northern california sgna meeting september 22, 2012
TRANSCRIPT
Northern CaliforniaNorthern California
SGNA MeetingSGNA Meeting
September 22, 2012September 22, 2012
Radiation safetyRadiation safety
in in thethe
ERCP suiteERCP suite
Disclosure StatementDisclosure Statement
Product Specialist forProduct Specialist for
Core Medical ImagingCore Medical Imaging
Distributor of Omega’s E-view Distributor of Omega’s E-view system for ERCP studiessystem for ERCP studies
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
EndoscopicEndoscopic
RetrogradeRetrograde
CholangioPancreatographyCholangioPancreatography
FluoroscopyFluoroscopy
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Objectives:Objectives:
To discuss: To discuss:
Four equipment configurationsFour equipment configurationsBasics of x-rayBasics of x-ray
Scatter radiationScatter radiation Minimize radiation doseMinimize radiation dose
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Today’s goal:Today’s goal:
Understand fluoroscopy to:Understand fluoroscopy to:Compliment examCompliment exam
Minimize radiation exposure Minimize radiation exposure
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Why are these goalsWhy are these goals
important to aimportant to a
Nurse?Nurse?
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Radiating the patientRadiating the patient
is part of is part of
““Patient Care!Patient Care!” ”
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
What is Fluoroscopy?What is Fluoroscopy?
(in English) (in English)
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
What is Fluoroscopy?What is Fluoroscopy? Low dose x-ray imageLow dose x-ray image Taken at 30,15 or 7.5 times/secTaken at 30,15 or 7.5 times/sec Displayed at 30 frames/secDisplayed at 30 frames/sec
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
2 Radiation items 2 Radiation items you need to know:you need to know:
#1 Less is better#1 Less is better#2 Inverse square law#2 Inverse square law
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
2 Radiation items 2 Radiation items
you need to know:you need to know:
#1 Radiation - Less is better#1 Radiation - Less is better
(= image quality)(= image quality)
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Radiation: the opposite of chocolateRadiation: the opposite of chocolate
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
2 Radiation items 2 Radiation items
you need to know:you need to know:
#2 Inverse square law#2 Inverse square law
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Inverse square law:Inverse square law:
2 x the distance =’s2 x the distance =’s
4 x the radiation4 x the radiation
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Inverse square law:Inverse square law:
3 x the distance =’s3 x the distance =’s
9 x the radiation9 x the radiation
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Application of Inverse Square lawApplication of Inverse Square law
Image Intensifier - close to patient Image Intensifier - close to patient as possibleas possible..
X-ray tube – far away from patient X-ray tube – far away from patient as possible.as possible.
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Equipment Equipment ConfigurationsConfigurations
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
4 equipment configurations4 equipment configurations
do 98.56% of all ERCP’sdo 98.56% of all ERCP’s
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
47.07% of exams47.07% of exams
ERCP Modalities - Portable C-armERCP Modalities - Portable C-arm
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Portable C-armPortable C-armAdvantages:Advantages: Least cost Least cost
(~$225,000)(~$225,000) Every hospital has Every hospital has
1 or 2 or 31 or 2 or 3 Tube angulationTube angulation
Tube angulationTube angulationImage viewed straight on
Cystic Duct superimposed
C-Arm angled to view
Cystic Duct
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Portable C-armPortable C-armDis-advantages:Dis-advantages: Image qualityImage quality Radiation doseRadiation dose Slow/hard to useSlow/hard to use
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
ERCP Modalities - Rad/Fluoro roomERCP Modalities - Rad/Fluoro room
28.52% of exams28.52% of exams
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Rad/Fluoro roomRad/Fluoro roomAdvantages:Advantages: Image qualityImage quality Radiation doseRadiation dose Moderate expenseModerate expense ($300K - $325K)($300K - $325K)
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Rad/Fluoro roomRad/Fluoro room
Dis-advantages:Dis-advantages: No tube angulationNo tube angulation Non elevating tableNon elevating table Patient orientationPatient orientation
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
ERCP Modality - Multi Purpose roomERCP Modality - Multi Purpose room
17.24% of exams17.24% of exams
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Multi Purpose roomMulti Purpose roomAdvantages:Advantages: Image qualityImage quality Radiation doseRadiation dose Tube angulationTube angulation Elevating tableElevating table
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Multi Purpose roomMulti Purpose roomDis-advantages:Dis-advantages: Equipment costEquipment cost ($550K+)($550K+) ComplexityComplexity Room sizeRoom size
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
2.72% of exams2.72% of exams
ERCP ModalitiesERCP ModalitiesDedicated designedDedicated designed
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Dedicated designed Dedicated designed Advantages:Advantages: Image qualityImage quality Radiation doseRadiation dose Tube angulation Tube angulation Elevating tableElevating table
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Dedicated designedDedicated designedDis-advantages:Dis-advantages: Cost $400KCost $400K
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Scatter Radiation Scatter Radiation
Why is it important?Why is it important?
