Transcript Document

Staff And Patient Radiation
Protection
Andrés Sinisterra
Assistant Radiation Safety Officer
for Medicine
Safety - Suave…....
You are in the
driver’s seat, so
make it safe….!!!
Medical Radiation Doses in the US
 Have increased ~ 6 times in past quarter century
 Increase use of computed tomography (e.g.:
multidetector spiral CT)
 Increased Nuclear Medicine procedures
 More interventional procedures
CAUTION
X-RAY
THIS EQUIPMENT PRODUCES
X-RAYS WHEN ENERGIZED
CAUTION
RADIATION
TO BE OPERATED ONLY BY
QUALIFIED PERSONNEL
A wave is a wave & nothing but a wave!
Radiation vs. Radioactivity
Radiation
Energy in transit in the form of high speed particles and
electromagnetic waves.
Ionizing Radiation
Radiation with enough energy so that during an interaction with an
atom, it can remove tightly bound electrons from their orbits, causing
the atom to become charged or ionized.
Radioactivity
Spontaneous transformation of an unstable atom and often results in
the emission of radiation. This process is referred to as a
transformation, a decay or a disintegration of an atom.
External vs. Internal Radiation Exposure
External Exposure – X-rays, Diagnostic Procedures.
+
Internal Deposition – Contamination from nuclear
medicine patient undergoing a diagnostic or therapeutic
procedure resulting in an ingestion of radioactive
materials by the staff.
=
TEDE
Units of Radiation Exposure
Roentgen
Measure of electrical charge
produced in air
1,000 mr = 1R
Fluoro @ SSD ~3-10 R/min
Rad
(Gray)
Measure of energy absorbed,
usually in tissue or bone.
200 rad = transient erythema
1 Gray = 100 Rad
Units of Radiation Exposure
Rem
(Sievert)
Measure of occupational risk
(cancer) from radiation exposure
1,000 mrem = 1 Rem
1 Sievert = 100 Rem
5 Rem/yr maximum limit
1 R = 1 Rad = 1 Rem
Image Quality Vs Exposure
Area of Interest Collimation
Calcification of the vas deferens.
These bilateral asymmetric calcifications
occur in the lower to middle portion of
the male pelvis
PHOTOELECTRON
INCIDENT X-RAY
Photoelectric effect occurs when an incident x-ray is totally absorbed during
the ionization of the inner-shell electron. The incident photon disappears
and the k-shell electron, now called a photoelectron, is ejected from the atom.
COMPTON ELECTRON
INCIDENT X-RAY
ANGLE OF
DEFLECTION
'
SCATTERED X-RAY
<'
Compton effect occurs between moderate-energy x-rays and
outer-shell electrons. It results in ionization of the target atom, change
in photon direction and reduction of photon energy. The wavelength
of the scattered x-ray is greater than that of the incident x-ray.
INCIDENT ELECTRON
EJECTED
ELECTRON
LEAVES A
HOLE TO BE
FILLED
O Shell
N Shell
M Shell
L Shell
K Shell
Characteristic X-ray Photons
(Characteristic Cascade)
Scatter
Radiation
Scatter
Radiation
Primary
Beam
X-Ray
Tube
Leakage
Radiation
Leakage
Radiation
Know Where Your Head Is At……!!!
Caudal
Coronal
Minimum
Scatter
Maximum
Scatter
plus
Leakage
Be aware of critically
exposed areas
Head
and
shoulders
knees
and toes
!!!!!
Know Where Your Head Is At……!!!
The greater
the distance
the greater
the scatter
Under Normal mode, there is
little magnification with the
whole beam used to generate
a bright image.
Under Mag 1 mode, a
smaller beam area is
projected to the same II
output. The resulting object
size is larger, but the image is
dimmer due to the less beam
input.
The ABC system would sense
the brightness loss and either
boost machine X-ray output,
increase tube voltage, or a
combination of both.
The following Table illustrates the effect of changing FieldOf-View, or magnification modes, for a typical fluoroscopy
system
Mag Mode
(Field-Of-View)
ESE (R/min)
Increase Factor
Normal
(9 inch)
1.2
1.0
Mag 1
(6 inch)
2.9
2.4
Mag 2
(4.5 inch)
5.2
4.3
Inverse Square Law
(X-Rays & Gamma Rays)
For a point source, the intensity varies inversely as the square of the distance
from the source.
