Table of Contents
for
Minimizing Risks from Fluoroscopic X Rays
Food and Drug Administration Warning
Ten Commandments for Minimizing Risks from Fluoroscopic X Rays
Introduction
A Short History Lesson
Responsibilities
Qualified users
The Need for Training
Before Operating the Fluoroscope
Training on Specific Equipment
Properties of X rays
X Rays and Light
Radiation Quantities and Units
Absorbed Dose
Effective Dose
Air Kerma (free-in-air) and Exposure
Equivalent Dose
Kerma-Area (Dose-Area) Product
Biological Effects
Radiation-Induced Cancer
Cancers in patients
Cancers in physicians
Radiation-Induced Heritable Effects
Radiation-Induced Injuries
Injuries to practitioners
Injuries in patients
Radiation-Induced Cataract
Fluoroscopy
When Do X Rays Exist?
About Dose Rates and Dose
Fluoroscopic Control of Dose Rate
Output control: Tube current (mA)
Conventional fluoroscopy
Pulsed fluoroscopy
Output control: Variable pulsed fluoroscopy
Dose savings from variable pulsed fluoroscopy
A warning
Last-image hold
Output control: Tube potential (kVp)
Output control: Filtration
Automatic Dose Rate Controls
Fluoroscopy Versus Fluorography
Ten Commandments for Minimizing Risks
#1. The Size of the Patient
Factors affecting dose rate
Image quality in large patients
Patient size and dose rates to personnel
#2. Establishing Appropriate Dose and Dose-Rate Settings
Settings for fluoroscopy
Fluoroscopic pulse rate
Beam filtration
Dose rate setting
The kVp floor
Systems under manual control
Recorded fluoroscopy
Fluorographic imaging
Cineangiocardiography and the cine loop
Digital fluorography
Machine settings and doses to personnel
#3. Beam On-Time and Dwell Time
Fluoroscopic on-time
Fluoroscopy timer
Beam dwell time
Fluorography on-time
Digital fluorography
Cine and the cine loop
Aids to reduce beam on-time
Beam on-time and doses to personnel
#4. Proximity of X-ray Tube to Patient
The separator cone (or spacer device)
SSD and dose to personnel
SSD and image quality
#5. Proximity of Image Receptor to Patient
The Combined Importance of Commandments 4 & 5
Patient dose and position of fluoroscope
Patient dose and physician height
Patient dose and invasive devices
#6. Image Magnification
Electronic magnification (field-of-view size)
Geometric magnification
#7. The Grid
#8. X-Ray Field Collimation
Practical applications
#9. Monitor Dose to Patients
Dose monitoring for pregnant patients
When to monitor
#10. Mastery of Radiation Safety
Protective aprons
Radiation monitoring for personnel
Using distance as a shield
Leaded eye wear, thyroid shields, and upper body shields
Mobile and lower body barriers
Hand protection
Equipment design safety features
Conventional GI fluoroscopy
Remote control fluoroscopy
C-arm fluoroscopy
Invasive devices and doses to patient and staff
Pregnant personnel
Other Methods to Protect Patients
Patient management
Informed consent
Diseases that render patients radiosensitive
Pregnant patients
Thoracic fluoroscopy in women
Dose management for prolonged procedures
Regulations
Moving Forward
References
Appendix - Quiz Answers
Index