Transcript Sample Staff Training Module

Radiation Safety in Children
www.pedrad.org
Contents
•
•
•
•
•
•
•
Why worry about radiation exposure?
What are radiation issues unique to children?
Examples of radiation doses in imaging
What does “ALARA” mean?
What is the “Image Gently Campaign”?
Methods radiologists use to decrease pediatric radiation exposure
Methods health care professionals can use to optimize radiation use
in children
• Personal protection from radiation exposure at work
Why worry about radiation exposure?
• Ionizing radiation is widely used in medicine and provides
information that can save lives.
• However, some studies have suggested that ionizing radiation can
result in biologic damage to living tissue, including genes and germ
cells.
• Up to 70% of medical ionizing radiation exposure is from CT scans.
X-rays and radionuclide studies also use ionizing radiation.
• In 2009, for the first time radiation exposure to individuals exceeded
natural background radiation.
Increase of medical ionizing radiation exposure from 1980 to 2006.
Fahey et al. THE JOURNAL OF NUCLEAR MEDICINE • Vol. 52 • No. 8 • August 2011
Question 1
Which of the following is true?
a) Ionizing radiation is widely used in medicine
b) Ionizing radiation may be harmful.
c) Ionizing radiation is of no concern.
d) A and C are correct.
e) A and B are correct.
What are radiation issues unique to children?
• Tissues are more radiosensitive at younger ages.
• Longer lifetime for children to experience radiation-induced injury
(cancer, cataracts).
Hall Pediatric Radiology, Apr 2002, pg 226
Question 2
Children are at higher risk from ionizing radiation, because:
1.
2.
3.
4.
Children have a longer life span to experience injury
Tissue is more radiosensitive at a younger age
Exam doses can be cumulative over a life time
1-3 are all true
Typical Radiation Dose Equivalents (mSv)
•
•
•
•
•
•
•
•
•
Natural background (without medical exposure)
3.50
Average annual technologist dose
3.20
Airline passenger (per flight)
0.04
Flight crew / attendants (per year)
1.60
Dental x-rays
0.09
Chest radiograph
0.01
Mammogram
0.50 (to 7.0)
Barium enema (adult)
8.75
Computed tomography (CT)
≤ 3 - 5.00
Relationship of
Typical Ionizing Radiation Doses*
Imaging study
Chest x-ray
equivalents
2-view chest
1
Fluoroscopy cystogram
16
Chest CT
Up to 150
Abdomen CT
Up to 250
* 5 year old patient, effective whole body dose equivalent
Question 3
The radiation dose for one CT scan is equal to how many 2 view chest
radiographs?
A. 1 CT = 1 CXR
B. 1 CT = 10 CXR
C. 1 CT = 150 CXR
D. 1 CT = 500 CXR
The ALARA Concept
ALARA is an acronym that stands for “As Low As Reasonably
Achievable”.
ALARA is a concept that guides health care professionals towards
reduction of exposure to ionizing radiation.
The concept is to expose a patient to the lowest possible radiation dose
while maintaining diagnostic quality if the study is indicated.
Question 4
The following statement regarding the ALARA concept is correct:
a) ALARA stands for “As Low As Reasonably Achievable”.
b) ALARA reminds health care professionals of limiting radiation
exposure whenever possible.
c) ALARA says that studies with radiation should not be used in
children.
d) A and B are correct
Image Gently Campaign
The “Image Gently Campaign” was launched to raise awareness of
ionizing radiation exposure risks.
The campaign reaches out to the general public, politicians, health care
workers, patients and their families.
Question 5
The primary goal of the “Image Gently Campaign” is to:
a) Promote techniques that can lower radiation exposure when
imaging children.
b) Raise awareness of radiation exposure risks in everyone.
c) Punish health care professionals who expose their patients to
unnecessary levels of ionizing radiation.
d) A and B
Minimizing ionizing radiation exposure
Radiology professionals optimize ionizing radiation dose by:
•
•
•
•
•
•
•
Imaging only when there is a clear medical benefit.
Optimizing imaging protocols for ages and sizes.
Providing updated equipment that utilizes less ionizing radiation.
