Radiation Safety For Anesthesiologists. R2 Pinyada Pisutchareonpong R2 Nawaporn Sateantantikul Supervised by Aj Chaowanan Khamtuicrua
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1 Radiation Safety For Anesthesiologists R2 Pinyada Pisutchareonpong R2 Nawaporn Sateantantikul Supervised by Aj Chaowanan Khamtuicrua
2 Modern World
3 Non Ionizing VS Ionizing Non Ionizing Harmless Ex. visible light, infrared radiation, microwaves, radio waves, ultrasound magnetic resonance Ionizing Harmful Ex. x-rays and gamma (γ) rays, alpha (α) and beta(β) particles, the products of certain radioactive decay processes
4 Source? Natural and Manufactured Exposure Sources of Ionizing Radiation Contributing to the Collective Dose for 2006
5 Area and Procedure Cardiac catheterization Computed tomography Electrophysiology laboratory Intervention radiology Nuclear medicine Radiation therapy
6 Source of radiation exposure Leakage Direct exposure Scatter
7 Unit Absorbed dose Effective dose
8 Effective dose(sievert) Absorbed dose (Gray) x tissue weighting factors (wt)
9 Action
10 Biological effect Deterministic effect Threshold Severity α dose Cell death Ex. Skin injury, Cataract, Teratogenesis Stochastic effect No threshold Probability α dose Ex. Cancer, Hereditary effect
11 Tissue Radio-sensitivity
12 1) Skin injury 2) Cataract 3) Teratogenesis DETERMINISTIC EFFECT
13 Skin injury Transient erythema : > 2 Gy
14 Cataract The threshold dose : 500 mgy (0.5 Gy)
15 Teratogenic Effect to embryo & fetus : IUGR, death, malformation, carcinogenesis The effect α Gestational age
16 Teratogenic
17 1 carcinogenesis 2 hereditary STOCHASTIC EFFECT
18 Latent period Probability α age Carcinogenesis
19 Hereditary Radiation effect to germ cells mutations of sperm or ova that can be passed on to future generations.
20 Radiation protection
21 Objective of radiation protection Prevention of deterministic effect Limiting the probability of stochastic effect
22 Principle of radiation protection Justification of practice Optimization of protection : ALARA Dose limit for occupational exposure
23 Principle of radiation protection Justification of practice Optimization of protection Dose limit for occupational exposure
24 1. Justification of practice Overall benefit > risk from ionizing radiation Use the lowest effective dose
25 Procedure effective dose Dental intraoral X-ray PA chest X-ray Abdomen X-ray Spine X-ray Barium swallow Barium enema CT head, each series CT abdomen, each series ERCP PET Procedure Coronary angiography Coronary angioplasty Transjugular intrahepatic Portosystemic Shunt Placement Effective dose(msv) Mettler, FA Jr, Huda, W, Yoshizumi, TT, Mahesh, M, Effective doses in radiology and diagnostic nuclear medicine: A catalog, Radiology 2008;248:
26 Principle of radiation protection Justification of practice Optimization of protection Dose limit for occupational exposure
27 2. Optimization of protection Magnitude of individual doses Number of people exposed likelihood of potential exposure as low as reasonably achievable (ALALA)
28 ALARA principle TIME DISTANCE SHIELDING As Low As Reasonably Achievable
29 Basic Principles of Personal Radiation Protection 1 Time 2 Distance 3 Shielding 4 Dose reduction
30 1 Time Minimize the time of exposure Don t turn the beam on unless you must view a live image Modern fluoroscopes emit an audible alarm after each 5 minutes of beam-on time : beam is taking longer than usual Total dose = dose rate x time
31 2 Distance Inverse square law = 1/distance 2
32 Over-table X-ray tube Under-table X-ray tube Lateral projection Radiation intensity is concentrated in the area near the x- ray tube High dose to the operator when standing on the same side of the tube. Short operators receive more radiation to the face Exposure is minimal at a distance more than 1 meter
33 Sitting : high dose radiation on chest Standing is better Stand a few feet back from the table and approach the patient periodically stand behind a protective barrier
34 3 Shielding Structural Equipmentmounted Personal
35 Personal shielding thyroid shields Eyewear Lead aprons
36 Lead aprons Attenuate radiation 97 percent (0.5 mm of lead) Wraparound lead is superior : provide protection from all angles New aprons materials like barium, tungsten, tin and antimony : lighter weight Lead aprons can crack with time if they are folded.
37 Thyroid shields Thyroid collars contain 0.25 mm of lead should wear especially males under 30 years old and females under 40 years old : minimize the chance of thyroid cancer
38 Eyewear Avoid radiation cataracts Glasses 0.5 or 0.75 mm lead eyeglasses with large lenses and protective side shields Conventional glasses with glass lenses Conventional plastic lenses Reduction radiation 98 % 30-40% -
39 4 Dose reduction Limiting beam-on time collimating the beam dose of patients Dose of workers
40 Principle of radiation protection Justification of practice Optimization of protection Dose limit for occupational exposure
41 3. Dose limits for occupational exposure New recommendation 20 msv per year averaged over five consecutive years (100 msv in 5 years) 50 msv in any single year
42 Monitoring High risk radiation exposure Type of dosimeter Film badge : most common Thermo-luminescent dosimeter Optically stimulated luminescent dosimeter Pocket dosimeter : most sensitive
43 Education Training programs are crucial to the development of safe operating practices in a radiation environment
44 Radiation protection for pregnant workers Assign non radiation duties Wear wraparound lead : 1.0 mm of lead protection at the level of the fetus Monitoring the doses : 2 film badges Fetal limit dose < 5 msv over gestation <0.5 msv per month The National Council on Radiation Protection and Measurements (NCRP)
45 How about anesthesiologists?
46 Multiple studies have shown that at 1.5 m from the source of radiation, anesthetists received no radiation, or amounts so small Anaesthesia Apr;71(4): doi: /anae Epub 2016 Feb 13
47 During neurointerventional angiographic procedures Radiation exposure to the anesthesiologist s face was six-fold greater than during angiography three-fold greater than that of the radiologist Anesthesiologists who spend significant time performing such procedures should wear protective eyewear. Anesthesiology , Vol.114,
48 Take home message As low as reasonably achievable (ALARA) TIME Minimize the time of exposure DISTANCE Maximizing the distance from radiation source : more than 1 meter SHIELD ING Lead aprons, thyroid shield, eyewear
49 Thank you
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RADIOLOGY (MEDICAL IMAGING) Radiology is the study of the diagnosis of disease by the use of radiant energy (radiation). In the past this meant the use of X-rays to make an image. Today many other forms
Radiation Protection: A Review
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 8 Ver. III (Aug. 2017), PP 89-94 www.iosrjournals.org Radiation Protection: A Review *Dr. Devika
The effect of the x-ray radiation for the organism Bionegatív effect
Radiation safety During each laboratory or diagnostic procedure, safety should be a primary objective. Radiography is no different. The veterinarian must establish and maintain a radiation safety program