Scattered
X-rays
10,000 1 cm
2,500 2 cm
400
5 cm
100 10 cm
X-Ray
Tube
Leakage
Radiation
25
20 cm
6
5
4
3
7
8
2
15 mR/hr @ 1 m from edge
3.75 mR/hr @ 2 m from edge
0.42 mR/hr @ 3 m from edge
Control Booth = Background
Basic Radiation Safety Principles
Time
Distance
Shielding
Contamination Control
Radiation Exposure Monitoring
Whole Body
Radiation Badge
Collar Radiation
Badge
Worn Underneath Pb
Apron
Worn Outside Pb
Apron At Neck Level
BLACK ICON
RED ICON
Extremity Radiation Badge
Worn on Primary Hand
Closest to Radiation Source
Collar
Radiation
Badge
Worn
Outside
Pb Apron At
Neck Level
Whole Body
Radiation
Badge
Worn
Underneath
Pb Apron
PROTECTIVE EQUIPMENT
Get The Lead Out but Watch Your Back !!
ALARA Investigational Level I
Reducing Patient Dose During Fluoroscopy
(And Yours)
Get off the pedal!! – Fluoro intermittently
Collimate and only expose clinical area
Use larger fields when possible
(Magnification increases patient dose)
Use distance of at least 30 cm for mobile
units and 38 cm for fixed installations
Use appropriate mA and KVp
Reducing Patient Dose During Fluoroscopy
(And Yours)
Remember the egg timer!!!
Be aware of the 5 minute timer (especially
in high level mode)
Have sufficient beam filtration
> 90 KVp requires 2.5 mm Al to 3.5 mm Al
@ 130 KVp
Fluoro only when necessary
Schedule annual QA of equipment
As
Low
ALARA Level I
> 10% of the maximum
quarterly exposure limit
(125 mrem)
As
ALARA Level II
Reasonably
Achievable
> 30% of the maximum
quarterly exposure limit
(375 mrem)
Dose
The amount of energy deposited in any substance
by ionizing radiation per unit mass of the
substance. It is expressed numerically in rads
(traditional units) or grays (SI units).
 Absorbed Dose
 Dose Equivalent
 Deep Dose Equivalent
 Eye Dose Equivalent
 Shallow Dose Equivalent
 Effective Dose Equivalent
 Committed Dose Equivalent
 Total Effective Dose Equivalent
Absorbed Dose - The amount of energy deposited in any
substance by ionizing radiation per unit mass of the
substance. It is expressed numerically in rads (traditional
units) or grays (SI units).
Dose Equivalent - The dose equivalent (H) is the product
of the absorbed dose in tissue, the quality factor and all
other modifying factors at the location of interest. The unit
is the rem (R) or the sievert (Sv).
Deep Dose Equivalent (Hd) - Applies to external whole
body exposure, means the dose equivalent at a tissue depth of
1 cm or greater.
Eye Dose Equivalent - The external dose equivalent to the
lens of the eye at a tissue depth of 0.3 cm.
Shallow Dose Equivalent (Hg) - Applies to the external
exposure of the skin or extremity. The dose equivalent at a
tissue depth of 0.007 cm averaged over an area of 1 cm2.
Committed Dose Equivalent (HE.50) - The dose equivalent
(H) is a given organ or tissue that will be accumulated over
50 years following a single intake of radioactive material.
Effective Dose Equivalent (HE) - The sum of the products
of the dose equivalent (HT) to each organ or tissue and the
weighting factor (WT) applicable to each of the body organs
or tissues that are irradiated (HE = ‡” WTHT).
Total Effective Dose Equivalent - The sum of the deep dose
equivalent for external exposures and the committed
effective dose equivalent for internal exposures.
Biological Effects of Ionizing Radiation Exposure
Cancer (Stochastic Effects, Carcinogenic)
The Radiologist
The Patient
The Fetus
Acute Somatic Effects (Non-Stochastic)
The Radiologist
The Patient
The Fetus ( Teratogenic Effects)
Mutagenic Effects
Radiation Exposure Limits
(State of Connecticut Administrative Regulations Sect. 19-24-5)
Type of Exposure
Rem Per Calendar
Quarter
Whole body; head and trunk; active
blood-forming organs; lens of eyes,
or gonads.
1.25
(1,250 mrem)
(5.0 rem/yr)
Hands and forearms; feet and ankles.
