Petrone Associates: Fluoroscopic Radiation Safety Training 2024

Chris Smitherman covers all topics of radiation safety for fluoroscopy procedures to comply with the standards set by the Joint Commission and New York City ORH. These topics include but are not limited to topics discussed in image gently and image wisely, patient dose optimization and image quality enhancement techniques, fluoroscopy personnel safety, NCRP 168 significant radiation dose level (SRDL) procedures, radiation effects and fluoroscopy dose monitoring.

Objectives:

• Joint Commission and NYC ORH compliance for fluoroscopic training
• Identify why fluoroscopy training is important
• Highlight the patient and operator dose savings techniques established in image gently and image wisely campaigns
• Explain radiation effects from fluoroscopy and how the potential and reaction of these can be tracked using the principles established in NCRP 168

Outline:

1. Why is fluoroscopy training needed?
   1. Amount of radiation injuries
   2. Increase in background radiation exposure
   3. Dose Limits in fluoroscopy?
2. Image Wisely and Image gently fluoroscopy principles and how they affect image quality and patient dose
   1. Protocols or Technique Selections
   2. ABC or AERC
   3. Beam Filtration
   4. Continuous vs. Pulsed Fluoroscopy
   5. Image Gently – Pulse Rat Recommendations
   6. Fluoroscopy modes
      1. Low Dose
      2. Normal
      3. High Level
      4. Cine
      5. DSA
   7. Magnification Modes
   8. Collimation
   9. Last Image Hold
   10. Anti-Scatter Grids
   11. Patient Positioning
       1. SSD
       2. SID
3. Patient Dose Monitoring
   1. Radiation Interaction with Patient
   2. Radiation Units
      1. Exposure
      2. Kerma
      3. Absorbed Dose
      4. Equivalent Dose
      5. Effective Dose
   3. Biological Effects of Radiation
      1. Stochastic Effects
      2. Deterministic Effects
         1. Radiation levels for deterministic effects pertinent to fluoroscopy
   4. Risk for pediatrics
   5. Fluoroscopy Dose Monitoring methods (NCRP 168 suggestions)
      1. Fluoroscopy Time
      2. Cumulative Air Kerma
      3. DAP/KAP
   6. Patient Follow Up
4. Reducing Radiation Exposure for Employees
   1. Employee exposure at 1 meter
   2. 3 cardinal rules of radiation protection to workers
      1. Time
      2. Distance
      3. Shielding
         1. Types
         2. Description of criteria
         3. Lead garment protection
   3. Staff position and tube geometry
5. Conclusion