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.
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