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Thanks to the advancement in the field of X-ray technology, it is now possible to diagnose complex medical conditions such as cardiovascular diseases, stroke and cancer at an earlier stage and treat them more effectively. However, ionising radiation such as X-rays can be harmful to both patients and medical staff. If the radiation dose exceeds a critical level, certain injury or even death will follow, the severity depends on the dose. Examples of such deterministic effects include cataract, erythema and infertility. But even smaller doses accumulated over time and across a population may have adverse effects, in that case, the probability is related to the dose. Cancer would be an example of such a stochastic effect.
While healthcare and medical technology develops and becomes available to more people, patients and staff are exposed to increasing amounts of X-ray radiation. Considering the fact that there is no known level of safe X-ray dose, it is more important than ever to minimise exposure to unnecessary radiation.
But what is unnecessary radiation? For patients in the diagnostic X-ray setting, unjustified X-ray examinations would be one example of unnecessary radiation. Likewise, any radiation that does not contribute to the image quality is also regarded as undesirable, because it causes dose to the patient without any benefit to the process of diagnosis. Such radiation can be from retakes, exposure errors, X-ray machines that are not performing optimally and so on. Medical staff is also exposed to unnecessary radiation, primarily in the form of scattered radiation, during interventional radiology and cardiology procedures.
Through building a better radiation safety culture within the diagnostic imaging workflow, dose and image quality can be optimised while minimising unnecessary radiation. Our endeavour to help you build a better radiation safety culture at your workplace includes solutions for:
I) Quality assurance (QA) of X-ray equipment: Atomic Energy Regulatory Board (AERB) recommends periodic quality assurance of X-ray equipment. The QA protocols are well defined by the regulatory board. For the actual implementation, accurate and calibrated QA instruments, phantoms and test tools are required. When service engineers install a new X-ray machine or service existing machines, they use QA instruments to check parameters such as dose, kVp and exposure time. The qualification of an X-ray machine depends on several factors, such as reproducibility and linearity of exposures, light and X-ray field alignment, contrast resolution and more. Needless to say, measurement accuracy is critical in order to make the right decision about the X-ray machine. The consequences of even one wrongly calibrated X-ray machine can be grave considering the workload of that particular machine. To secure the highest measurement accuracy – which means an increase in the reliability and credibility of each measurement, it is necessary to calibrate and test the QA instruments annually. It is this accuracy that helps the service engineer make a correct judgment whether or not an X-ray machine is safe to use.
The type of measuring instrument will have an impact on the QA, because the technology being used influences the measurements in certain situations. Unfors RaySafe’s solutions are primarily based on solid state technology and hence the QA instruments are extremely sensitive to detect lowest possible doses, have high durability and stability while being compact and light-weight.
II) Radiation safety for the patient: Several research groups and regulatory bodies in India have done studies and recommendations on dose reference levels for patients.1,2 To bring the numbers from paper to actual practice, our solution RaySafe S1 is ideal for filling the gap. RaySafe S1 is a cloud-based application that will collect, add value and share patient dose information to different individuals in the diagnostic radiology workflow including referring physicians, radiologists, operators, medical physicists and Radiation Safety Officers (RSO).
III) Medical staff: In order to be protected from exposure to the scattered radiation present in the X-ray room, medical staff needs to have knowledge about radiation protection devices – and a dedicated practice to use them adequately. However, even with correct use of radiation protection devices their doses are still affected by their behaviour. For example, where someone chooses to stand in the room will influence the amount of scatter radiation they are exposed to and will influence the absorbed dose, even though they may be wearing lead apron. The longer someone stays in the room and the closer they are to the X-ray machine, the higher the dose will be, even though they are standing behind a shield. So, two staff members with the same amount of radiation protection can still have very different doses!
In India, as per the safety code from AERB, all radiation workers should use appropriate personnel monitoring badges (TLD badges). In addition to wearing a legal dosimeter, International Atomic Energy Agency (IAEA) also recommends the use of a real-time dosimetry system.3 A real-time dosimetry system like RaySafe i2 helps medical staff visualise their exposure in real-time, so that they can take immediate action to reduce their dose by changing their behaviour within an X-ray room.
Unfors RaySafe provides a comprehensive solution for the X-ray room consisting of products which collect radiation information, add value and share it in an easy-to-understand way with all relevant stakeholders.
User friendliness combined with state-of-the-art technology and maximum accuracy form the backbone of the RaySafe product range, serving the company’s mission to help people avoid unnecessary radiation and to establish a better radiation safety culture wherever people encounter radiation.
References:
1. AU Sonawane, VK Shirva and AS Pradhan, “Estimation of skin entrance doses (SEDs) for common medical X-ray diagnostic examinations in India and proposed diagnostic reference levels (DRLs),” Radiat Prot Dosimetry, vol. 138, pp. 129-36, Feb 2010.
2. AU Sonawane, JV Sunil Kumar, M Singh, and AS Pradhan, “Suggested diagnostic reference levels for paediatric X-ray examinations in India,” Radiat Prot Dosimetry, vol. 147, pp. 423-8, Nov 2011.
3. IAEA, 10 Pearls: Radiation Protection of Staff in Fluoroscopy, https://rpop.iaea.org/RPOP/RPoP/Content/Documents/Whitepapers/poster-staff-radiation-protection.pdf
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