ROOM FOR IMPROVEMENT Judicious use of imaging and proper placement of the C-arm are keys to protecting patients and staff.
Radiation won't wrench your back. It doesn't cut or leave a bruise. But that doesn't mean the dangers of exposure are any less real than other surgical hazards that leave immediate marks. You might not feel it today, next week, next month or even next year, but repeated exposure to radiation increases future risks of cancer and bone loss. Is that worth overlooking proper safety precautions whenever a C-arm is switched on? That answer is obvious. Now try your luck with these questions.
Fluoroscopy alarms on C-arm units typically sound after ________ of uninterrupted use.
a. 2 minutesc. 7 minutes
b. 5 minutesd. 10 minutes
Show Answer
Answer: b
Physicians, while focusing on the procedure at hand, might forget they've activated the X-ray and keep it working long past when it's needed. Have them image only when necessary, and for only as long as it takes to capture usable pictures. That sounds like basic advice, and it is, but it's not always followed. Newer C-arms save and freeze the last image captured when the X-ray is deactivated. Working off of those pictures instead of relying on live fluoroscopy limits C-arm use and, in turn, reduces exposure risk.
When not actively involved in the procedure, you should stand at least ______ away from the X-ray field.
a. 6 feetc. 10 feet
b. 8 feetd. 12 feet
Show Answer
Answer: a
You're at risk of exposure from the radiation that bounces off patients, so stand away from the field whenever you're not needed during a procedure. That said, risks are not completely eliminated outside the supposed 6-foot safety zone, so you must always wear proper personal protection. We installed a stand-up shield in rooms where imaging procedures are performed. The shield doesn't preclude the need for personal protection, but it's an added safeguard for personnel who aren't actively involved in cases. Stand near the C-arm's image intensifier, where radiation levels are lower than near the X-ray tube. When you stand near the image intensifier, the patient shields you from radiation exposure, because most stray beams are deflected off the patient and back toward the X-ray source.
What personal protection is mandatory during imaging procedures?
a. lead glassesc. radiology gloves
b. lead apronsd. all of the above
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Answer: b
Anyone who enters procedure rooms while C-arms are in use must wear lead aprons and thyroid shields. Staff and surgeons will no longer complain about being weighed down by oversized aprons, thanks to newer, lightweight options designed for comfort.
Although not necessarily required, donning protective eye gear and radiology gloves is just good practice. The thicker radiology gloves can't be worn during intricate vascular procedures, but offer enough tactile sensation for use during basic orthopedic procedures. Surgeons should opt for the gloves if, like hand specialists, they're constantly working within the X-ray field. Lead eye protection is essential for extremity surgeons who must use the image intensifier as an operating surface. Protective surgical caps are new to the market. We haven't purchased them yet, but I'm looking into outfitting our staff and surgeons with the extra layer of protection.
0.5-mm lead aprons protect wearers from approximately ______ of scattered radiation.
a. 75%c. 90%
b. 80%d. 95%
Show Answer
Answer: d
That's why wearing lead aprons is so important. But it's also important to note that aprons provide that high level of protection only if they're properly cared for. They should be hung between uses and visually checked for imperfections before each case. Clean them according to the manufacturer's instructions (ours say to use only soap and water). X-ray the aprons annually to ensure they remain free of voids that can leave the wearer exposed. We lay ours on a translucent table and use fluoroscopy to check the integrity of each. We number each apron and keep a report of the inspection in our radiology book, which is reviewed annually and whenever an apron is taken out of service.
Where on lead aprons should staff and physicians wear dosimeters to capture the most accurate readings of their exposure to radiation scatter?
a. the midlinec. upper right side
b. upper left sided. the collar
Show Answer
Answer: d
Staff and surgeons need to understand the importance of accurately tracking their levels of radiation exposure. Doing so lets administrators identify caregivers with high levels of accumulated exposure and hold them out of imaging cases for a time. We collect dosimeters assigned to individual staffers on a quarterly basis, send them out for analysis and review the report that comes back to see if anyone's readings are higher than normal. High readings are rare in the outpatient setting, but I've seen pain management physicians with concerning levels of exposure.
You can alert them about their risk based on the dosimeter readings, but they're ultimately responsible for their own well-being. Most take the warning to heart, but some — the ones in denial — will ignore it. Surgical teams learn the basics of radiation safety during new-hire orientations and annual in-services, but I'm not sure they're truly aware of imaging's ever-present dangers. They know they're supposed to wear a lead apron and a dosimeter, but they may not know all the reasons why. They get a broad education about imaging's dangers, but then forget about the important details that mean the difference between proper protection and being placed in harm's way.
TEAM DEFENSE Staff and surgeons — especially younger surgeons — are becoming more conscious of the dangers associated with radiation exposure.
What are the recommended annual exposure dose limits for the extremities, according to the As Low As Reasonably Achievable (ALARA) principle?
a. 500 milliremsc. 5,000 millirems
b. 1,000 milliremsd. 10,000 millirems
Show Answer
Answer: c
ALARA should guide your radiation safety efforts. As mentioned, always wearing proper protection, standing on the correct side of the C-arm and judicious use of the X-ray will limit exposure risks. But don't ignore the importance and possibility of using a C-arm's low-dose settings and pulse fluoroscopy, instead of continuous imaging through its full range of motion, to capture enough images that are of high enough quality to complete most surgical tasks.
To help protect patients, the image intensifier should be placed as close as possible to the intended imaging site.
a. trueb. false
Show Answer
Answer: a
Your staff members aren't the only ones in harm's way when C-arms are activated. Placing the imaging intensifier near the imaging site keeps the X-ray tube away from patients, which lowers their exposure levels and lets you capture clearer pictures. Whenever possible, direct X-ray beams straight at patients, as angled approaches cause the beams to travel longer distances through tissue, which increases exposure levels. Finally, limit the use of image magnification and employ the lead shutters on C-arms to collimate beams on the imaging site to reduce scatter. Also be sure to place lead aprons and thyroid shields on patients.