18.75
(18,750 mrem)
(75 rem/yr)
(7,500 mrem)
(30 rem/yr)
Skin of whole body.
Fetus
7.5
500 mrem Total Gestation
(0.5 rem)
Conditions For Exceeding Quarterly Doses To Whole
Body
Total Dose For Any Quarter
Total Whole Body Dose
Plus
All Previous Whole Body Doses
< 3.0 rem
<= 5 (N-18) rem
N=
Your Age
In Years
Prior Dose Must Be On a Clear Record
! ! ! ! ALARA PROGRAM EXISTS ! ! ! !
PREGNANCY DECLARATION
Confidential Document
Confidential Declaration of Pregnancy
The United States Nuclear Regulatory Commission requires in the Code of Federal Regulations
Title 10, Chapter I, Part 20.1208, that special consideration be given to limitation of embryo/fetus
radiation exposure only in those instances where a woman has declared the pregnancy to the
l
appropriate representative of the employer (the UCHC). In cases where a pregnancy is not declared
tia
in writing, the larger occupational exposure limit for the working mother is used as a maximum
permissible dose limit. The purpose of this form is to officially notify the employer, through the
Medical Director of Employee Health Services, that dose limitation to your embryo/fetus is
requested. The information contained on this form will be treated as confidential, and only those
n
e
NRC requires a signed declaration of pregnancy
for occupational workers to limit exposures
to 500 mrem/9months or 50 mrem in any one
month.
directly involved in assessing the potential for embryo/fetal exposures will be informed. Please
sign the form where indicated and forward to:
if d
n
o
C
Marcia Trape-Cardoso, M.D., Medical Director
Employee Health Services
MC-6210
I, _________________________________ ______ , formally declare my pregnancy and request
dose limitation to my embryo/fetus such that my total radiation exposure during the gestational
period does not exceed 500 mrem, and if exposed, received at a uniform rate of no more than 50 mrem
per month. As required by the Nuclear Regulatory Commission, my approximate date of conception
was __________________.
Signed:
Department:
Telephone #:
c:\flw\pregwrk.pre ( rev. 10/2000 )
Date:
Are we at risk of danger?
Background
Equivalent
Radiation
Time
Typical Effective Doses And Bert Values For Some
Common X-Ray Studies To An Adult
(Adapted From Ipsm Report 53) 5
Effective Dose
(mSv)
BERT (time to get same
dose from nature)
Dental, intra-oral
0.06
1 week
Chest x-ray
0.08
10 days
Thoracic spine
1.5
6 months
Lumbar spine
3
1 year
Upper GI series
4.5
1.5 years
Lower GI series
6
2 years
X-ray Study
Radiation Exposures From ?
Smoking a pack and a
half of cigarettes a day
will add about 1,300
mrem/year to one's
effective dose
Flying from New York to London
results in the absorption of an
extra
2-3 mrem of cosmic radiation
6-8 mrem from NY to Japan
International Space Station ?
.11 mrad/d to .35 mrad/day
1,980 mrad to 6,300 mrad for 180
day mission
Radiation Exposures from
Consumer Products 1
# Of People in
U.S. Exposed
(in millions)
Avg. Annual Dose
Equivalent to
Exposed Population
Part of
Body
Exposed
Television Receivers
230
< 1 mrem
Whole Body
Video Display Terminals
50
< 1 mrem
Whole Body
Luminous 3 H in Watches and
Clocks
11
0.1 mrem
Whole Body
Luminous 147 Pm in Watches and
Clocks
8
0.04 mrem
Whole Body
120
7 mrem
Whole Body
4 mrem
Whole Body
& Gonadal
Dose
Source
Building Materials
Highway and Road Construction
Materials
1 Adapted from NCRP 95
5
Radiation Exposures from
1
Consumer Products
# Of People in
U.S. Exposed
(in millions)
Avg. Annual Dose
Equivalent to the
Exposed Population
Part the
Body
Exposed 2
Tobacco Products
50
16,000 mrem
BEDE
Domestic Water Supplies
230
15 - 90 mrem
BEDE
Fertilizer Products
200
0.5 - 5 mrem
Natural Gas Heaters
16
22 mrem
WB and
IDF
BEDE
Natural Gas Cooking Ranges
125
5 mrem
BEDE
Dental Protheses
45
700 mrem
BMDE
Opthalmic Glass
50
4000 mrem
CGDE
Gas Mantles
50
0.2 mrem
WB and
SODE
Source
1 Adapted from NCRP 95
2 BEDE = Bronchial Epithelial Dose Equivalent; WB = Whole Body; IDF = Ingestion Dose from Foods
BMDE = Bronchial Mucosa Dose Equivalent; CGDE = Corneal Germinal Dose Equivalent; SODE = Selected Organ Dose Equivalent
Risks which Increase Chance of
Death by 1 in 1 million a
Smoking 1.4 cigarettes
Drinking 1/2 liter of wine
Spending 1 hour in a coal mine
Spending 3 hours in a coal mine
Living 2 days in New York or Boston
Traveling 6 minutes by canoe
Traveling 10 miles by bicycle
Traveling 300 miles by car
Flying 1000 miles by jet
Flying 6000 miles by jet
Living 2 months in Denver on vacation from N.Y.
