Radiation Safety in Radiology

¶ … radiation safety in radiology, particularly for health care workers whose radiation exposure results from the risks of their occupation. This essay argues for improved understanding of occupational health risks and proposes that workplace hazards need to be better acknowledged and reduced as much as possible.

Ionizing radiation is used to obtain highly detailed images of the body. Modern imaging techniques contribute to earlier and more accurate diagnoses, which promote better treatments for patients and better outcomes. Many advances in modern medical science require tests that use ionizing radiation to confirm diagnoses, to manage a treatment plan, or to monitor the response to the treatment. As long as radiation is used with care, the use of ionizing radiation in diagnostic imaging offers many benefits with reasonably low risk.

The risks associated with ionizing radiation, a form of high energy, result from its ability to break up atoms or molecules as the radiation passes through, thereby potentially damaging our bodies and organs. Much of what is known about the ability of radiation to cause cancer comes from studies on survivors of atomic bombs that were dropped on Nagasaki and Hiroshima. Using this data, scientists have calculated the risk for lower medical doses of radiation. Even though these extrapolations remain controversial, medical science has chosen to err on the side of caution in determining guidelines and procedures for radiation exposure.

A key aspect of radiation safety focuses on reducing occupational health risks for individuals working in interventional laboratory settings. Even though radiation exposure for health care workers has decreased as a result of technological advances, it is still not uncommon for busy interventionists to come close to or even exceed limits that are considered acceptable (Klein et al., 2009).

Discussion

Cardiologists, radiologists, surgeons working with fluoroscopy and the many support personnel working in these environments are among those who must deal with daily exposure to radiation. Some individuals cope by not wearing the required radiation badge, preferring not to know the truth, while others are pulled from the laboratory due to "excess" monthly exposures (Klein et al., 2009). None of these behaviors solve the basic problem of excessive radiation exposure.

One way of minimizing radiation exposure in the interventional laboratory is the use of a quality assurance (QA) program in diagnostic radiology. According to the International Atomic Energy agency (IAEA), QA programs for medical exposures are required to include measurements of the physical parameters of radiation generators and imaging devices at the time of commissioning as well as periodically thereafter. QA programs should also include procedures to verify the appropriate physical and clinical factors that are used in patient diagnosis and treatment. Important components of QA programs for medical exposures also include maintaining written records of relevant procedures and results, verifying the appropriate calibration and conditions of operation of dosimetry and monitoring equipment. QA programs must also include regular and independent quality audit reviews of the QA program (IAEA, 2011).

Health care workers are also concerned with finding additional ways to minimize radiation exposure and its consequences. Physicians performing invasive procedures that require x-ray exposure are concerned about the potential damaging effects. Studies have suggested that exposure may, over time, be associated with an increased incidence of cataracts, cancers, and possibly other diseases. There have also been anecdotal reports of hematologic malignancies and brain cancers as well. These studies and reports are not conclusive, but they are cause for concern (Klein et al., 2009).

Current standards for occupational exposure are defined by the policy of "As Low As Reasonably Achievable (ALARA). Questions remain, however, as to what exactly is "low" and what is "reasonably achievable." While interventional medicine has undergone a dramatic evolution in the past 30 years, radiation protection technology has not kept pace. There are still no clear answers to these questions (Klein et al., 2009).

Conclusion

A survey of the literature shows that the need to create a safer radiology workplace continues to exist. Whether it is done as a matter of personal responsibility or by governmental mandate, the interventional laboratory needs to be made into a safer work environment. Creating a safer laboratory environment means eliminating all unnecessary radiation exposure to physicians. It also means that individual operators need to have enough knowledge of radiation to be able to make informed decisions about personal safety. Practitioners must be aware of their own occupational radiation dose and must minimize it as much as possible.