Radiation Protection

[PainMedicine]

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Hi all,

I'll be starting my fellowship this coming July. Excited to be joining the world of Pain!

Not sure if this has been discussed before, but was wondering if I could get some recs regarding radiation protection. What are your thoughts regarding front only vs. total lead apron protection? One piece vs vest/apron combo? Lead glasses?

Any recommendations as far as companies that make the above products that you have been happy with?

Thanks!

 

[geauxg8rs]

Your fellowship should supply you with lead. The glasses would be a great investment (my fellowship did not provide lead glasses). You may be able to take it from your education fund if you have one. Radiation reducing gloves would be a good idea (see if Epimed or some other company can get you some samples). I am not sure on specific companies for the lead glasses. The practice I joined has lead masks which work better for my four eyes.
Work your reps as much as possible. You are poor as a fellow and they want to build a long lasting relationship.

 

[Tenesma]

best way to minimize radiation.... stand 6 feet away from c-arm ...

remember distance is your friend

 

[Mister Mxyzptlk]

Ask your hospital to get you a Da Vinci system so you can be in another room.

 

[PMR 4 MSK]

1-piece vs 2-piece is a personal decision based on how it feels, I like 1-piece.

Use a thyroid shield.

Use lead goggles, mine cost about $150, some are cheaper, some are more expensive. Lead face shield probably better but probably costs even more.

Some stand behind a lead movable, standing window.

Use extension tubing to get farther away from the x-ray.

Consider using lead gloves.

Use the minimal pulses of x-ray you can.

 

[Aether2000]

Excellent suggestions. Always always set your default starting fluoro settings to "Low Dose". Pulsed works but some machines have to pulse for a couple of seconds before image acquisition occurs that may effectively negate the advantage of using pulsed. Never ever put your hands into the fluoroscope field unless you want to have your fingers falling off later in life. Direct beam exposure is 10-50 times more than the scatter radiation you receive standing immediately by the bedside so KEEP YOUR HANDS OUT OF THE FIELD!!!! If you need a pointer, get a large hemostat or use your needle and spot fluoro to find the appropriate starting point. Another way to reduce radiation is via collimation from a 23 cm field size on your monitor to a 16 cm field size, which will reduce scatter radiation by 2/3. Avoid protracted lateral fluoroscopy views or ipsilateral oblique views....these not only ramp up the x-ray energy by 50-400%, but also change the angle of scatter radiation towards your eyes and thyroid. If you feel sunburned after a day of fluoroscopy, you probably are. Low energy scatter radiation 20-40keV will be absorbed by the physician's skin and can cause a sunburn like effect. If this happens, you are being exposed to too much radiation, regardless of what your radiation badges say (they respond preferentially to higher energy rays).
You can use all the above to lower the radiation exposure or could alternatively stand 6 feet away from the table and employ 72 inch needles. They are a little cumbersome at first but eventually you learn how to harpoon with a metal noodle. 🙂

 

[buddy 2004]

Does magnification reduce the field size of the beam, as would collimation? For example, if you have your finger at the edge of a wide view and magnify up such that you can no longer see your fingers, are you protecting them or not?