Living 2 months in average stone or brick building
One chest x-ray taken in a good hospital
Living 2 months with a cigarette smoker
a
Cancer, Heart disease
Cirrhosis of the liver
Black lung disease
Accident
Air pollution
Accident
Accident
Accident
Accident
Cancer from cosmic radiation
Cancer from cosmic radiation
Cancer from natural radioactivity
Cancer from radiation
Cancer, Heart disease
B.L. Cohen and I.S. Lee, ”Catalog of Risks Extended and Updated”, Health Physics, Vol. 61, Sept. 1991.
More Risks which Increase Chance of Death
by 1 in 1 million a
Drinking Miami drinking water for 1 year
Cancer from chloroform
Drinking 30, 12 oz. cans of diet soda
Cancer from saccharin
Living 5 years at site boundary of a typical nuclear power plant Cancer from radiation
in the open
Drinking 1000, 24 oz. soft drinks from banned plastic bottles
Cancer from acrylonitrile monomer
Living 20 years near PVC plant
Living 150 years within 20 miles of a nuclear power plant
Cancer from vinyl chloride (76
standard)
Cancer from radiation
Eating 100 charcoal broiled steaks
Cancer from benzopyrene
Risk of accident by living within 5 miles of a nuclear reactor for Cancer from radiation
50 years
Eating 40 tablespoons of peanut butter
Liver cancer from aflatoxin B
a B.L. Cohen and I.S. Lee, “Catalog of Risks Extended and Updated”, Health Physics, Vol. 61, Sept. 1991.
Estimated Loss of Life Expectancy
from Health Risks
Health Risk
Average Days of Life Expectancy Lost
Smoking 20 cigarettes/day
Overweight (by 20%)
All accidents combined
Auto accidents
Alcohol consumption
Home accidents
Drowning
Natural background radiation
Medical diagnostic x-rays
All catastrophes (fire, flood, etc.)
1,000 mrem (1 rem) occupational radiation dose
1,000 mrem (1 rem)/yr for 30 years
2370 (6.5 years)
985 (2.7 years)
435 (1.2 years)
200
130
95
41
8
6
3.5
1
30
Note: Average U.S. occupational radiation dose is estimated at 0.34 - 0.65 rem/year.
PROGRAM FOR IMPLEMENTING
PATIENT INFORMED CONSENT
AND
FOLLOW UP REGARDING HIGH DOSE SPECIAL
X-RAY PROCEDURES
Purpose:
There are certain x-ray guided procedures
that could result in the delivery of a radiation
dose to an area of a patient’s skin of
sufficient magnitude to produce clinical
symptoms.
This program was developed to inform patients
of this potential risk prior to such procedures,
determine if a procedure may lead to a large
skin dose and to follow up with the patient if
there is a possibility of a skin reaction.
Policy:
This program is applicable to personnel involved
with the following x-ray guided procedures:
Percutaneous Transluminal Angioplasty
Radiofrequency Cardiac Catheter Ablation
Vascular Embolization
Stent and Filter Placement
Thrombolytic & Fibrinolytic Procedures
Percutaneous Transhepatic Cholangiography
and/or Biliary Drainage
Policy (continued):
Endoscopic Retrograde
Cholangiopancreatography
Transjugular Intrahepatic Portosystemic Shunt
Percutaneous Nephrostomy
Urinary/Biliary Stone Removal
Or
Any other x-ray guided procedure that could
expose the same area of the skin for more
than 30 minutes
Policy (continued):
For such cases, the patient must be informed
in writing prior to the procedure of the risks
associated with large x-ray skin doses.
