Update Course Rewind: Intraoperative Radiation Safety 2022

Best practice guidelines for fluoroscopy are not routinely taught to surgeons in the United States.

Best practice fluoroscopy includes positioning the patient as close as possible to the image intensifier or flat plate detector.

In standard C-arm configuration, raising the bed as far as possible brings the patient close to the image intensifier.

Pulse mode is a feasible option in most pediatric surgery fluoroscopy applications.

Every time the magnification setting is used on the fluoroscopy machine, it significantly increases the radiation dose to both the patient and the room.

Collimation focuses the x-ray beam to a specific area, which increases image detail and clarity.

Collimation decreases the total radiation dose to the patient because the surface area getting irradiated is smaller.

Collimation decreases radiation dose to the room.

In small patients, overexposure can occur if collimation is not used appropriately.

By convention, the x-ray source in the C-arm is placed below the table.

The patient and table protect personnel in the room from radiation when the x-ray source is below the table.

Placing a radiation shield drape on top of a patient does nothing to protect them from radiation because the x-ray source is below the table.

Fluoroscopy machines utilize automatic brightness control, which increases x-ray energy when something blocks the beam from reaching the image intensifier.

If a radiation shield is in the fluoroscopy field, automatic brightness control increases radiation exposure to the patient.

If shielding is used, it must be placed below the patient to be effective.

Fluoroscopy technicians know that shields should be placed below the patient, but they enter the room after drapes are placed and don't know where shields are located.

Shielding can be placed underneath the gel pad or similar patient positioning device.

Shielding underneath the patient is probably problematic for multiple reasons including increased potential for increased exposure if the right image is not obtained.