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    Lecture 01 Overview RP in DR and IR RTC Accra 2011

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    1. The use of radiation in medical applications has increased worldwide with the advent of new technologies like multi-detector CT and hybrid imaging. While this has huge benefits for healthcare, it also increases radiation exposures. 2. Radiation protection issues in diagnostic and interventional radiology include unjustified exposures, lack of optimization leading to variable patient doses, and occasional accidental high exposures. Exposures can be high for certain interventional procedures and CT, especially in children. 3. While medical radiation doses are generally lower than background levels, continued efforts are needed to justify exposures, optimize procedures, and reduce unnecessary testing to minimize patient risks. Radiographers play an important role through attention to technique factors and quality assurance.

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    Lecture 01 Overview RP in DR and IR RTC Accra 2011

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    1. The use of radiation in medical applications has increased worldwide with the advent of new technologies like multi-detector CT and hybrid imaging. While this has huge benefits for healthcare, it also increases radiation exposures. 2. Radiation protection issues in diagnostic and interventional radiology include unjustified exposures, lack of optimization leading to variable patient doses, and occasional accidental high exposures. Exposures can be high for certain interventional procedures and CT, especially in children. 3. While medical radiation doses are generally lower than background levels, continued efforts are needed to justify exposures, optimize procedures, and reduce unnecessary testing to minimize patient risks. Radiographers play an important role through attention to technique factors and quality assurance.

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    1. The use of radiation in medical applications has increased worldwide with the advent of new technologies like multi-detector CT and hybrid imaging. While this has huge benefits for healthcare, it also increases radiation exposures. 2. Radiation protection issues in diagnostic and interventional radiology include unjustified exposures, lack of optimization leading to variable patient doses, and occasional accidental high exposures. Exposures can be high for certain interventional procedures and CT, especially in children. 3. While medical radiation doses are generally lower than background levels, continued efforts are needed to justify exposures, optimize procedures, and reduce unnecessary testing to minimize patient risks. Radiographers play an important role through attention to technique factors and quality assurance.

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    Download as ppt, pdf, or txt
    64 views30 pages

    Lecture 01 Overview RP in DR and IR RTC Accra 2011

    Uploaded by

    pramoth_cm1194
    1. The use of radiation in medical applications has increased worldwide with the advent of new technologies like multi-detector CT and hybrid imaging. While this has huge benefits for healthcare, it also increases radiation exposures. 2. Radiation protection issues in diagnostic and interventional radiology include unjustified exposures, lack of optimization leading to variable patient doses, and occasional accidental high exposures. Exposures can be high for certain interventional procedures and CT, especially in children. 3. While medical radiation doses are generally lower than background levels, continued efforts are needed to justify exposures, optimize procedures, and reduce unnecessary testing to minimize patient risks. Radiographers play an important role through attention to technique factors and quality assurance.

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    IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology Adapted for Regional Training Course on RP of Patients

    for Radiographers Accra, Ghana, 11-15 July 2011

    RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY L 01. Overview of Radiation Protection in Diagnostic & Interventional Radiology Motivation for the Course

    IAEA
    International Atomic Energy Agency

    Introduction
    An overview of medical uses of radiation Radiation protection issues in diagnostic &
    interventional radiology

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    Current use of radiation in medicine


    Every year, throughout the world, ionizing radiation is used in*:
    4.000.000.000 diagnostic procedures 35.000.000 nuclear medicine procedures 8.000.000 radiotherapy treatment courses

    These bring huge benefit to healthcare

    - An expanding activity worldwide - Impacts on large portion of global population

    Diagnostic procedure

    Nuclear medicine procedure

    Radiotherapy procedure *UNSCEAR 2010


    3

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    Increasing use of radiation in medical applications worldwide More machines, etc New technologies and techniques
    Single slice CT Multi-Detector CT Film Computed & Digital Radiography Hybrid imaging, PET-CT

    Image-guided interventional procedures Virtual procedures

    New roles

    E.g. Changes in the role of imaging: First port of call A move towards screening, in all its guises

    Increasing complexity in the planning &


    delivery of the radiation
    IAEA
    E.g. IMRT, IGRT, etc.

    Introduction to Radiation Protection in Diagnostic Radiology

    Increasing medical exposure


    UNSCEAR 1993 Global annual per caput effective dose

    IAEA

    Increasing medical exposure


    UNSCEAR 2000 Global annual per caput effective dose

    IAEA

    Increasing medical exposure


    UNSCEAR 2008 Global annual per caput effective dose

    IAEA

    Increasing medical exposure


    NCRP160 2009 U.S. annual per caput effective dose

    IAEA

    Collective dose from medical exposures


    Relative contribution Level I versus USA
    Relative contribution to collective dose
    60%

    50%

    40%

    Percentage

    30%

    USA Level I

    20%

    10%

    0% CT Nuclear Medicine Interventional Conventional Rad/fluoro


    9

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    Context another reality


    However, reports continue to appear on:
    Accidental and unintended exposures Unnecessary exposures

    Newspaper report on recent radiotherapy accident

    Advertisement for radiological screening gift certificates

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    10

    Is this increasing use of radiation in medicine cause for concern? How do patient doses compare with other sources of exposure?