Appropriate follow up must be made, if after
completion of a procedure, a large skin dose
is possible.
1. Document the total x-ray “ON” time, not the
duration of the procedure
2. For procedures with total x-ray “ON” time
exceeding 30 minutes, determine what body area
may have been exposed for the greatest duration
and ESTIMATE the maximum fraction of the total
“ON” time this occurred.
3. If the total x-ray “ON” time exceeded 30 minutes
and the same area of the skin was irradiated for 30
minutes or longer, notify the Radiation Safety
Office (2250).
4. The Radiation Safety Officer (or delegate) will
estimate the maximum skin dose for the procedure.
5. The Radiation Safety Officer will provide a report
to the interventionalist indicating the maximum
estimated skin dose.
6. The interventionalist, upon receiving the RSO’s
report, shall notify the patient or the patient’s
referring physician if the possibility of a skin
reaction exists.
7. The referring physician and/or interventionalist will
provide treatment instructions to the patient as is
medically necessary.
Prior to a procedure, the patient should be asked about previous
fluoroscopic interventions.
Connective tissue diseases (e.g. scleroderma, lupus
erythematosus, mixed connective tissue disease), diabetes
mellitus, hyperthyroidism and the homozygous form of ataxia
telangiectasia have been associated with an increased sensitivity
to radiation [9]. Some chemotherapy agents are also known to
increase radiation effects. The history should include these risk
factors. The patient should be advised about the potential higher
risk .
To avoid injuries when using an oblique or lateral beam
projection, the patient's arm must be secured away from the
primary beam. Direct exposure of the female breast, especially
entrance-beam exposure, must also be avoided.
Radiation Biology
Radiosensitivity of Cells 1
 As cells mature they become less sensitive to radiation
 As metabolic rate increases cells become more
sensitive to radiation
 As reproductive rate increases cells become more
sensitive to radiation
 Cell types that are most sensitive to radiation include
lymphocytes and stem cells
 Cell types that are least sensitive to radiation include
muscle and ganglion cells
1 Adapted
from The 1906 Law of Bergonie and Tribondeau
Various degrees of sensitivity to radiation exist
due to the type of tissue which receives the
exposure
Radiosensitive
Radioresistant
Breast tissue
Heart tissue
Bone marrow cells
Large arteries
Mucosa lining of small intestines
Large veins
Sebaceous (fat) glands of skin
Mature blood cells
Immune response cells
Neurons
All stem cell populations
Muscle cells
Lymphocytes
Radiation Induced Skin Injuries
TABLE 1.
REPORTS RECEIVED BY FDA OF SKIN INJURY FROM FLUOROSCOPY
Type of Procedure with Injury Report
Number of Injuries
RF Cardiac Ablation
13
Catheter Placement for Chemotherapy
1
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
3
Coronary Angioplasty
4
Renal Angioplasty
2
Multiple Hepatic/Biliary Procedures
3
Percutaneous Cholangiogram with Multiple Embolizations
1
* Food and Drug Administration, USA, Internet Site.
Radiation Induced Skin Injuries
TABLE 2.
EXAMPLES OF SKIN INJURIES FROM FLUOROSCOPY *
Patient
Sex
Age
Procedure
A
Male
40
Coronary angiography & PTCA, followed by 2nd
coronary angiography
B
Female
nag
RF catheter ablation
C
Female
25
RF catheter ablation
Skin breakdown 3 weeks post
procedure
D
Female
34
RF catheter ablation
Draining skin lesions on back 3
weeks after procedure
E
Female
62
Balloon ablation bile duct
Burn-like injury on back
Anastomosis requiring a skin graft
F
Female
61
Renal angioplasty
* Food and Drug Administration, USA, Internet Site.