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
WGO 2009WGO 2009
““For endoscopists and staff, the major For endoscopists and staff, the major source of x-ray exposure is scattered source of x-ray exposure is scattered radiation from the patient, not the primary x-radiation from the patient, not the primary x-ray beam.” ray beam.”
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
<1% Table top<1% Table top
98+% Patient98+% Patient
<1% Image Int.<1% Image Int.
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Scatter Radiation Scatter Radiation
How to minimize itHow to minimize it
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suiteMinimize Radiation DoseMinimize Radiation Dose
Lead ShieldingLead Shielding
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Table drape for Table drape for nurses nurses
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suiteMinimize Radiation DoseMinimize Radiation Dose
Pay attentionPay attention to to
the fluoro dosethe fluoro dose
readout devicereadout device
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suiteMinimize Radiation DoseMinimize Radiation Dose
Required in 2006Required in 2006
Display resultsDisplay results
WGO GuidelinesWGO Guidelines
http://www.worldgastroenterology.org/assets/downloads/en/http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/pdf/guidelines/23_wgo_radiation_protection_in_endo_suite_en.pdf23_wgo_radiation_protection_in_endo_suite_en.pdf
WGO GuidelinesWGO Guidelines
Level 1: high resource levelsLevel 1: high resource levels
Level 2: average resource levelsLevel 2: average resource levels
Level 3: minimum resource levelsLevel 3: minimum resource levels
WGO GuidelinesWGO Guidelines
Use of proper technique to Use of proper technique to minimize the radiation dose to the minimize the radiation dose to the patient (e.g., keeping the x-ray tube patient (e.g., keeping the x-ray tube as far away from the patient as as far away from the patient as possible and the image receptor as possible and the image receptor as close as feasible, …) close as feasible, …)
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
SummarySummary1) Radiation – less is better1) Radiation – less is better2)2) Use Inverse square law Use Inverse square law3) Proper shielding3) Proper shielding
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
Questions?Questions?
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
ReferencesReferencesSlide # 10 – WGO Practice Guideline: Slide # 10 – WGO Practice Guideline:
Radiation protection in the endoscopy suiteRadiation protection in the endoscopy suite
Slide # 20 – Survey conducted by Don Dockter Slide # 20 – Survey conducted by Don Dockter
Slide # 21 – Survey conducted by Don DockterSlide # 21 – Survey conducted by Don Dockter
Slide # 25 – Survey conducted by Don DockterSlide # 25 – Survey conducted by Don Dockter
Slide # 28 – Survey conducted by Don DockterSlide # 28 – Survey conducted by Don Dockter
Slide # 31 – Survey conducted by Don DockterSlide # 31 – Survey conducted by Don Dockter
Radiation Safety in the ERCP suiteRadiation Safety in the ERCP suite
ReferencesReferencesSlide # 36 – Mr. James Princehorn, President Omega MedicalSlide # 36 – Mr. James Princehorn, President Omega Medical
– – WGO Practice Guideline:WGO Practice Guideline:
Radiation protection in the endoscopy suiteRadiation protection in the endoscopy suite
Slide # 41Slide # 41 – 2– 21CFR, part 1020.32 1CFR, part 1020.32 allall diagnostic x-ray device must diagnostic x-ray device must
display Entrance Air Kerma Rate, Accumulated Airdisplay Entrance Air Kerma Rate, Accumulated Air
Kerma, and Accumulated Fluoro Time.Kerma, and Accumulated Fluoro Time.
Slide # 44 – WGO Practice Guideline:Slide # 44 – WGO Practice Guideline:
Radiation protection in the endoscopy suiteRadiation protection in the endoscopy suite