending on the study – the patient may begin in the upright position

The Radiologist may then place the patient and table recumbant to finish the fluoro study


Overheads

AFTER FLUOROSCOPY IS COMPLETE upright position

LARGER FORMAT IMAGE 14X17

DIGITAL 14X14 MAX

“OVERHEADS”


Enteroclysis procedure smb
Enteroclysis procedure upright position (SMB)



PROCEDURE??? upright position


Problem pathology
Problem ? Pathology? upright position

  • DO NOT give

  • Barium to this

  • Patient…….

  • Why Not?

  • Will cover with contrast media lecture


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