radiation exposure risks for physiatrists

[canal]

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Maybe I am being too cautious if there is such a thing, but I wanted to know what the radiation exposure risks are for physiatrists. I am a little concern because I have several family members who died of cancer hence the concern.

 

[PMR2008]

Maybe I am being too cautious if there is such a thing, but I wanted to know what the radiation exposure risks are for physiatrists. I am a little concern because I have several family members who died of cancer hence the concern.

This is taken from the following article
"Radiation Exposure to the Physician in Interventional Pain Management"
Laxmaiah Manchikanti, MD, Kim A. Cash, RT, Tammy L. Moss, RT and Vidyasagar Pampati, MSc. Pain Physician, Volume 5, Number 4, pp 385-393 2002.

"Fluoroscopy is an integral part of the practice of interventional pain management in present day modern medical practices. The major purpose of fluoroscopy in interventional pain management is correct needle placement to ensure target specificity and accurate delivery of the injectate. Fluoroscopy has become mandatory for multiple procedures based either on the definition of the procedure or the requirement of third parties. The most commonly used fluoroscopy in interventional pain management is with C-arm fluoroscopes with image intensification. Fluoroscopy is associated with risk for patients, clinicians, and the personnel in the operating room unless it is managed with appropriate understanding, skill, and vigilance.​

A total of 1,000 consecutive patients undergoing interventional procedures with chronic pain performed by one physician were studied. Two fluoroscopy units were utilized and operated by two certified radiological technologists. The procedures performed included caudal and interlaminar epidural injections, facet joint nerve blocks, percutaneous adhesiolysis, intercostal nerve blocks, sympathetic blocks, transforaminal epidural injections, along with other procedures. Results showed that a total of 1,000 patients underwent 1,729 procedures with average radiation exposure of 13.2 ± 0.33 seconds per patient and 7.7 ± 0.21 seconds per procedure. Dosimetry measurements showed total exposure of 1,345 mREM outside the apron and 0 mREM inside the apron during this period. The average exposure outside the apron was 1.345 mREM per patient and 0.778 mREM per procedure outside the apron and 0 mREM inside the apron. The levels of exposure are significantly below the annual limits recommended. It is concluded that it is feasible to perform all procedures under fluoroscopy in the described setting safely and effectively in interventional pain management."
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The complete PDF can be downloaded from here . http://www.megaupload.com/?d=4J2JFF89

 

[PMR 4 MSK]

Stay away from fluoro and you have nothing to worry about. Do interventional pain and you wear your lead with collar, lead glasses, even lead gloves if you want, collimate, stand back, use extension tubing, use lead sheild, etc. You decide how much exposure you get. My exposure badges have been consistently around 300 mrem per quarter. I do about 15 procedures unbder fluoro per week.

 

[canal]

At the risk of sounding ignorant because I am only a third year med student: so the only time I will be exposed to radiation is during my residency training but I CAN choose to work as a physiatrist without having to be exposed as long as I don't perform fluoro?

 

[Hemisphere]

that's not possible. you can't work as a physiatrist without being exposed. you can't live on this planet or fly an airplane without being exposed. The average person takes in a certain amount of "cosmic radiation per year" which is higher at higher altitudes, frequent air travel, etc. there are some good tools on the web where you can calculate the 'average' radiation you might get per year. then compare that to the 'average' dose of radiation you would get performing fluoscopy procedures, it's not much more. you are right though the risk of radiation over time is unknown. there is a term called stochastic' events where maybe because u get more radiation there is more of a chance that a radiation particle will knock out a DNA that will give u cancer. but there is no definite link that this will occur. not all fluoroscopists get cancer and as u know peopel with average radiation exposure per year get cancer...

but yes, you do not HAVE to do flouroscopy as a physiatrist. check with individual residency programs about what is required during your residency training. You can do inpatient rehab, consulting, you can even do outpatient rehab without doing flouroscopy such as peripheral joint injections, EMG's, PT/OT scripts, cancer rehab, medical pain managment, general outpatient rehab, botox injections, etc.