ICRP Publication 117: Radiological Protection in Fluoroscopically Guided Procedures Performed Outside the Imaging Department

An increasing number of medical specialists are using fluoroscopy outside imaging departments. There has been general neglect of radiological protection coverage of fluoroscopy machines used outside the imaging departments. Lack of radiological protection training of those working with fluoroscopy o [...]
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An increasing number of medical specialists are using fluoroscopy outside imaging departments. There has been general neglect of radiological protection coverage of fluoroscopy machines used outside the imaging departments. Lack of radiological protection training of those working with fluoroscopy outside imaging departments can increase the radiation risk to workers and patients. Procedures such as endovascular aneurysm repair (EVAR), renal angioplasty, iliac angioplasty, ureteric stent placement, therapeutic endoscopic retrograde cholangio-pancreatography (ERCP) and bile duct stenting and drainage have the potential to impart skin doses exceeding 1 Gy. Although tissue reactions among patients and workers from fluoroscopy procedures have so far been reported only in interventional radiology and cardiology, the level of usage of fluoroscopy outside radiology departments creates potential for such injuries. A brief account of the health effects of ionising radiation and protection principles is presented in Section 2.Section 3 deals with general aspects of workers' and patient protection that are common to all whereas specific aspects are covered in Section 4 separately for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology, gastroenterology and hepato-biliary system,anaesthetics and pain management. Although sentinel lymph node biopsy (SLNB) involves use of radio-isotopic methods rather than fluoroscopy, this procedure being performed in operation theatre is covered in this document as ICRP is unlikely to have another publication on this topic. Information on level of radiation doses to patients and workers and dose management is presented against each speciality. Issues connected with pregnant patient and pregnant worker are covered in Section 5. Although the Commission has recently published a document on training, specific needs for the target groups in terms of orientation of training, competency of those who conduct and assess specialists and guidelines on curriculum are provided in Section 6. The document emphasizes that patient dose monitoring is essential whenever fluoroscopy is used.Recommendations for manufacturers to develop systems to indicate patient dose indices with the possibility to produce patient dose reports that can be transferred to the hospital network are provided as are also shielding screens that can be effectively used for protection of workers using fluoroscopy machines in operating theatres without hindering the clinical task.