Radiation Safety for the Speech-Language Pathologist

Abstract

It is the responsibility of the medical SpeechLanguage Pathologist (SLP) who performs video-assisted fluoroscopy of swallowing (VFSS) to be aware of guidelines, recommendations, and preventive measures to reduce radiation to oneself and the patient. Established parameters to reduce radiation during videofluoroscopy include keeping the exposure time brief, using lead aprons and other shielding, and maximizing the distance from the source of radiation. The purpose of this study was to measure radiation exposure to SLPs in the clinical setting and to provide practical recommendations to keep radiation exposure as low as reasonably achievable. Our study measured radiation exposure to six SLPs practicing in an acute-care university hospital. We monitored the radiation received during 130 examinations, 102 of which were of the pharynx only and the other 28 included pharynx and intrathoracic viscera. Individual times were documented, and average doses per exam were calculated from dosimetry badges worn on the lead apron of the SLP doing inpatient exams. Average fluoroscopy time per procedure was 165 s. Average radiation to the dosimeter worn on the front of the lead apron at chest level was 0.15 mR (0.0015 mGy) per procedure. SLPs stood behind the lead shield during fluoroscopy when feasible. Our measurements document the practical importance of reducing radiation exposure to health-care personnel by increasing the distance from the source of radiation and by shielding. While recommendations are not new, details of the findings may help guide and reinforce good radiation safety practice.

Instrumental Assessment of Pediatric Dysphagia

“…Hayes et al studied radiation exposure to SLPs during VFSS procedures and reviewed recommendations to minimize their exposure to ionizing radiation. 26 The investigation emphasized the use of shielding and maximizing distance from the radiation source as two primary considerations in achieving this goal. SLPs who participate in VFSS or other procedures using ionizing radiation may find it helpful to review the literature on occupation exposure.…”

“…Some sources are listed in the references at the conclusion of this article. 7,[26][27][28][29][30][31] Outcomes and Future Directions The relationship between findings of VFSS examinations and outcomes on the health and quality of life in children undergoing the procedure warrants further investigation. Specific areas that need to be addressed are the clinical validity of the VFSS findings relative to health and developmental outcomes; the impact of standardization on use of terminology, diagnostic accuracy, targeting of therapies, reproducibility of findings; and advances in technology.…”

Knee Extension and Stiffness in Osteoarthritic and Normal Knees: A Videofluoroscopic Analysis of the Effect of a Single Session of Manual Therapy

“…6 The total amount of radiation exposure from 36 fluoroscopic images was estimated by the facility radiation physicist to be equal to that of a standard set of knee radiographic images. 25,28 The loading conditions applied forces equal to 30%, 40%, 50%, and 60%…”

The Modified Barium Swallow Study for Oropharyngeal Dysphagia: Recommendations From an Interdisciplinary Expert Panel

“…Use of typical lead shielding for both clinicians and patients has been shown to reduce radiation exposure by 95% (Christodoulou et al, 2003). Thus, radiation exposure to a clinician wearing lead shielding is extremely minimal Hayes et al, 2009). Nevertheless, clinicians should adhere to the "As Low As Reasonably Achievable" principle, including routinely using personal protective equipment, increasing the distance from the radiation source, and limiting unnecessary exposure Galgano et al, 2019;Martin-Harris, Canon, et al, 2020;Peladeau-Pigeon & Steele, 2013).…”