Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea.
Find articles by Jae Hun Kim
Received 2018 Jun 7; Accepted 2018 Jun 19.
Copyright © The Korean Pain Society, 2018
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (//creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Pain physicians usually use C-arm fluoroscopy for the treatment of patients. The C-arm fluoroscope is an important device for pain interventions. However, pain physicians can be exposed to radiation during use of C-arm fluoroscopy. According to a previous study in Korea, most pain physicians were worried about the adverse biological effects of radiation exposure [1]. However not many pain physicians had knowledge of radiation safety [1,2]. Furthermore, not many pain physicians used radiation protective devices and radiation protective methods [1,2]. Even though almost all pain physicians had used thyroid protectors and aprons, the use of lead glasses and gloves was low. For reducing radiation exposure, there are 3 principals: time, distance, and shielding.
Radiation exposure can be accumulated over the time of exposure. In C-arm fluoroscopy guided interventions, the time spent checking the C-arm fluoroscopy is related to the radiation exposure. The longer the exposure time, the more radiation exposure to the pain physician. Therefore, it is important to reduce the usage time of C-arm fluoroscopy [2,3]. For reducing the usage time, the physician has to improve his skill in intervention and the radiographer has to check the X-ray at the correct location, and at the right moment without blurred image.
A greater distance from the radiation source can reduce radiation exposure. The amount of radiation exposure is not inversely proportional to the distance from the radiation source, but is inversely proportional to the square of the distance [2,4]. This means that double the distance from the radiation source can reduce the radiation exposure not to 1/2 but to 1/4. Therefore, maintaining a greater distance from the X-ray generator is a very effective method for radiation safety. In a previous study of radiographers, two steps behind the mobile support structure can decrease the exposure of the radiographer by about 80% [4]. In another study, being only 20 cm farther from the center of the X-ray field can decrease the radiation exposure by about 73% [5].
There are many shielding devices such as caps, lead glasses, thyroid protectors, aprons, radiation reducing gloves, and so on, for radiation safety during C-arm fluoroscopy-guided interventions. Even though the protective effect is enough for radiation safety, no use of the devices cannot protect the physician from radiation. In Korea, the use rate of the apron and thyroid protector by pain physicians is over 80% [1,2,6]. However, the use rate of lead glasses was about 40%, and the use rate of radiation reducing gloves was lower than 35% [1]. The radiation shielding devices are expensive, and the use of shielding devices can be uncomfortable. However, when a physician uses these devices, they can be protected from radiation exposure.
Reducing the time of radiation exposure, a greater distance from radiation sources, and the use of shielding devices for radiation protection are important. Even if pain physicians have to use these three principles, I want to emphasize the importance of distance from the radiation source, because the longer distance from the radiation source may be more effective than reducing time or the use of shielding devices. If a pain physician decreases the time of radiation exposure in half, his radiation exposure will be halved. If a pain physician uses radiation protective devices with double the lead equivalent thickness, his radiation exposure will also be halved. However, if a pain physician stands double the distance from a radiation source, his radiation exposure will reduce to 1/4. Physicians do not pay money for a longer distance from the radiation source. Therefore, all physicians can use the principle of greater distance easily.
Do you want to reduce your radiation exposure? Please remember the 3 principles; time, distance, and shielding.
1. Kim TH, Hong SW, Woo NS, Kim HK, Kim JH. The radiation safety education and the pain physicians' efforts to reduce radiation exposure. Korean J Pain. 2017;30:104–115. [PMC free article] [PubMed] [Google Scholar]
2. Park PE, Park JM, Kang JE, Cho JH, Cho SJ, Kim JH, et al. Radiation safety and education in the applicants of the final test for the expert of pain medicine. Korean J Pain. 2012;25:16–21. [PMC free article] [PubMed] [Google Scholar]
3. Jung CH, Ryu JS, Baek SW, Oh JH, Woo NS, Kim HK, et al. Radiation exposure of the hand and chest during C-arm fluoroscopy-guided procedures. Korean J Pain. 2013;26:51–56. [PMC free article] [PubMed] [Google Scholar]
