Main description:

An increasing number of medical specialists are using fluoroscopy outside imaging departments. There has been general neglect of radiological protection coverage of fluoroscopy machines used outside the 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 (EVAR), renal angioplasty, iliac angioplasty, ureteric stent placement, therapeutic endoscopic retrograde cholangio-pancreatography (ERCP) 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 so far been reported only in interventional radiology and cardiology, the level of usage of fluoroscopy outside radiology departments creates potential for such injuries.

Contents:

SUMMARY POINTS * 1. What is the motivation for this report? * 1.1. Which procedures are of concern and who is involved? * 1.2. Who has the potential to receive high radiation doses? * 1.3. Lack of training, knowledge, awareness and skills in radiological protection * 1.4. Patient versus occupational radiation doses * 1.5. Fear and overconfidence * 1.6. Training * 1.7. Why this report? * 1.8. References * 2. HEALTH EFFECTS OF IONISING RADIATION * 2.1. Introduction * 2.2. Radiation exposure in context * 2.3. Health effects of ionising radiation * 2.3.1. Tissue reactions * 2.3.2. Stochastic effects * 2.3.3. Individual differences in radiosensitivity * 2.4. References * 3. PATIENT AND OCCUPATIONAL PROTECTION * 3.1 General methods and principles of radiological protection * 3.2. Requirements for the facility * 3.3. Common aspects of patient and occupational protection * 3.3.1. Patient specific factors * 3.3.2. Technique factors * 3.4. Specific aspects of occupational protection * 3.4.1. Shielding * 3.4.2. Individual monitoring * 3.5. References * 4. SPECIFIC CONDITIONS IN CLINICAL PRACTICE * 4.1. Vascular surgery * 4.1.1. Levels of radiation dose * 4.1.2. Radiation dose management * 4.2. Urology * 4.2.1. Levels of radiation dose * 4.2.2. Radiation dose management * 4.3. Orthopaedic surgery * 4.3.1. Levels of radiation dose * 4.3.2. Radiation dose management * 4.4. Obstetrics and gynaecology * 4.4.1. Levels of radiation dose * 4.4.2. Radiation dose management * 4.5. Gastroenterology and hepato-biliary system * 4.5.1. Levels of radiation dose * 4.5.2. Radiation dose management * 4.6. Anaesthetics and pain management * 4.7. Sentinel lymph node biopsy (SLNB) * 4.7.1. Levels of radiation dose * 4.7.2. Radiation dose management * 4.8. References * 5. PREGNANCY AND CHILDREN * 5.1. Patient exposure and pregnancy * 5.2. Guidelines for patients undergoing radiological examinations/procedures at child bearing age * 5.3. Guidelines for patients known to be pregnant * 5.4. Occupational exposure and pregnancy * 5.5. Procedures in children * 5.5.1. Levels of radiation dose * 5.5.2. Radiation dose management * 5.6. References * 6. TRAINING * 6.1. Introduction * 6.2. Curriculum * 6.3. Who should be the trainer? * 6.4. How much training? * 6.5. Recommendations on training * 6.5. References * 7. Recommendations * ANNEX A. DOSE QUANTITIES AND UNITS * A.1. Quantities for assessment of patient doses * A.2. Quantities for occupational dose assessment * A.3. References *