Cancer Risk

[TheGreatestTrochanter]

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Question for you all. How much do you think about increased risk of cancers with fluoro exposure? I'm largely sports with just 4 hrs of fluoro per week, but it still sometimes worries me. From my lit review I can't seem to find anything very conclusive for pain providers (I assume less exposure than interventional cards, hand surgeons.) I obviously try to do what I can to limit my own exposure but some is unavoidable. And I don't have enough money for the really fancy new fluoroscopes that may have lower dosing.

 

[rmsdudqkr]

Not much. I think the relative risk is low, but certainty of MSK deterioration from the lead wearing is 100%. So I care way more about that.

 

[BoardingDoc]

Question for you all. How much do you think about increased risk of cancers with fluoro exposure? I'm largely sports with just 4 hrs of fluoro per week, but it still sometimes worries me. From my lit review I can't seem to find anything very conclusive for pain providers (I assume less exposure than interventional cards, hand surgeons.) I obviously try to do what I can to limit my own exposure but some is unavoidable. And I don't have enough money for the really fancy new fluoroscopes that may have lower dosing.

I worry about it but do what I can. Get well fitting lead to save your back. Don't use live imaging unless necessary. Stay away from the beam. I also have lead lined glasses and a lead lined cap that I wear.

I take a giant step backwards when I take a shot. My rad tech knows that's the signal to take a picture. Started doing that during fellowship and it clearly made a difference. My dosimeter numbers were 1/4 that of my co-fellows.

 

[clubdeac]

Good question. No idea. Collimation is your friend. Also never use live fluoro and use low dose as much as possible. Refusing to inject fat people helps too 😆

 

[Crybaby]

Good question. No idea. Collimation is your friend. Also never use live fluoro and use low dose as much as possible. Refusing to inject fat people helps too 😆

Haha I dream about refusing to inject the fluffy ones!
One of my favorite past partners was just diagnosed with thyroid cancer, he always joked that he never wore is thyroid shield. Makes me wonder.

 

[SSdoc33]

i worry about it b/c nobody really knows the risks, and they are variable.

but there is no doubt that sittting in front of that cancer machine for 30 years does increase your risk esp head and neck cancers

 

[PM&ARGHH]

There was a thread awhile back on using a lead drape over the patient off the field, essentially draped over their butt. I have adopted this, and I take big steps back. My dose has been non-detectable FWIW. I also collimate, use low dose, etc.

Previous to this I did a deep lit dive, I was worried enough I considered switching fields. The dose we get over lead is lower than the dose cardiologists used to get under their lead before the cardiology field became more cognizant of the risks of radiation. I saw somewhere (can’t find source) their risk of brain cancer is 2-3 times higher than the general population. So if there is a dose-dependent relationship, our relative risk is likely much smaller than that, maybe marginally to mildly elevated compared to general population, but still non-zero.

 

[TheGreatestTrochanter]

I worry about it but do what I can. Get well fitting lead to save your back. Don't use live imaging unless necessary. Stay away from the beam. I also have lead lined glasses and a lead lined cap that I wear.

I take a giant step backwards when I take a shot. My rad tech knows that's the signal to take a picture. Started doing that during fellowship and it clearly made a difference. My dosimeter numbers were 1/4 that of my co-fellows.

I definitely do the giant step back. I haven't used the lead-lined cap - nobody in my training ever used them, but it seems like a good idea. How heavy are they? I worry some about neck fatigue/pain with that which might be more certain than neoplasm!

 

[Painologist]

Anyone using a lead skirt on the fluoro table? Thinking about that. I would also consider adding a lead cap if there was any data to suggest it’s worthwhile

 

[BoardingDoc]

I definitely do the giant step back. I haven't used the lead-lined cap - nobody in my training ever used them, but it seems like a good idea. How heavy are they? I worry some about neck fatigue/pain with that which might be more certain than neoplasm!

I just weighed it on my kitchen scale. It's 282g. There's no appreciable weight on my head when I'm wearing it. Mine is made by Burlington Med and it's the Xenolite material.