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    11

    Radiation from Natural Sources


    Normally 1-3 mSv/year Global average is estimated to be 2.4 mSv
    per year (UNSCEAR) In areas of high background, > 10 mSv/year

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    12

    Patient effective doses


    Depends on the radiological procedure E.g.
    Whole body dose LD50 3000 - 5000 mSv

    Radiography A few Sv to a few mSv CT A few mSv to tens of mSv X ray exams Image-guided interventional procedures A few mSv to tens of mSv Skin doses up to several 1000 mSv

    NBR, 2.4 mSv

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    13

    What are some of the RP issues in diagnostic and interventional radiology?

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    14

    What are the issues - radiography?


    Staff doses are typically very low < 1 mSv per year Doses to the patient are typically low Effective dose a few Sv to a few mSv But variation by a factor of 20 more Many exams lack proper justification and/or optimization

    Hospital A Dose = X
    IAEA

    Hospital B Dose = 2X

    Hospital C Dose = 10X


    15

    Introduction to Radiation Protection in Diagnostic Radiology

    Radiography
    Diagnostic reference levels (DRLs)
    Very effective tool in optimization Concept introduced in the 1990s Implementation in Member States is very uneven
    How many African countries have Established DRLs; and Use them in practice?

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    16

    In radiographic practice, does it happen?



    Unjustified exposures - Yes Wrong patient - Yes Wrong body part - Yes Lack of optimization - Yes Lack of calibration Yes Lack of QA Yes DRLs not used - Yes

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    17

    Fluoroscopic examinations - diagnostic


    Staff doses are typically low Doses to the patient are
    typically a few mSv But variation through lack of optimization

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    18

    Image-Guided Interventional Procedures


    Increase in use continues, in some countries
    doubling every 2 - 4 years

    Who are the patients?


    Mostly adults, > 40 years old But also children, ~ 5 %

    Doses can be high


    Effective doses
    Can exceed 20 mSv

    Peak skin doses


    Can exceed several Gy IAEA
    Introduction to Radiation Protection in Diagnostic Radiology 19

    Repeat procedures not insignificant


    Udine, Italy Cardiac Interventions Analysis of > 3000 patients
    Number of procedures per patient Number of patients

    >7

    1967

    940

    194

    138

    41

    29

    14

    Nearly 6% of patients had 3 or more interventions

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    20

    Image-Guided Interventional Procedures


    Staff issues
    Induced lens opacities

    Reference: Va E et al, BJR 1998; 71, 728-733

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    21

    Image-Guided Interventional Procedures



    Increasing frequency High doses Paediatric patients Repeat rate not insignificant Radiation protection issues for staff

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    22

    CT
    Usage increasing
    More scanners Quicker to use Can do more with them
    47%

    Level I - UNSCEAR 2008

    43%

    CT Nuclear Medicine Interventional Conventional Rad/fluoro

    Staff doses low at console,


    but hand doses of concern in CT fluoroscopy

    4%

    6%

    Patient doses
    Effective doses 1 10 mSv But can exceed 20 mSv

    Many patient dose reduction tools now available


    But optimization often not happening IAEA
    Introduction to Radiation Protection in Diagnostic Radiology 23

    CT
    But issues with:
    Justification
    Unnecessary exams Self-referral Pressure through media for
    screening

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    24

    CT
    Issues with:
    Multiple follow-up examinations

    Hospital in Boston - 22 years of CT


    Number of CT exams: 33% of patients - 5 or more CT exams 5% - between 22 & 132 CT exams Cumulative doses: 15 % - greater than 100 mSv 4 % - between 250 & 1375 mSv

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    25

    CT
    Issues with children
    Increasing number of children
    undergoing CT examinations
    E.g. in USA (Mettler, 2000) 1989 ~ 4 % of all CT scans 1993 ~ 6 % 2000 ~ 11 %

    Optimization not always


    implemented

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    26

    Deterministic Effects in CT?

    Stroke protocol plus angiography caused temporary hair loss in this study

    CT dose 2-3 Gy; angiography dose?


    Yoshimasa Imanishi et al Eur Radiol (2005) 15:4146

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    27

    Principles of radiation protection


    Justification Optimization Dose limitation (not for patients)
    In Practice: Unjustified examinations are 20-50% Optimization can bring down patient doses by about 50%

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    28

    Radiographers make a difference


    Radiographers reduce radiation exposure in Finland 2011 ECR
    April 18, 2011 Radiographers have an important role to play in monitoring patient radiation exposure and adjusting x-ray equipment settings when rates rise, according to Finnish researchers.

    The radiographer's attention to imaging details, such as chamber positioning, mAs and kVp settings, have helped reduce radiation exposure during lumbar x-ray studies at the Haukipudas Health Center in northwest Finland.

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    29

    Summary
    1. Medical uses of radiation are increasing,
    bringing great benefit 2. But there is a need to reduce unnecessary exposures 3. Radiographers have a key role to play

    IAEA

    Introduction to Radiation Protection in Diagnostic Radiology

    30

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