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Cardiovascular Fluoroscopy

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Introduction

References Kcare. (2006). Report 06044 Cardiovascular Imaging Systems A Comparative Report Edition 5. Retrieved January 1st 2010 from http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_064707.pdf IR(ME)R, DH (2000). The Ionising Radiation (Medical Exposure) Regulations 2000. Retrieved November 28th, 2009, from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4007957 MHRA. (2005). Comparative Specifications of Single Plane Cardiovascular Imaging Systems Edition . Retrieved January 1st 2010 from http://www.pasa.nhs.uk/pasa/Doc.aspx?Path=%5BMN%5D%5BSP%5D/NHSprocurement/CEP/X-ray/MHRA%2004148.pdf. Medicine on-line. (2006). Radiation exposure in the cath lab - safety and precautions. Retrieved January 1st 2010 from http://www.priory.com/med/radiation.htm GE Healthcare (2009). X-ray education - dose. Retrieved January 1st 2010 from http://www.gehealthcare.com/usen/xr/edu/products/dose.html#G RadioGraphics. (2000). The AAPM/RSNA Physics Tutorial for Residents General Overview of Fluoroscopic Imaging. Retrieved January 1st 2010 from http://radiographics.rsna.org/content/20/4/1115.full.pdf+html M. Ipe (2002). Medical and Dental Guidance Notes: A Good Practice Guide on All Aspects of Ionising Radiation Protection in the Clinical Environment. Institute of Physics and Engineering in Medicine, York. Stewart C Bushong (2004). Radiologic Science for Technologists. Elsevier Mosby, Missouri. Kenneth L Bontrager, John P Lampignano (2005). Textbook of Radiographic Positioning and Related Anatomy. 6th ed. Elsevier Mosby, Missouri. National Cancer Institute (2005). Interventional Fluoroscopy: Reducing Radiation Risks for Patients and Staff . Retrieved January 1st 2010 from http://www.cancer.gov/cancertopics/interventionalfluoroscopy/allpages/print#91998d72-2c08-46fa-a98f-3cff106794bd Cath Lab Digest. (2009). Angio Procedures Growing at a Steady 4%-5% Clip, with Positive Market Prospects for Angio Systems. Retrieved January 1st 2010 from http://www.cathlabdigest.com/articles/Clinical-and-Industry-News-39 Cardiovascular Fluoroscopy This essay will look at cardiovascular fluoroscopy, identifying its purpose, the medical procedures it is required for and how it meets the needs of these procedures, whilst explaining how this links with existing radiation protection guidelines, mainly IR(ME)R and ALARP. ...read more.

Middle

electronic magnification Control fluoroscopy time: * Limit use to necessary evaluation of moving structures * Employ last-image-hold to review findings Control images: * Limit acquisition to essential diagnostic and documentation purposes Reduce dose: * Reduce field size (collimate) and minimize field overlap * Use pulsed fluoroscopy and low frame rate Include medical physicist in decisions * Machine selection and maintenance Incorporate dose-reduction technologies and dose-measurement devices in equipment Establish a facility quality improvement program that includes an appropriate x-ray equipment quality assurance program, overseen by a medical physicist, which includes equipment evaluation/inspection at appropriate intervals. Minimize Dose to Operators and Staff Keep hands out of the beam Use movable shields Maintain awareness of body position relative to the x-ray beam: * Horizontal x-ray beam - operator and staff should stand on the side of the image receptor * Vertical x-ray beam - the image receptor should be above the table Wear adequate protection * Protective well-fitted lead apron * Leaded glasses Improve ergonomics of operators and staff: * Train operators and staff in ergonomically good positioning when using fluoroscopy equipment; periodically assess their practice * Identify and provide the ergonomically best personal protective gear for operators and staff * Urge manufacturers to develop ergonomically improved personal protective gear * Recommend research to improve ergonomics for personal protective gear http://www.cancer.gov/cancertopics/interventionalfluoroscopy/allpages/print#91702217-5416-4240-9f20-33a604b2b913 Patient dose reduction features incorporated in interventional equipment include copper filtration, low dose selection, removable anti scatter grids, virtual collimation, automatic wedge filters, real time dose display and tantalum filters. ...read more.

Conclusion

(Cowan, Davies, Sivananthan, 2008). Copper grids are incorporated within the detector, and can be removable or fixed. The fixed grids can be troublesome when imaging paediatrics, as doses to the patient are increased. Similarly, with a removable grid, it is easy to start imaging without it in place, causing unnecessary scatter. (Kcare, 2006). Display System Images during procedures are displayed on 2 to 3 ceiling mounted LCD television screens. One captures immediate imaging whilst the others hold the previous images. Images connect with the main work station where post processing takes place. Operator controls The units c-arm and table positioning, collimation, filters, magnification, manipulation of image and pps (pulses per second) rates can be controlled by the health professional from the console. C-arm and table positions can be stored here as well. (Kcare, 2006). Images can be flipped and rotated, have black and white inversion applied as well as adjust contrast and brightness. Acquisition and review Reviewing and storage of images is based at the systems workstation, comprising of 1 or more computers with system software, mouse and keyboard. Acquisition and storage is compatible with PACS, DICOM and RIS. Conclusion Cardiovascular and interventional fluoroscopy is increasing in popularity due to its capability of supporting non evasive procedures, which would have once been evasive surgical procedures. With infection control currently a priority for hospitals, this can only be an advantage in reducing infections and costs to the NHS. With constantly improving technology, and in line with ALARP and IR(ME)R, patient and operator doses are decreasing, without detriment to image quality. ?? ?? ?? ?? Student no. 90209 ...read more.

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