Leaded Cap - Accessories - Wearables

<p>In addition to our thyroid shield and apron, our mesh-top Leaded Cap can give you extra protection for your most important organ, your brain. The width of the cap can be easily adjusted with a rear adjustable drawstring. Available in three protection l

burmed.com

 

[BoardingDoc]

Anyone using a lead skirt on the fluoro table? Thinking about that. I would also consider adding a lead cap if there was any data to suggest it’s worthwhile

I thought a lead skirt on the flouro table was essentially mandatory. I've never seen a flouro room without one. Definitely get one. Massively decreases scatter from under the table when taking AP (or minimally oblique) shots.

As to the cap, as I posted above, I think they're worthwhile. There're some data from interventional cards saying it's a good idea, albeit the data are somewhat mixed.

Taking a step backwards whenever possible is far and away the best protection you can get. Stepping back 6 ft from the beam gives you 2.8% of the dose that you'd get from standing 1 foot away.

Lead Cap Use in Interventional Cardiology: Time to Protect Our Head in the Cardiac Catheterisation Laboratory?

Background: Radiation exposure is an occupational hazard for interventional cardiologists and cardiac catheterisation laboratory staff that can manifest with serious long-term health

www.icrjournal.com

 

[Dr. Ice]

All of my current colleagues except me use that rolling shield thing. One of them has the shield like a mile away from the fluoro table and runs behind there every time she has to fluoro. Seems a bit absurd..but maybe should start using it

 

[Taus]

All of my current colleagues except me use that rolling shield thing. One of them has the shield like a mile away from the fluoro table and runs behind there every time she has to fluoro. Seems a bit absurd..but maybe should start using it

I’ve never seen one used…. But may start, particularly with how much kypho I do now, lots of live xray under lateral ….

 

[Dr. Ice]

I’ve never seen one used…. But may start, particularly with how much kypho I do now, lots of live xray under lateral ….

It’s cumbersome and heavy, honestly seems like it just slows everything down. Also, none of these people use live fluoro with contrast. Also no digital subtraction ever. Makes me wonder how much I’ve been radiating myself over the years

 

[BoardingDoc]

All of my current colleagues except me use that rolling shield thing. One of them has the shield like a mile away from the fluoro table and runs behind there every time she has to fluoro. Seems a bit absurd..but maybe should start using it

I wish I had one of those. Even better than the giant step backwards I would assume. Plus, if you have it right up against the table you could use it during live shots as well.

 

[Taus]

It’s cumbersome and heavy, honestly seems like it just slows everything down. Also, none of these people use live fluoro with contrast. Also no digital subtraction ever. Makes me wonder how much I’ve been radiating myself over the years

Yeah I’m trying to figure out how I’d make it work with positioning, etc.. Every esi gets a brief live run. I do a lot of c tfesi with dsa, and on Kypho I’m fully scrubbed/gown etc, and would need to sterily reach around it when injecting cement.

 

[CleanUp]

Anyone using a lead skirt on the fluoro table? Thinking about that. I would also consider adding a lead cap if there was any data to suggest it’s worthwhile

Does anyone know the name or McKesson item number for the lead skirt? Thanks

 

[paindoc007]

Yeah I’m trying to figure out how I’d make it work with positioning, etc.. Every esi gets a brief live run. I do a lot of c tfesi with dsa, and on Kypho I’m fully scrubbed/gown etc, and would need to sterily reach around it when injecting cement.

You’re still doing ctfesi? Why? Is it surgeons who still request it?

 

[Taus]

You’re still doing ctfesi? Why? Is it surgeons who still request it?

Yes and yes

With careful technique, visualized artery on mri, dex, barely enter foramen, dsa….. not any more risk than you have re epidural hematoma or cord stick on C7/t1 interlam

 

[Ducttape]

Anyone using a lead skirt on the fluoro table? Thinking about that. I would also consider adding a lead cap if there was any data to suggest it’s worthwhile

you should always use a lead skirt.

scatter is a significant source of radiation exposure

collimation is our friend.



also, and this may be a hard take, but have a rad tech involved. docs by ourselves are far too liberal with the foot pedal and routinely overdose ourselves. we rarely collimate (because we are prepped), and we usually will use continuous rather than pulsed and forget to turn on low dose imaging. they can also our lead ready for us, check it for cracks and collect radiation safety badges.

