If the flat panel detector is positioned downwards to obtain an image (C), a large amount of scattered radiation is generated to the upper body, neck, and head.
#A 0.5 mm thick lead apron reduces scatter radiation generator
When a lateral view is taken (B), more scattered radiation is generated on the side where the X-ray generator is located. When an image is taken with the X-ray generator (red circle) positioned below (A), more scattered radiation is generated in the lower extremities of the physician and medical staff. In this review, radiation safety among pain physicians who use C-arm fluoroscopic machines is discussed.ĭepending on the location of the X-ray generator, the parts of the body exposed to scattered X-rays vary. Therefore, radiation safety awareness and practice by medical staff are important for reducing the risk of radiation exposure and its potential negative biological effects. The relatively low incidence of neck tumors may be due to the thyroid shield effect. Of the reported cases, 87.1% were brain tumors and the remainder were neck tumors. This reflects the effect of a differential dose distribution of radiation exposure in interventionists who typically work with the left side of the head in closest proximity to the primary X-ray beam and scattered radiation. A striking finding was the disproportionate occurrence of tumors on the left side of the brain (85% of cases). The study included data from 31 interventional physicians with brain and neck cancer. In another study, they reported cases of brain and neck tumors that occurred in physicians performing interventional procedures. Orthopedic surgeons using X-ray equipment had a significantly higher risk of tumors compared to unexposed medical workers ( P = 0.002).
According to a report in 2005, the average cumulative radiation dose (35.2 mSv) and cancer incidence (29%) are both higher in orthopedic surgeons than in other medical specialties. In one study, a more significant incidence of cataract was found in medical staff who work in the ionizing radiation zone, where the relative risk was 4.6, when compared with the medical staff who work in the non-radiation zone. Small, cumulative doses over a long time period can produce adverse effects in health workers in the ionizing radiation zone.
However, C-arm fluoroscopy may expose patients and medical staff to radiation. C-arm fluoroscopy has several advantages, such as the ability to assess the patient’s bone structure or shape, ease of assessing intravascular injection compared to that associated with using ultrasound, and ease of discerning the needle’s location regardless of the needle’s gauge or insertion angle. Although the use of ultrasound has gradually been increasing in recent years, procedures using C-arm fluoroscopic machines are still widely used in the treatment of pain. Various imaging devices are used to treat pain patients. This article aimed to review the literature on radiation safety in relation to C-arm fluoroscopy and provide recommendations to pain physicians during C-arm fluoroscopy-guided interventional pain management. Pain physicians should practice these principles and also be aware of the annual permissible radiation dose as well as checking their radiation exposure. It is also important to carefully select the C-arm fluoroscopy mode, such as pulsed mode or low-dose mode, for ensuring the physician’s and patient’s radiation safety. Taking images with collimation and minimal use of magnification are ways to reduce the intensity of the primary X-ray beam and the amount of scattered radiation. Some methods reduce not only the pain physician’s but also the patient’s radiation exposure. Pain physicians can reduce their radiation exposure by use of several effective methods, which utilize the following main principles: reducing the exposure time, increasing the distance from the radiation source, and radiation shielding. The major radiation exposure risk for most medical staff members is scattered radiation, the amount of which is affected by many factors. There are three types of radiation exposure sources: (1) the primary X-ray beam, (2) scattered radiation, and (3) leakage from the X-ray tube. Therefore, efforts are needed to reduce radiation exposure. However, with the increasing use of C-arm fluoroscopy, the risk of accumulated radiation exposure is a significant concern for pain physicians. C-arm fluoroscopy is a useful tool for interventional pain management.
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