1. Time
ALARA ("as low as reasonably achievable") is the guiding principle
of radiation practices: use the lowest possible dose to obtain need-
ed 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 flu-
oroscopy 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 fluo-
roscopy will limit the amount of time the C-arm is activated.
2. Distance
Radiation intensity drops off rapidly with distance. While physicians
and X-ray techs control how long radiation is used in a procedure, the
OR staff can control their proximity to it. When a surgeon or tech
steps on the pedal of the C-arm, radiation is being produced. There is
usually a light on the gantry that goes on when the pedal is pushed. Or
you can simply look at the monitor. If you see a moving picture, that
means the X-ray machine is on (unless it's in loop review mode).
When the light goes on, or the image on the monitor starts to move,
take a step — or 2 or 3 steps — back.
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