Yes and yes

With careful technique, visualized artery on mri, dex, barely enter foramen, dsa….. not any more risk than you have re epidural hematoma or cord stick on C7/t1 interlam

on separate threads we have already disproved this, even with coddling terms added.

 

[Taus]

Good thread. Definitely got me thinking… In process of ordering lead table skirt, never even seen one used before. Also plan on using lead standing barrier, perpendicular to the table, between me and the source, on laterals. Will have to play around with draping it, position, etc. on kyphoplasty when injecting cement under live lateral.

 

[CleanUp]

Good thread. Definitely got me thinking… In process of ordering lead table skirt, never even seen one used before. Also plan on using lead standing barrier, perpendicular to the table, between me and the source, on laterals. Will have to play around with draping it, position, etc. on kyphoplasty when injecting cement under live lateral.

Lmk what lead table skirt number you use pls. I can’t seem to find it on McKesson

 

[Ducttape]

id think you would find them with the lead companies...

quick search for you:

Lead Table Shield 36" x 36"

The Lead Table Shield 36″ x 36″ is an adjustable table shield designed to reduce exposure to scatter radiation emanating from a patient's body.

phillips-safety.com

Lead Table Shield - 36" x 36"

Our Lead Table Shield - 36" x 36" is a table-attached lead shield that significantly reduces scatter radiation. Attaches to your table's side rail with our optional Traditional Stainless Steel Clark Socket - Fits Up to 11/16" Round Post. 36" W x 36" H panel size. 0.5 mm lead equivalent...

www.universalmedicalinc.com

 

[clubdeac]

Also stop doing scs trials, MILD and kypho. Cuts back on radiation exposure significantly 😉

 

[DOctorJay]

I believe our table skirt is from Burlington. they have velcro at the top so each panel of the skirt can be removed if necessary for CLO view.

 

[ED50]

I use a lead rolling shield. Once you get used to it it's really not bad and my radiation is practically nil. I do about 50 procedures a week. Highly recommend.

 

[SSdoc33]

I use a lead rolling shield. Once you get used to it it's really not bad and my radiation is practically nil. I do about 50 procedures a week. Highly recommend.

how do you move the shield during the procedure? how do you maintain sterility?

 

[Ferrismonk]

I understand the fear, and of course less radiation is always better, but if I'm not mistaken the amount of radiation we get nowadays is pretty minimal. Most of the existing literature on exposure risk is based on old machines with old techniques. There is even a question whether or not we even need to wear leaded glasses anymore.

If you aren't sticking your hands in the beam or doing big bouts of live fluoro at full dose, you're likely okay with just a normal vest.

 

[Taus]

how do you move the shield during the procedure? how do you maintain sterility?

While I await the table skirt (my practice is getting a few quotes) I used a shield today for the first time to block scatter on lateral views. It took some getting used to, back is a bit sore from contorting around it at times.

 

[SSdoc33]

While I await the table skirt (my practice is getting a few quotes) I used a shield today for the first time to block scatter on lateral views. It took some getting used to, back is a bit sore from contorting around it at times.

Worst thing we can do is spend a lot of time leaning over while we wear the lead

 

[Taus]

Worst thing we can do is spend a lot of time leaning over while we wear the lead

Yeah, I agree…. It got better as day went on as I adjusted how I was doing things, pushed it w my arm a bit as needed. Kept it under drape with kypho… that worked well

 

[oneforfighting]

While I await the table skirt (my practice is getting a few quotes) I used a shield today for the first time to block scatter on lateral views. It took some getting used to, back is a bit sore from contorting around it at times.

How much does something like that cost? And is it pretty easy to roll around?

 

[Taus]

How much does something like that cost? And is it pretty easy to roll around?

