Radiation Protection in Gastroenterology: IAEA activities

M.M. Rehani, R. Ramirez
International Atomic Energy Agency, Vienna, Austria
(M.Rehani@iaea.org; R.Ramirez@iaea.org)

X- rays are used by gastroenterologists in ERCP. Knowledge of radiation safety in the use of X rays in areas such as gastroenterology is important both from the point of view of avoiding unnecessary fears and also in avoiding unnecessary radiation doses to staff and patients. Just few hours of training can achieve the above objectives. Recognizing that gastroenterologists typically lack training in radiation protection, the International Atomic Energy Agency (IAEA), in discharge of its responsibility of providing for application of radiation safety standards, started a training course for group of doctors who use fluoroscopy (gastroenterologist, urologists, orthopedic surgeons, gynecologists, neuro-surgeons). The first training course was conducted in Auckland, New Zealand. Earlier IAEA training courses for doctors have covered radiologists, interventional cardiologists, radiation oncologists and nuclear medicine physicians (http://rpop.iaea.org). The survey conducted in these courses is presented in Table 1 below. The participants in these courses were from Azerbaijan, Bangladesh, Bolivia*, Bosnia and Herzegovina, Brazil, Bulgaria*, Chile*, China*, Costa Rica, Croatia, Ecuador*, El Salvador, Georgia*, India, Iran, Jordan, Kyrgyzstan, Lebanon*, Lithuania, Malaysia, Mongolia, Nicaragua, Pakistan, Panama, Paraguay, Peru*, Poland, Sri Lanka*, Thailand*, UAE*, Uruguay*, Venezuela, Vietnam* and Yemen. [* gastroenterologist]

ERCP involves X rays during fluoroscopy and for taking radiographs. The points that are useful can be summarized as:

• X rays are emitted only when the X ray tube is switched on while doing fluoroscopy or taking static pictures. These X ray disappear in millions of a second and no radiation can be detected as soon X ray switch is off.
• The typical duration of fluoroscopy in ERCP is about 3 to 6 min and 3 to 5 films are taken.
• The radiation protection principles are time, distance and shielding (TDS). One should keep X rays ON for lowest possible time, keep as much distance as convenient from X ray source and use shielding (lead apron, eye glass wear). One must wear radiation monitoring badge as it is mandatory requirement in most countries. The main exposure to staff is from scattered radiation as there is hardly any possibility of any body part of doctor falling in primary beam. Follow the guidelines given on the website.
• With these simple actions, one can perform few tens of ERCPs every week for full professional life (say 20 to 70 years of age) and still avoiding radiation effects.
• The patient gets typically hundreds of time more radiation exposure in one sitting than the staff performing the procedure in that sitting. Thus every effort should be made to reduce patient exposure without compromising on clinical purpose. More information on patient protection is given on the above website.

 

Table 1. Results of Survey conducted in regional training courses

Question regarding Radiation Protection (RP)	Auckland, NZ 2006	Dubai 2007	Sofia, Bulgaria 2008	Uruguay 2008
Is this 1st time you are attending a structured program on RP. Ans. Yes	100 %	100%	100%	95%
Any Gastroenterologists conference you attended where there was lecture on RP. Ans. No	100%	87%	100%	100%
Do you measure radiation dose to patient. Ans. No	100%	95%	89%	95%
Do you use badge to monitor your personal exposure (yes)	20%	9%	78%	47%
Was this course relevant to you (highly relevant)	100% (80)	100 % (75%)	100 % (88%)	100 % (96%)
Will you like the course to be more than 2 days, Yes	50%	33%	12%	19%

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