PULSED AND CONTINUOUS SCREENING.
In pulsed fluoroscopy, X-rays are emitted in short bursts rather than
continuously. Each X-ray burst produces an image of the part under
investigation. 30 images (called frames) can be obtained in a second ie 30
frames/sec. By pulsing the radiation in short bursts, radiation dose to the patient
is reduced compared to a continuous screening.
Continuous fluoroscopy uses a continuous stream of X-ray to give dynamic
view of internal structures. The constant radiation exposure can lead to a higher
radiation dose to the patient and staff.
RADIATION PROTECTION.
Radiographers and/or physicians performing fluoroscopically guided procedures
should be aware of the potential for serious radiation-induced skin injury.
Occasionally this is an unavoidable consequence of the time required to perform
complex procedures. Some of this, however, can be minimized through a better
understanding of how the equipment works and how some operational
procedures affect the total skin dose.
Significant patient dose reduction can be achieved by proper use of the
fluoroscopic unit, and many of these dose reduction measures will also produce
good quality images. The most common operator error when using C-arm units
(where the operator can vary the distance from the x-ray tube to the skin entry
point) is to place the x-ray tube too close to the patient skin. Because dose
reduction is proportional to the square of the tube-focal-spot-to-skin distance,
moving the tube housing closer to the patient can greatly increase the patient
skin dose, and will also result in blurring of the image.
The Following are some desirable techniques to optimize Fluoroscopy use and
reduce dose to patient and operator.
X-ray Tube Position
Position the X-ray tube under the patient not above the patient. The largest
amount of scatter radiation is produced where the x-ray beam enters the patient.
By positioning the x-ray tube below the patient, you decrease the amount of
scatter radiation that reaches your upper body
Collimation
Closing the collimators down to irradiate only the tissue of interest will reduce
the area and volume of tissue irradiated, and will improve the image contrast by
reducing the amount of radiation which scatters back into the intensified image.
Pulsed Fluoro
Several newer units have the capability of boosting the fluoro output to a higher
level for larger patients. Care should be exercised since the dose can increase
significantly over normal fluoro. Many of these same units can pulse the beam
on and off several times per second, sparing patient dose due to turning the
beam off between pulses. All newer units also have a “last image hold” feature
which leaves the last fluoro image on the screen after the beam is turned off,
allowing one to study the image or discuss it with colleagues without the need
to keep the radiation beam on. ”Keep beam-on time to an absolute minimum!” -
The Golden Rule
Time
Take foot off fluoro pedal if physician is not viewing the TV monitor
Use last image hold (freeze frame)
Operation Mode
Use pulsed fluoro instead of continuous fluoro
Lower doses can be obtained with less pulses/sec and shorter pulse duration.
Low-Dose mode: 40% dose of Normal fluoro
Pulsed Low-Dose provides further reduction with respect to Normal Dose
continuous mode: Use record mode only when a permanent record is required
Record beam-on time for review
Record cumulative dose for review
DISTANCE
One step back from tableside (double distance) reduces staff exposure by factor
of 4 ie as distance from the radiation source increases, radiation intensity
decreases exponentially
Lateral or Oblique fluoroscopy gives 5x less dose if you stand on Receiver
(Image Intensifier) side
Move Image Int. (panel) close to patient, this leads to less scatter (more dose
interception by panel), less patient skin exposure and a sharper image.
SHIELDING
X-ray can be attenuated using a lead shields equivalent of 0.5mm Pb
Proper storage (hanging vs. folding). Do not fold or throw the lead apron
randomly, There should be yearly checks on lead apron for cracks.
Thyroid collars; eye glasses; wrap around aprons
Properly used ceiling mounted shields
Use shielded rooms
There should be regular checks on Device to avoid tube-housing leakage
Health personnel involved during the fluoroscopic process should have their
dosimeter on them.
Factors influencing dose:
Patient size
kVp, mA and time,
Tube - patient distance (SSD)
Image Intensifier - patient distance
Use / non-use of grid vs. patient dose
Image magnification vs. patient dose
X-ray field collimation
Obliques vs. perpendicular views
