Radiation Recommendations?

[westcoastresdoc]

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New In-coming fellow

I wanted to know what recommendations that experienced physicians can give to minimize risk. I have a heavy cancer history in my family and would like to know your recommendations in addition to the obvious lead gowns, thyroid shield, goggles, and possibly lead cap. I also plan on hiding behind a lead glass during procedures. I know as a fellow I may have to compromise depending on how busy it is but I figured it would be something I would definitely invest in in the future.

Any other thoughts and suggestions would be much appreciated. Thank you!

 

[wendalltwolf]

A shield that can roll easily and with arm-cutouts can make you more efficient:

 

[geauxg8rs]

New In-coming fellow

I wanted to know what recommendations that experienced physicians can give to minimize risk. I have a heavy cancer history in my family and would like to know your recommendations in addition to the obvious lead gowns, thyroid shield, goggles, and possibly lead cap. I also plan on hiding behind a lead glass during procedures. I know as a fellow I may have to compromise depending on how busy it is but I figured it would be something I would definitely invest in in the future.

Any other thoughts and suggestions would be much appreciated. Thank you!

Collimate, cone in. Low dose. Limit live fluoro where you can

Work as a fellow to find ways to take less pictures, like moving multiple mbb needles at once. Get the c arm lined up right first so you are not wasting pictures

and get on the lazy rad techs who move the c arm in live mode. Just radiating patient and you for nothing.

step back when they take their pics.

 

[SSdoc33]

You are not gonna like that lead glass barrier. Increases your risk of a needle stick and complications with procedures.

Best advice is to only take a pic when you need to. Dont have a heavy foot.

 

[painfree23]

Average fluorotimrs for bilateral lumbar mbnb? Lesi? Scs trial?

 

[BobBarker]

Scs trial varies from 30s to 12 min. 😂

 

[myrandom2003]

Try to get those lead drapes for the table.

 

[Ferrismonk]

Radiation decreases inverse to the square. Stepping back for pictures will do wonders.

Also collimate, this dramatically decreases scatter.

 

[pastafan]

As above plus get a rolling screen to stand behind on laterals.

 

[nvrsumr]

Radiation decreases inverse to the square. Stepping back for pictures will do wonders.

Also collimate, this dramatically decreases scatter.

This. Looks like I'm doing the 2 step all day long.

 

[geauxg8rs]

This. Looks like I'm doing the 2 step all day long.

I am more of a hokey pokey fan myself

 

[cowboydoc]

 

[SommeRiver]

Collimate and step back, especially in lateral. Limited live fluoro (you don't need to run it for 10 sec straight).

 

[HiddenGentleman]

I use the pedal and put it about 6 feet or more from the c arm. Doesn't really add much time to my procedures doing things this way. My radiation badge report usually comes back too low to register.

Of course I do move the pedal closer when doing live runs to drive the scs lead.

 

[jsaul]

i will never forget one dinosaur attending back in the day drive a needle with his hand under live flouro for all injections.

 

[geauxg8rs]

i will never forget one dinosaur attending back in the day drive a needle with his hand under live flouro for all injections.

I saw an old timer do this at a cadaver class. It’s bad enough when it’s on a live patient. But on a cadaver class???

 

[pastafan]

Heard old proceduralist with great hands quip "if you are worried about radiation you should have been a pediatrician". 😵

 

[lobelsteve]

Heard old proceduralist with great hands quip "if you are worried about radiation you should have been a pediatrician". 😵

You should their hairless, nail less hands today.

 

[mid|ine]

Steve will disagree with me, but I put lead drapes OVER the patient, above and below the field to minimize scatter. Also agree with everything else above.

 

[lobelsteve]

No Shield From X-Rays: How Science Is Rethinking Lead Aprons - KFF Health News

A number of radiology organizations are trying to end the decades-old practice of shielding patients from radiation with lead aprons. They say it provides no benefit and might even inadvertently expose people to higher radiation levels. But the policy about-face is moving slowly.

khn.org

 

[callmeanesthesia]

No Shield From X-Rays: How Science Is Rethinking Lead Aprons - KFF Health News

A number of radiology organizations are trying to end the decades-old practice of shielding patients from radiation with lead aprons. They say it provides no benefit and might even inadvertently expose people to higher radiation levels. But the policy about-face is moving slowly.

khn.org

We talked about this before. Lead drapes don’t protect the patient because the radiation is scattered internally. That’s what the article is talking about. What Midline is talking about is lead drapes over the patient to reduce scatter onto the doctor. That actually makes sense, and would work as long as you aren’t catching the drape in the edge of your view and increasing radiation.

 

[lobelsteve]

We talked about this before. Lead drapes don’t protect the patient because the radiation is scattered internally. That’s what the article is talking about. What Midline is talking about is lead drapes over the patient to reduce scatter onto the doctor. That actually makes sense, and would work as long as you aren’t catching the drape in the edge of your view and increasing radiation.

This sounds like you would increase radiation to the patient at the expense of the physician. Strike that and reverse it you would increase radiation to the patient to protect the doc.

 

[callmeanesthesia]

This sounds like you would increase radiation to the patient at the expense of the physician. Strike that and reverse it you would increase radiation to the patient to protect the doc.

Why?

 

[lobelsteve]

Trapping radiation between the lead with the patient in the middle.

 

[mid|ine]

Trapping radiation between the lead with the patient in the middle.

Radiation doesn't just bounce around. A small amount does scatter. However, the lead drapes will probably STOP (or "catch") most of the radiation that hits it. A small amount of a small amount or radiation may bounce back to the patient. However, the dose we give the patient is NOT clinically significant, and a theoretically small percent increase in that is negligible at worst. The cumulative dose to the physician can be clinically significant and its reasonable to try to reduce that.