1. Fluoroscopy and Radiation Exposure
2009 Pediatric and Congenital/Structural
Fellows Course
Fluoroscopy and Radiation Exposure
Thomas K. Jones, MD
Professor, Pediatrics and Medicine
University of Washington School of Medicine
Director, Cardiac Catheterization Laboratories
Seattle Children’s Hospital

2. None for purposes of this presentation
2009 Pediatric and Congenital/Structural
Fellows Course
Conflicts of Interest
None for purposes of this presentation
Acknowledgements
Thomas Bashore, MD, FSCAI
Stephen Balter, PhD, FSCAI
Joseph Babb, MD, FSCAI

7. Message
Keep the x-ray source (the tube) as far away from you (the operator) as possible consistent with optimal imaging.

11. Radiation Safety Principle
Use the least amount of magnification consistent with seeing the object adequately.
BIGGER IS NOT ALWAYS BETTER!!
A larger image means more radiation
If it is necessary for adequate visualization, fine
If it does not improve procedure safety or performance, reduce the magnification

14. Risks are Radiogenic Cancer and Genetic Damage
Stochastic effects
Probability proportional to dose
Severity independent of dose
Assumed zero threshold
Risks are Radiogenic Cancer and Genetic Damage

15. Deterministic effects
Certainty of effect
Severity is a function of dose
Substantial threshold High dose risks are: hair loss, skin damage, cataracts, and congenital abnormalities

22. Time Radiation is only produced when the beam is on!
Irradiate only when it is necessary to observe motion.
Last-image-hold and instant replay can usually save dose.

23. Distance effect Use the inverse square law to your advantage and
whenever possible move away from the x-ray source
as far as safety allows.

24. Shielding
Protective shielding can markedly reduce staff risk. (when used!)
Structural Shielding
Mobile Shielding
Personal Shielding

25. Protective Clothing
Well tailored apron
Thyroid collar
Eye protection

26. Collimation

28. Wear Your Exposure Badge
It is for your benefit
The readings should correlate with your workload
Over-lead monitor on midline at neck level
Under-lead monitor on midline at waist level
Weighted average for estimating stochastic risk

29. Summary
Safe use of radiography demands understanding of basic radiation physics
Sources of radiation
Proper positioning of patient in x-ray beam
Maintenance of I.I. close as possible to patient
Proper use of shielding
Use the inverse square law of radiation exposure to your advantage
Use the least magnification consistent with adequate visualization
Only activate the x-ray when moving a device or assessing and injection!
Always wear your film badge and change it monthly