Very easy to move, on 4 wheels. Not sure re cost as we already had it… I didn't know. My xray tech dusted it off when I started talking about this stuff

 

[ED50]

This is what we have. It's pretty easy to move around with your forarms and feet. It is clear lead so you can see through it.

 

[mid|ine]

There was a thread awhile back on using a lead drape over the patient off the field, essentially draped over their butt. I have adopted this, and I take big steps back. My dose has been non-detectable FWIW. I also collimate, use low dose, etc.

Previous to this I did a deep lit dive, I was worried enough I considered switching fields. The dose we get over lead is lower than the dose cardiologists used to get under their lead before the cardiology field became more cognizant of the risks of radiation. I saw somewhere (can’t find source) their risk of brain cancer is 2-3 times higher than the general population. So if there is a dose-dependent relationship, our relative risk is likely much smaller than that, maybe marginally to mildly elevated compared to general population, but still non-zero.

This was my post and what I have been doing since coming out of training. My badge is always non-detectable and I do 300+ cases a month.

 

[clubdeac]

After reading this thread my annoyance with poor Xray tech skill has sky rocketed. There’s one or two of them that double my fluoro time bc we always have to take an additional pic for every shot bc their first pics sucks…ughhh

 

[CleanUp]

This was my post and what I have been doing since coming out of training. My badge is always non-detectable and I do 300+ cases a month.

Thanks. How much does the apron fall over the sides of the table? Are you able to take a photo and share? Thank you in advance. Impressive your radiation dose and #s per month.

 

[mid|ine]

I have 2 separate drapes, about a 1x2ft rectangle and 2x2ft square. The larger is 1mm equivalent. I place the larger one over the bottom of the field. They drape a bit to the side (depending on pt size).

I also columnate a lot.

 

[PM&ARGHH]

I have 2 separate drapes, about a 1x2ft rectangle and 2x2ft square. The larger is 1mm equivalent. I place the larger one over the bottom of the field. They drape a bit to the side (depending on pt size).

I also columnate a lot.

Do you perform SCS, kypho, or anything with more radiation than bread and butter, and do you utilize this during those procedures as well?

 

[Ducttape]

even if i did just bread and butter injections, i would use the side shield to protect those organs below the table.

there is no risk other than a few hundred dollars and a miniscule inconvenience for significant benefit by reduction in scatter radiation.

 

[BobBarker]

If you have access to a flat panel, use it. Better imaging and less rad scatter.

My rad exposure was typically through the roof at the hospital due to using worn out 9900s and being a heavy kypho and vertiflex user. It is less now as I can turn down my Genoray office unit to 8 pulses per second and vertiflex isn’t around. I’m doing my big cases with a flat panel also.

 

[mid|ine]

Do you perform SCS, kypho, or anything with more radiation than bread and butter, and do you utilize this during those procedures as well?

I do SCD (1-4 cases a month). I did kypho in the past (still undetectable). I use the shielding where I can. So on an SCS I use it below the field.

 

[MiddleOfNowherrr]

After reading this thread my annoyance with poor Xray tech skill has sky rocketed. There’s one or two of them that double my fluoro time bc we always have to take an additional pic for every shot bc their first pics sucks…ughhh

This right here has been my biggest problem with keeping fluoro exposure down. Access to a good/knowledgeable tech makes a huge difference. I cant always control who i get to work with which gets super frustrating.

 

[Taus]

Very easy to move, on 4 wheels. Not sure re cost as we already had it… I didn't know. My xray tech dusted it off when I started talking about this stuff

I’ve gotten used to it. I leave it away from bed on initial ap or slight oblique. I wheel it over with my forearms for laterals and clo. It was too rough on my back leaning around it all day when I left it next to bed bw me and c arm all day. Lead bed skirt is on order as well.

I feel much better about all the live fluoro on scs and kypho with this, plus laterals on injections/rfa.

 

[gazzer]

I do SCD (1-4 cases a month). I did kypho in the past (still undetectable). I use the shielding where I can. So on an SCS I use it below the field.

can you please link the product you use.