Limiting radiation exposure to the area of interest.
Avoiding multiple scans.
Using non-radiation diagnostic studies, such as US and MRI,
when possible.
Involving a physicist to oversee quality assurance of dose
parameters and equipment.
Example:
Dose reduction up to 50%
can be achieved with
“Automated Exposure Control”
- a technology that is standard
on modern CT scanners.
Radiology: Volume 258: Number 3—March 2011
Methods health care professionals can use
to minimize ionizing radiation use in children
Health care professionals can significantly reduce ionizing radiation
exposure by asking the following questions:
• Is it appropriate to do the exam?
• Is this appropriate timing of the exam or should another
diagnostic test be done first?
• What is the appropriate imaging modality for the clinical
question?
In order to answer some of these questions clinicians need to have a
basic understanding of imaging modalities or access to radiologists
for consultation.
Question 6
Clinicians can help reduce ionizing radiation exposure by asking the
following questions:
a) Is it appropriate to do the exam?
b) Is this appropriate timing of the exam?
c) What is the appropriate imaging exam for the clinical question?
d) All the above.
Appropriateness
For many diseases there are clinical guidelines (“best practice”,
“evidence-based medicine”) that set forth very well defined clinical
criteria as an indication for imaging.
Clinicians should use these guidelines to determine if an imaging study,
especially one with ionizing radiation exposure, is necessary.
Question 7
Which of the following ensures that the appropriate
diagnostic imaging study is being ordered
a) Use guidelines from accepted “best practices” or “evidence-based
medicine”
b) Use guidelines that have been established by the American
College of Radiology
c) Consult with a radiologist.
d) All the above.
Timing and Modality
At times a clinical question can be answered using a modality that does
not involve ionizing radiation exposure.
Clinicians should consider other modalities such as US or MRI when a
clinical question requires imaging.
Reviewing results from previous exams may help in preventing
unnecessary repetition of imaging studies.
Clinicians can consult with a radiologist to determine the best
modality for a given clinical problem.
Personal protection
•
•
•
•
•
Well fitted lead apron
Leaded glasses
Thyroid shield
Lead gloves
Barrier shields
Question 8
What are ways in which you can protect yourself from radiation
exposure?
a)
b)
c)
d)
e)
Keep exposure time short.
Keep a large distance from the radiation source.
Wear a lead apron and neck shield.
Drink lots of water.
A-C are correct
Pregnancy
Pregnant patients may not be able to undergo an imaging
study in order to protect the unborn fetus from untoward
effects.
As a referring health care provider you can help protect the
patient and fetus by obtaining a history regarding
possibility of pregnancy and ordering a pregnancy test
whenever the possibility exists.
Pregnancy evaluation at Children’s National should be
done for all female patients ≥10 years prior to ionizing
radiation exposure. Patients' pregnancy status and date
of LMP must be documented for all female patients 10
years or older.
Please discuss imaging options for your patient with a
radiologist if you have any questions.
Question 9
Which of the statements below regarding imaging of pregnant patients
are true?
a)
b)
c)
d)
Very high doses of radiation can harm a fetus.
The potential for pregnancy should be considered in any female in
which an ionizing radiation imaging study is being considered
Only A is correct.
A and B are correct
Downloadable Parent Pamphlets on
www.imagegently.org
• 2 page and 8 page material
Question 10
What should be my attitude towards ionizing radiation as a health care
professional?
a)
b)
c)
d)
I should think of ionizing radiation as of medication- it can have
side effects, especially in young children.
The use of ionizing radiation is not hazardous at all.
Like with any other medication, I need to weigh the risks against
the benefits.
A and C are correct
Image Gently
Just like medications that you are prescribing, studies that involve
radiation exposure may have long term effects particularly in
children.
Balance the risk and benefits for each individual patient in whom you
are prescribing an imaging study.
Question 12
What should be my attitude towards ionizing radiation as a health care
professional?
a) I should think of ionizing radiation as of medication- it can have side
effects, especially in young children.
b) The use of ionizing radiation is not hazardous at all.
c) Like with any other medication, I need to weigh the risks against the
benefits.
d) A and C are correct