Injury
Skin necrosis requiring 12x10 cm
skin graft
Second degree burn (7.5x12.5 cm)
Skin necrosis requiring graft
Radiation Induced Skin Injuries
TIME TO THRESHOLD
EFFECT
THRESHHOLD
DOSE, Rad
NORMAL
5 R/MIN
HIGH
20 R/MIN
TIME TO
ONSET
Early Transient Erythema
200
0.7 hr
0.17 hr
Hours
Temporary Epilation
300
1.0 hr
0.25 hr
3 Weeks
Main Erythema
600
2.0 hr
0.50 hr
10 Days
Permanent Epilation
700
2.3 hr
0.58 hr
3 Weeks
Dry Desquamation
1,000
3.3 hr
0.83 hr
4 Weeks
Moist Desquamation
1,500
5.0 hr
1.25 hr
4 Weeks
Late Erythema
1,500
5.0 hr
1.25 hr
6 – 10 Weeks
Dermal Necrosis
1,800
6.0 hr
1.50 hr
> 10 Weeks
Radiation Induced Skin Injuries
TIME TO THRESHOLD
EFFECT
THRESHHOLD
DOSE (Gy)
NORMAL
5 R/MIN
HIGH
20 R/MIN
TIME TO
ONSET
Early Transient Erythema
200
0.7 hr
0.17 hr
Hours
Temporary Epilation
300
1.0 hr
0.25 hr
3 Weeks
Main Erythema
600
2.0 hr
0.50 hr
10 Days
Permanent Epilation
700
2.3 hr
0.58 hr
3 Weeks
Dry Desquamation
1,000
3.3 hr
0.83 hr
4 Weeks
Moist Desquamation
1,500
5.0 hr
1.25 hr
4 Weeks
Late Erythema
1,500
5.0 hr
1.25 hr
6 – 10 Weeks
Dermal Necrosis
1,800
6.0 hr
1.50 hr
> 10 Weeks
Free Radical Production from Irradiated Water
H2O
H2O
H2O + e H2O OH + OH
H2O + + e H + + OH
H2O H + OH H2O2
Stochastic Effects (by chance)
Health effects that occur randomly. Effects that occur by
chance, generally occurring without a threshold level of
dose, whose probability is proportional to the dose and
whose severity is independent of the dose. .
(examples: cancer incidence and genetic effects)
Stochastic Effects (by chance)
1,000,000 persons buy a
lottery ticket for $1,00 each.
999,999 persons will not get
the large prize. Only one
will win the BIG ONE.
Return on scratch tickets is
not certain.
Nonstochastic (Deterministic) Effects
Health effects that can be induced upon reaching an
apparent threshold, and their severity varies with the
radiation dose.
examples:
cataract in the lens of the eye, non- malignant
damage to the skin
Nonstochastic (Deterministic) Effects
100 persons invest $1,000 at
5% interest
Each person will receive
$1,050.00
Return is certain
So....., how really dangerous is
this so called
“RADIATION??”
Industrial Radiation Accident
An example of a skin injury attributable to x-rays from
fluoroscopy is shown in Figure 2.
This case, patient A in Table 2, is that of a 40-year-old
male who underwent coronary angiography, coronary
angioplasty and a second angiography procedure due
to complications, followed by a coronary artery bypass graft, all on March 29, 1990.
Source:
Thomas B. Shope, Ph.D. (HFZ-140)
FDA/Center for Devices and Radiological Health
Figure 2(a).
Condition of patient's
back six to eight weeks
following multiple
coronary angiography
and angioplasty
procedures
Source:
Thomas B. Shope, Ph.D. (HFZ-140)
FDA/Center for Devices and Radiological Health
Figure 2(b).
Appearance of skin
injury approximately
16 to 21 weeks
following the
procedures with small
ulcerated area present.
Source:
Thomas B. Shope, Ph.D. (HFZ-140)
FDA/Center for Devices and Radiological Health
Figure 2(c).
Appearance of skin
injury approximately
18 to 21 months
following procedures,
evidencing tissue
necrosis.
Source:
Thomas B. Shope, Ph.D. (HFZ-140)
FDA/Center for Devices and Radiological Health
Figure 2(d).
Close-up view of lesion
shown in 2(c).
Source:
Thomas B. Shope, Ph.D. (HFZ-140)
FDA/Center for Devices and Radiological Health
Figure 2(e).
Appearance of
patient's back
following skin grafting
procedure.
Source:
Thomas B. Shope, Ph.D. (HFZ-140)
FDA/Center for Devices and Radiological Health
Transjugular Intrahepatic Portosystemic Shunt
This patient received 3
TIPS procedures within
a week
month
23
22
610
month
7.5
month
Source:
Koening, Wagner, et al., University of Texas
Health Science Center
Radiofrequency Cardiac Catheter Ablation
Tissue necrosis 5
months after
procedure, and deep
ulceration with
exposure of the
humerus at 6.5
months
Source:
Koening, Wagner, et al., University of Texas
Health Science Center
Remember ....!!!
Following Proper
Protection Procedures
Minimizes Unnecessary
Exposures
The End