Radiaition hazard and sefety in cath lab, we talk about type of radiation and safety in cath lab and talk about unit and measuring method also.

1. Muhammad Naveed Saeed
CardioVascular Technologist
Cardiac Catheterization Laboratory
KFSH&RC Heart Centre
April 13, 2017

2. Radiation Hazards & Safety
Muhammad Naveed Saeed
CardioVascular Technologist
Cardiac Catheterization Laboratory
KFSH&RC Heart Centre
April 06, 2017

3. What is Radiation
PHYSICS
the emission of energy as electromagnetic waves or
as moving subatomic particles, especially high-
energy particles that cause ionization.
BIOLOGY
divergence out from a central point, in particular
evolution from an ancestral animal or plant group
into a variety of new forms.

4. Ionizing Radiation Non Ionizing Radiation
Categories
 Ultraviolet radiation
 X-ray
 Gamma radiation
 Alpha radiation
 Beta radiation
 Neutron radiation
 Ultraviolet light
 Visible light
 Infrared
 Microwave
 Radio waves
 Very low frequency
 Extremely low frequency
 Thermal radiation (heat)
 Black-body radiation

5. non-occupational exposure
 It is well-known that there is naturally occurring background
radiation exposure for everyone, everywhere. The average person
in the United States receives an approximate 3 mSv per year from
naturally occurring radioactive background activity from land and
atmospheric sources. For example, for those individuals with
atmospheric exposure at high elevation locations such as New
Mexico and Colorado, there is an increase of approximately 1.5
mSv more per year than at sea level. Individuals flying on
commercial airplanes on coast-to-coast round trip flights are known
to accumulate another 0.03 mSv, since the high altitude fails to filter
out other sources of background radiation. In addition, radon gas in
homes accounts for approximately 2 mSv per year as a background
exposure. In simple terms, the radiation exposure from one chest x-
ray is equivalent to the amount of radiation exposure from our
natural surroundings over a 10-day period.

6. Occupational exposure / Ionizing
Radiation
Ionizing radiation is radiation that carries enough energy to
free electrons from atoms or molecules, thereby ionizing them.
Ionizing radiation is made up of energetic subatomic
particles, ions or atoms moving at high speeds (usually greater
than 1% of the speed of light), and electromagnetic waves on
the high-energy end of the electromagnetic spectrum.

7. External Exposure / Irradiation
 External irradiation occurs
when all or part of the body
is exposed to penetrating
radiation from an external
source.
 During exposure, some of
this radiation is absorbed by
the body and some passes
completely through.
 Following external exposure,
an individual is not
radioactive.
s




Local
Partial
Body
Whole
Body


8. Internal Exposure
 Internal exposure is from
radioactive materials that
have been taken into the
body.
 Radioactive material can
enter the body through:
 Injection
 Inhalation
 Ingestion
 Absorption
 Once radioactive materials
are in the body, they irradiate
body tissues as long as they
remain in the body
Thyroid
Lung
Liver
Bone

9. Cath Lab Exposure
Factors influencing radiation exposure:
Skin effects radiation exposure:

10. Cath Lab Exposure
 In the cath lab and interventional suite, high-dose fluoroscopy
may sometimes be needed. Remember the dose is
approximately 10-fold for skin entrance exposures compared
to normal fluoroscopy (10-50 mGy/min vs. 100-200
mGy/min). Comparing radiation exposure for diagnostic
coronary angiography to coronary interventional procedures,
a diagnostic study may have a total exposure of 900-1900
mGy, whereas the coronary interventional procedure often
ranges from 2400-5500 mGy. With radiofrequency catheter
ablation procedures, the fluoro time may increase from
approximately 5 minutes for diagnostic study to 40 minutes
for a radiofrequency catheter ablation study. Compare this
with the average 22 minutes of fluoro time for coronary
interventional procedures.

11. Type of Radiation
Primary Radiation:
 Useful beam.
 Most hazardous to the
patient.
 Emitted directly from the x-
ray tube to the image
intensifier.
Secondary Radiation:
 Most commonly referred to
as scattered radiation.
 Scattered by object in
primary beam (such as a
patient).
 This is most hazardous to
the healthcare worker.

12. Measuring Units
 RAD (Gray) Gy- Radiation Absorbed Dose -This is the
amount of radiation the patient absorbs. One Gray is one
joule deposited per kilogram of mass.
 REM (Sievert) Sv –Radiation dose for healthcare providers
who working with radiation producing equipment. The Sievert
is used to measure radiation effects.

