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Published byJeffery Cook Modified over 9 years ago
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Northern California SGNA Meeting September 22, 2012
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Radiation safety in the ERCP suite
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Disclosure Statement Product Specialist for Core Medical Imaging Core Medical Imaging Distributor of Omega’s E-view system for ERCP studies
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Radiation Safety in the ERCP suite EndoscopicRetrogradeCholangioPancreatographyFluoroscopy
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Radiation Safety in the ERCP suite Radiation Safety in the ERCP suite Objectives: To discuss: Four equipment configurations Basics of x-ray Scatter radiation Minimize radiation dose
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Radiation Safety in the ERCP suite Radiation Safety in the ERCP suite Today’s goal: Understand fluoroscopy to: Compliment exam Minimize radiation exposure
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Radiation Safety in the ERCP suite Why are these goals important to a Nurse?
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Radiation Safety in the ERCP suite Radiating the patient is part of “Patient Care!”
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Radiation Safety in the ERCP suite What is Fluoroscopy? (in English)
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Radiation Safety in the ERCP suite What is Fluoroscopy? Low dose x-ray image Taken at 30,15 or 7.5 times/sec Displayed at 30 frames/sec
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Radiation Safety in the ERCP suite 2 Radiation items you need to know: #1 Less is better #1 Less is better #2 Inverse square law
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Radiation Safety in the ERCP suite 2 Radiation items you need to know: #1 Radiation - Less is better #1 Radiation - Less is better (= image quality)
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Radiation Safety in the ERCP suite Radiation: the opposite of chocolate
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Radiation Safety in the ERCP suite 2 Radiation items you need to know: #2 Inverse square law #2 Inverse square law
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Radiation Safety in the ERCP suite Inverse square law: 2 x the distance =’s 4 x the radiation
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Radiation Safety in the ERCP suite Inverse square law: 3 x the distance =’s 9 x the radiation
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Radiation Safety in the ERCP suite Application of Inverse Square law Image Intensifier - close to patient as possible. X-ray tube – far away from patient as possible.
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Radiation Safety in the ERCP suite EquipmentConfigurations
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4 equipment configurations do 98.56% of all ERCP’s
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Radiation Safety in the ERCP suite 47.07% of exams ERCP Modalities - Portable C-arm
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Radiation Safety in the ERCP suite Portable C-arm Advantages: Least cost (~$225,000) Every hospital has 1 or 2 or 3 Tube angulation
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Tube angulation Image viewed straight on Cystic Duct superimposed C-Arm angled to view Cystic Duct
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Radiation Safety in the ERCP suite Portable C-arm Dis-advantages: Image quality Radiation dose Slow/hard to use
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Radiation Safety in the ERCP suite ERCP Modalities - Rad/Fluoro room 28.52% of exams
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Radiation Safety in the ERCP suite Rad/Fluoro room Advantages: Image quality Radiation dose Moderate expense ($300K - $325K) ($300K - $325K)
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Radiation Safety in the ERCP suite Rad/Fluoro room Dis-advantages: No tube angulation Non elevating table Patient orientation
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Radiation Safety in the ERCP suite ERCP Modality - Multi Purpose room 17.24% of exams
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Radiation Safety in the ERCP suite Multi Purpose room Advantages: Image quality Radiation dose Tube angulation Elevating table
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Radiation Safety in the ERCP suite Multi Purpose room Dis-advantages: Equipment cost ($550K+) ($550K+) Complexity Room size
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Radiation Safety in the ERCP suite 2.72% of exams ERCP Modalities Dedicated designed
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Radiation Safety in the ERCP suite Dedicated designed Advantages: Image quality Radiation dose Tube angulation Elevating table
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Radiation Safety in the ERCP suite Dedicated designed Dis-advantages: Cost $400K
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Radiation Safety in the ERCP suite Scatter Radiation Why is it important? Why is it important?
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Radiation Safety in the ERCP suite WGO 2009 “For endoscopists and staff, the major source of x-ray exposure is scattered radiation from the patient, not the primary x- ray beam.”
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Radiation Safety in the ERCP suite <1% Table top 98+% Patient <1% Image Int.
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Radiation Safety in the ERCP suite Scatter Radiation How to minimize it How to minimize it
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Radiation Safety in the ERCP suite Minimize Radiation Dose Lead Shielding
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Radiation Safety in the ERCP suite Table drape for nurses
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Radiation Safety in the ERCP suite Minimize Radiation Dose Pay attention to the fluoro dose the fluoro dose readout device readout device
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Radiation Safety in the ERCP suite Minimize Radiation Dose Required in 2006 Display results
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WGO Guidelines http://www.worldgastroenterology.org/assets /downloads/en/pdf/guidelines/23_wgo_radi ation_protection_in_endo_suite_en.pdf
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WGO Guidelines Level 1: high resource levels Level 2: average resource levels Level 3: minimum resource levels
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WGO Guidelines Use of proper technique to minimize the radiation dose to the patient (e.g., keeping the x-ray tube as far away from the patient as possible and the image receptor as close as feasible, …)
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Radiation Safety in the ERCP suite Summary 1) Radiation – less is better 2) Use Inverse square law 3) Proper shielding
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Radiation Safety in the ERCP suite Questions?
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References Slide # 10 – WGO Practice Guideline: Radiation protection in the endoscopy suite Slide # 20 – Survey conducted by Don Dockter Slide # 21 – Survey conducted by Don Dockter Slide # 25 – Survey conducted by Don Dockter Slide # 28 – Survey conducted by Don Dockter Slide # 31 – Survey conducted by Don Dockter
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Radiation Safety in the ERCP suite References Slide # 36 – Mr. James Princehorn, President Omega Medical – WGO Practice Guideline: – WGO Practice Guideline: Radiation protection in the endoscopy suite Slide # 41 – 21CFR, part 1020.32 all diagnostic x-ray device must display Entrance Air Kerma Rate, Accumulated Air display Entrance Air Kerma Rate, Accumulated Air Kerma, and Accumulated Fluoro Time. Kerma, and Accumulated Fluoro Time. Slide # 44 – WGO Practice Guideline: Radiation protection in the endoscopy suite
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