4. Chang YJ, Kim AN, Oh IS, Woo NS, Kim HK, Kim JH. The radiation exposure of radiographer related to the location in C-arm fluoroscopy-guided pain interventions. Korean J Pain. 2014;27:162–167. [PMC free article] [PubMed] [Google Scholar]
5. Kim AN, Chang YJ, Cheon BK, Kim JH. How effective are radiation reducing gloves in C-arm fluoroscopy-guided pain interventions? Korean J Pain. 2014;27:145–151. [PMC free article] [PubMed] [Google Scholar]
6. Ryu JS, Baek SW, Jung CH, Cho SJ, Jung EG, Kim HK, et al. The survey about the degree of damage of radiation-protective shields in operation room. Korean J Pain. 2013;26:142–147. [PMC free article] [PubMed] [Google Scholar]
Articles from The Korean Journal of Pain are provided here courtesy of Korean Pain Society
1. Baek SW, Ryu JS, Jung CH, Lee JH, Kwon WK, Woo NS, et al. A randomized controlled trial about the levels of radiation exposure depends on the use of collimation C-arm fluoroscopic-guided medial branch block. Korean J Pain. 2013;26:148–153. [PMC free article] [PubMed] [Google Scholar]
2. Ryu JS, Baek SW, Jung CH, Cho SJ, Jung EG, Kim HK, et al. The survey about the degree of damage of radiation-protective shields in operation room. Korean J Pain. 2013;26:142–147. [PMC free article] [PubMed] [Google Scholar]
3. Fish DE, Kim A, Ornelas C, Song S, Pangarkar S. The risk of radiation exposure to the eyes of the interventional pain physician. Radiol Res Pract. 2011;2011:609537. [PMC free article] [PubMed] [Google Scholar]
4. Botwin KP, Freeman ED, Gruber RD, Torres-Rames FM, Bouchtas CG, Sanelli JT, et al. Radiation exposure to the physician performing fluoroscopically guided caudal epidural steroid injections. Pain Physician. 2001;4:343–348. [PubMed] [Google Scholar]
5. Manchikanti L, Cash KA, Moss TL, Pampati V. Radiation exposure to the physician in interventional pain management. Pain Physician. 2002;5:385–393. [PubMed] [Google Scholar]
6. Jung CH, Ryu JS, Baek SW, Oh JH, Woo NS, Kim HK, et al. Radiation exposure of the hand and chest during C-arm fluoroscopy-guided procedures. Korean J Pain. 2013;26:51–56. [PMC free article] [PubMed] [Google Scholar]
7. Cho JH, Kim JY, Kang JE, Park PE, Kim JH, Lim JA, et al. A study to compare the radiation absorbed dose of the C-arm fluoroscopic modes. Korean J Pain. 2011;24:199–204. [PMC free article] [PubMed] [Google Scholar]
8. National Council on Radiation Protection and Measurements (US) Occupational dose limits. In: NCRP Report No. 116. Limitation of exposure to ionizing radiation. Bethesda (MD): National Council on Radiation Protection and Measurements; 1993. pp. 33–35. [Google Scholar]
9. Park PE, Park JM, Kang JE, Cho JH, Cho SJ, Kim JH, et al. Radiation safety and education in the applicants of the final test for the expert of pain medicine. Korean J Pain. 2012;25:16–21. [PMC free article] [PubMed] [Google Scholar]
10. Fink GE. Radiation safety in fluoroscopy for neuraxial injections. AANA J. 2009;77:265–269. [PubMed] [Google Scholar]
11. Little MP. Do non-targeted effects increase or decrease low dose risk in relation to the linear-non-threshold (LNT) model? Mutat Res. 2010;687:17–27. [PMC free article] [PubMed] [Google Scholar]
12. Shah DJ, Sachs RK, Wilson DJ. Radiation-induced cancer: a modern view. Br J Radiol. 2012;85:e1166–e1173. [PMC free article] [PubMed] [Google Scholar]
13. Hendee WR, O'Connor MK. Radiation risks of medical imaging: separating fact from fantasy. Radiology. 2012;264:312–321. [PubMed] [Google Scholar]
14. Crawley MT, Shine B, Booth A. Radiation dose and diagnosticity of barium enema examinations by radiographers and radiologists: a comparative study. Br J Radiol. 1998;71:399–405. [PubMed] [Google Scholar]
15. Tilson ER. Educational and experiential effects on radiographers' radiation safety behavior. Radiol Technol. 1982;53:321–325. [PubMed] [Google Scholar]
16. Johnston J, Killion JB, Vealé B, Comello R. U.S. Technologists' radiation exposure perceptions and practices. Radiol Technol. 2011;82:311–320. [PubMed] [Google Scholar]
17. Vano E, Gonzalez L, Fernandez JM, Prieto C, Guibelalde E. Influence of patient thickness and operation modes on occupational and patient radiation doses in interventional cardiology. Radiat Prot Dosimetry. 2006;118:325–330. [PubMed] [Google Scholar]
18. Ghobadifar MA, Zarei S. Effect of collimation on radiation exposure and image quality. Korean J Pain. 2013;26:307–308. [PMC free article] [PubMed] [Google Scholar]
19. Miller DL, Vañó E, Bartal G, Balter S, Dixon R, Padovani R, et al. Occupational radiation protection in interventional radiology: a joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. Cardiovasc Intervent Radiol. 2010;33:230–239. [PMC free article] [PubMed] [Google Scholar]
20. Schueler BA. Operator shielding: how and why. Tech Vasc Interv Radiol. 2010;13:167–171. [PubMed] [Google Scholar]
Page 2
Demographic Characteristics