Therefore, the inappropriate use of fluoroscopy can result in high radiation exposure and can significantly increase the risk of cancer. It is known that radiation causes cancer in fact, radiation-induced cancers account for 2% of all cancers. In this case, as the exposure dose increases, the probability of side effects increases. Thus, because stochastic effects have no threshold, side effects may occur when the operator is exposed to radiation. Stochastic effects (i.e., carcinogenesis and teratogenesis) have no threshold below which they do not occur. Thus, scatter radiation is a significant concern for pain physicians during C-arm fluoroscopic procedures. As a result, they are easily exposed to scatter radiation. Usually, pain physicians tend to stand close to the patient and the X-ray tube. Thus, the major factor in radiation exposure is how close the operator is to the patient during the procedure. The primary X-ray beam produces scatter radiation, which interacts with the patient's body in all directions. The major radiation exposure risk for most medical staff, including pain physicians, originates from scatter radiation. Furthermore, because the amount of leaking X-rays is not large, it does not substantially affect the practitioner. There is no danger of being exposed to the primary X-ray beam unless the operator places his or her hand in the X-ray irradiation area during the procedure. There are three types of ionizing radiation exposure sources: 1) direct exposure from the primary X-ray beam, 2) scattered radiation reflected from patient's body or table, and 3) leakage from the X-ray tube. Major sources of radiation exposure during C-arm fluoroscopy In this review, we discuss the basic strategies for reducing radiation exposure, as well as the proper use of lead aprons and thyroid shields in interventional pain management.Ģ. Of these, lead aprons and thyroid shields are the standard shields for the radiation safety of interventional medical staff, including pain physicians. These radiation protective devices include lead aprons, thyroid shields, radio-protective caps, gloves, lead glasses, lead barriers, and table-side or patient lead drapes. Based on these factors, the time required to use fluoroscopy should be reduced, the physician should be positioned as far away from the radiation source as possible, and the physician should be shielded with appropriate radiation protective devices.
The most important among these factors is proper shielding. There are three major factors in reducing scatter radiation doses: the time of exposure, the distance from the radiation source, and shielding from radiation. However, in some surveys, pain physicians reported a lack of interest, awareness, and knowledge about radiation safety. Therefore, efforts to reduce radiation exposure during pain management are very important. Pain physicians perform the procedures close to a patient's body and the X-ray beam (the radiation source), so it is difficult to avoid unwanted exposure to scatter radiation from the patient. However, the increased use of C-arm fluoroscopy in pain management has resulted in greater exposure to ionizing radiation. It ensures the target specificity of a needle for accurate injection and delivery of a drug through continuous visible X-ray images. The purpose of this article was to review the literature on radiation safety with a focus on lead aprons and thyroid shields and present recommendations related to those devices during C-arm fluoroscopic-guided interventions by pain physicians.Ĭ-arm fluoroscopy is very important and useful for diagnosis and treatment in interventional pain management. Also, inappropriate care and use of radiation protective devices may result in a higher risk of radiation exposure. However, the operator's radiation safety cannot be guaranteed because pain physicians seem to lack sufficient interest, knowledge, and awareness about radiation safety. Lead aprons with thyroid shields are the most fundamental radiation protective devices for interventional procedures, and are very effective. It is therefore necessary to strive to reduce radiation exposure. The harmful biological effects of ionizing radiation on the human body are well known. However, due to increased use of C-arm fluoroscopy in various pain procedures, the risk of radiation exposure is a significant concern for pain physicians. C-arm fluoroscopy is useful equipment in interventional pain management because it helps to guide correct needle targeting for the accurate injection and drug delivery.
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