Original InvestigationEducational Effects of Radiation Reduction During Fluoroscopic Examination of the Adult Gastrointestinal Tract
Introduction
Radiation exposure from medical examinations has been increasing consistently (1). Although computed tomography is regarded as an important source of radiation, fluoroscopy should also be considered (2). Fluoroscopy is still used for functional evaluations, but radiation exposure from fluoroscopy is often neglected (3). Many studies have focused on radiation exposure from fluoroscopy in children, but few studies have paid attention to radiation exposure in adults 4, 5, 6, 7, 8. Fluoroscopy examinations of adult patients should also follow the as-low-as-reasonably-achievable principle to decrease radiation exposure.
A noticeable feature of fluoroscopy examination is that radiation exposure can depend on who performs the examination (9). The protocols for fluoroscopy examinations can be flexible depending on the circumstances of each examination, including patient condition, anatomical variants, and the purpose of the examination. Because radiologists and nonradiologist physicians operate fluoroscopy machines regardless of their experience or knowledge about radiation protection and reduction exposure during fluoroscopy, less experienced trainees and radiographers may not have optimal fluoroscopic technique which could therefore lead to increased radiation dose. Radiographers' awareness of radiation is also important as they assist during fluoroscopic examinations carried out according to nonradiologists' instructions. Different levels of knowledge about radiation have been reported among medical staff from different professions and workplaces, as well as among doctors with different specialties, positions, and experience 10, 11, 12, 13.
Many techniques are available to reduce the radiation dose during fluoroscopic examinations. Examiners should keep a small subject to detector distance, use pulsed fluoroscopy rather than continuous fluoroscopy, replace spot or cine images with images captured digitally, avoid magnification, and use collimation 6, 9, 14. Therefore, education for fluoroscopy examiners could be useful to decrease radiation exposure or fluoroscopy time during fluoroscopy 8, 15, 16.
The purpose in this retrospective study was to evaluate the effects of educating radiology residents and radiographers about radiation exposure on reduction of dose area product (DAP) and fluoroscopy time in diagnostic fluoroscopy of the gastrointestinal (GI) tract in adult patients.
Section snippets
Materials and Methods
Radiology residents and radiographers received a 1-hour education course about fluoroscopy in April 2015. A GI radiologist with 7 years of experience taught 68 radiographers and 39 radiology residents each once. The information provided included (1) radiation exposure from fluoroscopic examinations, (2) the importance of radiologist and radiographer knowledge about reducing radiation exposure during fluoroscopy, and (3) how to reduce patient radiation dose during fluoroscopy.
We evaluated
Results
We found no significant difference in patient demographic factors for fluoroscopy examinations before and after education (Table 1). Variable numbers of GI fluoroscopy examinations were performed during the study period (Table 2). The most frequently performed examinations were barium swallow and UGI with WSC.
Median DAP decreased significantly after education, from 21.1 to 18.2 Gy∙cm2 (P < .001) in all examinations. DAP was significantly decreased after education in defecography, esophagography
Discussion
Significant reduction of DAP could be achieved by 1 hour of education for radiologist residents and radiographers who perform fluoroscopy examinations of the GI tract. Fluoroscopy time tended to decrease after education. Spot images and cine video were less frequently used, and captured images and captured video were more frequently used after education. Therefore, even a short education course could interest radiologists and radiographers in the radiation produced during fluoroscopy and make
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2023, European Journal of Vascular and Endovascular SurgeryDefecating proctography: A pictorial essay
2022, RadiographyCitation Excerpt :Defecating proctography has historically yielded high radiation doses with long screening times in lateral projection.12 However, recent data suggest that the dose can be significantly reduced with radiation education, to a level comparable to oesophagography (swallow) studies, by minimising use of spot images and cine video.13 In the neutral resting position, the anal canal should be closed with an anorectal angle of 90–140° (variable) formed by indentation of puborectalis on the posterior wall (Fig. 1a).