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| ICRP PUBLICATION 85: AVOIDANCE OF RADIATION INJURIES FROM MEDICAL INTERVENTIONAL PROCEDURES, 85
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 Annals of the ICRP Volume 30/2
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By
. International Commission on Radiological Protection
Included in series
International Commission on Radiological Protection, 85
Description
Interventional radiology (fluoroscopically-guided) techniques are being used by an increasing number of clinicians not adequately trained
in radiation safety or radiobiology. Many of these interventionists are not aware of the potential for injury from these procedures or
the simple methods for decreasing their incidence. Many patients are not being counselled on the radiation risks, nor followed up when
radiation doses from difficult procedures may lead to injury. Some patients are suffering radiation-induced skin injuries and younger
patients may face an increased risk of future cancer. Interventionists are having their practice limited or suffering injury, and are
exposing their staff to high doses.
In some interventional procedures, skin doses to patients approach those experienced in some cancer
radiotherapy fractions. Radiation-induced skin injuries are occurring in patients due to the use of inappropriate equipment and, more
often, poor operational technique. Injuries to physicians and staff performing interventional procedures have also been observed. Acute
radiation doses (to patients) will cause erythema at 2 Gy, cataract at 2 Gy, permanent epilation at 7 Gy, and delayed skin necrosis at
12 Gy. Protracted (occupational) exposures to the eye will cause cataract at 4 Gy if the dose is received in less than 3 months, at 5.5
Gy if received over a period exceeding 3 months.
Practical actions to control dose to the patient and to the staff are listed. The absorbed
dose to the patient in the area of skin that receives the maximum dose is of priority concern. Each local clinical protocol should include,
for each type of interventional procedure, a statement on the cumulative skin doses and skin sites associated with the various parts
of the procedure. Interventionists should be trained to use information on skin dose and on practical techniques to control dose. Maximum
cumulative absorbed doses that appear to approach or exceed 1 Gy (for procedures that may be repeated) or 3 Gy (for any procedure) should
be recorded in the patient record, and there should be a patient follow-up procedure for such cases. Patients should be counselled if
there is a significant risk of radiation-induced injury, and the patient?s personal physician should be informed of the possibility of
radiation effects. Training in radiological protection for patients and staff should be an integral part of the education for those using
interventional techniques. All interventionists should audit and review the outcomes of their procedures for radiation injury. Risks
and benefits, including radiation risks, should be taken into account when new interventional techniques are introduced.
A concluding
list of recommendations is given. Annexes list procedures, patient and staff doses, a sample local clinical protocol, dose quantities
used, and a procurement checklist.
Contents
Preface. Abstract. 1. Introduction.
1.1. History. 1.2. Safety and interventional techniques. 1.3. Purpose of this document.
1.4. References for Introduction.
2. Case Reports.
2.1. Background. 2.2. Injuries. 2.3. References for Case Reports.
3. Radiopathology of Skin and Eye and Radiation Risk.
3.1. Introduction. 3.2. Radiopathology - skin. 3.3. Radiopathology
- eye. 3.4 References for radiopathology and radiation risk.
4. Controlling Dose.
4.1. Factors that affect dose to patients.
4.2. Factors that affect staff doses. 4.3. Procurement. 4.4. References for controlling dose.
5. Patient's Needs.
5.1.
Counselling on radiation risks. 5.2. Records of exposure. 5.3. Follow up. 5.4. Information to personal physician. 5.5. Advice to patient.
5.6. System to identify repeated procedures.
6. Interventionist's Needs.
6.1. Knowledge. 6.2. Training. 6.3. Continuing
professional development. 6.4. Audits. 6.5. Development of new procedures.
7. Recommendations. Annex A: Procedures List. Annex
B: Patient and Staff Doses. Annex C: Example of Clinical Protocol. Annex D: Dose Quantities. Annex E: Procurement Checklist.
Bibliographic & ordering Information
Paperback, 80 pages, publication date: AUG-2001
ISBN-13: 978-0-08-043975-4
ISBN-10: 0-08-043975-6
Imprint: ELSEVIER
063/663
Last update: 23 Jul 2008
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