Influence of Provider and Radiology Technician Radiation Safety Practice on Radiation Exposure among Interventional Pain Specialists
Tam Nguyen MD, Luke Johnson MD, Ajay Vellore MD, Rachael Rzasa Lynn MD
There are over 1 million interventional pain procedures performed annually in the United States, with at least 50% being performed under fluoroscopy (1). Fluoroscopy is considered critical to the performance of many pain management procedures for accurate needle placement and medication delivery (2,3). However, radiation exposure entails health risks to physicians, patients, and personnel (4). Radiation exposure data for interventional pain management specialists are still relatively few (5). In this study, we aimed to evaluate how the radiation safety practice of individual pain providers and radiology technicians influenced radiation exposure in a clinical practice setting.
Institutional review board exempt status was obtained for this study. Radiation dosimeter badge data were analyzed for the years 2011-2016 from all attending and fellow interventional pain providers at our institution. Comparisons were made between two practices within our institution, one where practitioners were known to step back from the C-arm prior to images being taken and consciously limit radiation dose and fluoroscopy time (two attending and five fellow providers) and one where these measures were not incorporated (four attending and five fellow providers). Calculations of radiation exposure in both mrem/year and mrem/day were made.
To measure the influence of radiology technician practice upon radiation exposure, two separate fluoroscopy suites were studied. In one, low-dose and pulsed mode fluoroscopy, image magnification and collimation were regularly practiced, while in the other, conventional mode and continuous mode fluoroscopy without magnification or collimation were utilized. Radiation dose meters were placed at a location 20 feet from the C-arm fluoroscope and directly on the C-arm in both suites, and data were collected at these locations for a two-month time period.
Average annual radiation exposure for non-”radiation safe” attending and fellow providers was 728 mrem/year and 386 mrem/year, respectively while average annual radiation exposure for those attending and fellow providers who did implement the above radiation safety practices was 31 mrem/year and 46 mrem/year, respectively (Figure 1). Average radiation exposure at 20 feet from the C-arm and at the C-arm were 1.65 and 9.6 mrem/day, respectively in the non-”radiation safe” procedure suite verses minimal and 1.95 mrem/day, respectively in the procedure suite where low dose, pulsed mode and image collimation/magnification were utilized (Figure 2).
In our study, there was a large difference in provider radiation exposure as measured by radiation dosimeter badges between the two groups of interventional pain providers based on radiation safety practices. Additionally, radiation dose was much lower in the fluoroscopy suite where image magnification/collimation, low-dose and pulsed mode were utilized. Limitations Include:
This study highlights the importance of radiation safety training both for providers and radiology technicians., and the degree to which radiation exposure can be minimized through radiation safety practices. Simple means of minimizing radiation exposure such as maintaining the appropriate distance from the radiation source, consciously minimizing radiation dose and time, employing image magnification and collimation and use of low dose or pulsed mode instead of continuous mode fluoroscopy whenever possible should be emphasized during interventional pain fellowship training.