13. Radiation Dose Limits
and Dosimetry
Radiation Dose Limits
and Dosimetry

16. Personnel Dosimetry
Dosimetry coordinator will receive monthly reports.
You will receive an annual report.
RSO investigate if you exceed ALARA limits.
Level I = 1.25 mSv Level II = 3.75 mSv
(per monitoring period)

19. ICRP Prescribed Limits per annum
Members of public
Radiation workers
20 mSv per annum above background
20 mSv to eye
500 mSv to hands
1 mSv per annum above background
5 mSv to eye
20 mSv to hands
Pregnant women must receive not more than 5mSv
during the course of pregnancy

20. Pregnant Radiation Workers
May declare pregnancy (voluntary).
For declared pregnant rad workers:
Dose history review.
5 mSv limit (to protect fetus).
Fetal monitoring badge.
Possible work limitations.
Monthly review by the Radiation
Safety Office.

22. Dose Equivalence
• Dose equivalence takes into account the
effectiveness of the radiation to damage human tissue
• Unit is Sievert (Sv); old unit is rem
• Dose Equivalence is the product of the Dose (Gray)
multiplied by a Radiation Weighting Factor (WR)
• Dose Equivalence = D x WR
Radiation Weighting factors (WR) are approximately:
Alpha particles = 20
Protons, neutrons = 10
Beta particles = 1
Gamma rays and x-rays = 1

23. Why is Radiation Safety an Issue?
 In most hospitals, radiation safety is the joint responsibility of
the facility’s radiation safety officer and the technologists who
work in the department but typically we have only minimal
training. Because we are unfamiliar with all of the sources of
radiation exposure, we know little about risk-reduction and
safety strategies.

24. Making Improvements in Radiation Safety
Radiation safety course.

25. Making Improvements in Radiation Safety
Radiation safety course.
Speak up

26. Making Improvements in Radiation Safety
Radiation safety course.
Speak up
Scatter and Minimize Flouro

27. Making Improvements in Radiation Safety
Radiation safety course.
Speak up
Scatter and Minimize Flouro
Proper Gear and Shielding

28. ALARA
As Low As Reasonably Achievable

29. 3 ALARA Principles For
Reducing Radiation Exposure in
Cath Lab

30. 3 ALARA Principles For
Reducing Radiation Exposure in
Cath Lab
Time – less time, less dose.

31. 3 ALARA Principles For
Reducing Radiation Exposure in
Cath Lab
Distance – more distance – less dose

32. 3 ALARA Principles For
Reducing Radiation Exposure in
Cath Lab
Shielding – more shielding – less dose

33. • ALARA means keeping dose “As Low As
Reasonably Achievable”
• Reducing dose wherever practicable reduces the
probabilities associated with stochastic effects
• ALARA principles guide the periodic
scanning of x-ray equipment for scatter and
leakage as well as following the time and
distance rules
Ionising Radiation and ALARA

34. Prescribed Limits for Dose
Equivalence
• The ICRP (International Commission for Radiation
Protection) is an international non-governmental
organisation providing recommendations and guidance
on ionising radiation protection based on current
scientific evidence

35. Radiation Risk
ICRP data:
1 mSv increases lifetime cancer risk of 1/20,000
Lifetime cancer risk for whole population is 1/4

36. Effect of Ionising Radiation on
Humans
The effects of ionizing radiation on humans are
classified in two broad categories:
• Deterministic
• Stochastic

37. Deterministic Effects
These effects have thresholds above which damage occurs and
effects are then dose dependent e.g. lens opacification, burns, hair
loss.
Determinisitic effects like the burns below suffered by those who put
their hands in the path of a x-ray beam are relatively easy to avoid
Effect of Radiation on Humans

38. Stochastic Effects
• Mutational, non-threshold effects in which the chance of
occurring rather than the severity are dose dependent.
• These affects are not predictable e.g. cancer
• Note that stochastic effects are not predictable and give rise to
the notion that there is no absolutely safe dose and the concept
of ALARA.
Effect of Radiation on Humans

39. Protecting the Provider
 Patient safety remains the number-one major concern of
healthcare professional.
 The healthcare providers should receive equal attention
compare with other high risk departments (occupational and
non occupational hazard areas).

40. The take home messages…
1. Use intermittent fluoroscopy. Stay off the
fluoro pedal whenever possible
2. Remove the x-ray grids when appropriate to
reduce patient dose
3. Use last image hold technology with
electronic collimation
4. Employ automatic adjustment of beam
quality to limit kVp and mA (built in)
5. Reduce image magnification when possible.
(Note that at a normal mode, an entrance
skin dose increases 2.4 times when
magnification increases from 23-cm field to a
15-cm field and increases 4.4 times the dose
when the magnification goes to an 11-cm
field)

41. The take home messages…
6. Use pulsed fluoroscopy. (Dose reduction
of approximately 20% over continuous
fluoro dose at 30 pulses per second and
reduction to 80% at 15 pulses per
second)
7. When the time comes that an x-ray dose
of CT angiography is minimal, this will
likely turn out to be our best non-invasive
screening tool for CAD. In the meantime,
wear sun block
8. Radiology Info: The radiology information
source for patients. Available at:
http://www.radiologyinfo.org. Accessed
January 10, 2005.

42. Special Thanks to Keith
(Quality Coordinator)for
helping/reviewing and editing
my presentation