Radiation safety for pain physicians: principles and recommendations

Abstract

C-arm fluoroscopy is a useful tool for interventional pain management. However, with the increasing use of C-arm fluoroscopy, the risk of accumulated radiation exposure is a significant concern for pain physicians. Therefore, efforts are needed to reduce radiation exposure. There are three types of radiation exposure sources: (1) the primary X-ray beam, (2) scattered radiation, and (3) leakage from the X-ray tube. The major radiation exposure risk for most medical staff members is scattered radiation, the amount of which is affected by many factors. Pain physicians can reduce their radiation exposure by use of several effective methods, which utilize the following main principles: reducing the exposure time, increasing the distance from the radiation source, and radiation shielding. Some methods reduce not only the pain physician’s but also the patient’s radiation exposure. Taking images with collimation and minimal use of magnification are ways to reduce the intensity of the primary X-ray beam and the amount of scattered radiation. It is also important to carefully select the C-arm fluoroscopy mode, such as pulsed mode or low-dose mode, for ensuring the physician’s and patient’s radiation safety. Pain physicians should practice these principles and also be aware of the annual permissible radiation dose as well as checking their radiation exposure. This article aimed to review the literature on radiation safety in relation to C-arm fluoroscopy and provide recommendations to pain physicians during C-arm fluoroscopy-guided interventional pain management.

Augmented Reality-Assisted Navigation System for Transforaminal Epidural Injection

“… 28 The incidence of cataract and cancer in workers with occupational radiation exposure is significant and relatively higher. 21 , 29 …”

“…Thus, radiation exposure during the procedure is unavoidable. 21 Radiation exposure is associated with leukemia, solid cancer, cataract, and tissue damage in the brain and breast tissue. [22][23][24][25][26][27] In addition, concerns are being raised about cardiovascular, cerebrovascular, and dermal damage.…”

“…28 The incidence of cataract and cancer in workers with occupational radiation exposure is significant and relatively higher. 21,29 To reduce the radiation exposure to the medical staff during the procedure, the main concepts that should be followed are "time", "distance", and "shielding", 21 during which it is necessary to reduce the irradiation time and perform a procedure by taking a minimum number of fluoroscopy images. Through AR guidance, radiation exposure during the procedure can be significantly reduced, ensuring the safety of both the physician and the patient from radiation.…”

Radiation shielding effects of lead equivalent thickness of a radiation protective apron and distance during C-arm fluoroscopy-guided pain interventions: A randomized trial

“…[9][10][11] The 3 main components that determine a physician's dose of radiation exposure are exposure time, distance from the radiation field, and shielding equipment. [12][13][14][15][16][17] The total exposure time related to fluoroscopic time per procedure can be reduced by enhanced personal proficiency gained through experience. [17] The position and location of each part of the body (e.g., chest, eye) during the procedure also affect the radiation exposure dose.…”

“…[12–17] The total exposure time related to fluoroscopic time per procedure can be reduced by enhanced personal proficiency gained through experience. [17] The position and location of each part of the body (e.g., chest, eye) during the procedure also affect the radiation exposure dose. [14] Radiation decreases according to the square of the distance from the radiation source, which is known as the “inverse square law.” [18,19] Shield devices such as lead aprons, thyroid protectors, lead gloves, and lead glasses can reduce radiation exposure.…”