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Archive Staff & Patient Safety 2019

Focus on the Fundamentals Of Radiation Safety

Understanding the principles of time, distance and shielding will limit your team's exposure risks.

Michael Bohan

Michael Bohan, BS


Pamela Bevelhymer, RN, BSN, CNOR
RESPECT THE RISKS Surgical team members should understand the dangers associated with intraoperative imaging and take the necessary steps to protect themselves from harm.

Members of your surgical team are at risk every time C-arms are switched on from a danger they can't see or feel. Luckily, the steps they can take to protect themselves from X-ray scatter are rooted in common sense. My role as a radiation safety officer at a large hospital lets me track the amount of radiation thousands of surgical professionals are exposed to each year, and most have little to extremely low levels of exposure because they work with the latest imaging technologies, practice proper fluoroscopy techniques and understand the 3 fundamentals of radiation safety.

1. Time

ALARA ("as low as reasonably achievable") is the guiding principle of radiation practices: use the lowest possible dose to obtain needed images. That can be achieved by keeping the beam-on time to an absolute minimum. The Golden Rule is to reduce fluoroscopy doses to the minimum necessary to achieve the clinical result.

Several features on newer machines help you achieve that aim:

  • Pulsed fluoroscopy delivers radiation in short bursts, instead of continuously, to capture images.
  • Loop functions cycle through a series of captured images, letting the physician review what has been captured to decide if he can avoid reactivating the C-arm to capture useful images.
  • Last-image hold features freeze the image that's captured as soon as the C-arm is deactivated. This mode can be used in place of live fluoroscopy to confirm anatomical information and the locations of hardware and implants.

Remember, doses accumulate as exposure time increases. Relying on these features found on new C-arms and a judicious use of fluoroscopy will limit the amount of time the C-arm is activated.

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