Where should the Radiologic Technologist (RT) be positioned during a duodenal ulcer perfusion procedure?

Radiologic Technologist Positioning During Duodenal Ulcer Perforation Procedures

The radiologic technologist (RT) should not be located in the procedure room during imaging of a duodenal ulcer perforation, but should stand outside the controlled area without physical contact with the team or any objects. 1

Optimal RT Positioning for Radiation Safety

General Positioning Guidelines

• Recording and monitoring technologists should not be located in the procedure room during imaging to minimize radiation exposure 1
• When performing portable radiography, the RT should preferably work in pairs using a contact/non-contact technique 1
• The non-contact RT should stand outside the controlled area and be responsible for image acquisition/exposure while ensuring radiation protection principles 1

Two-Person Technique for Optimal Safety

• When possible, use a two-person approach where one RT positions the X-ray tube and makes the exposure, while the second RT positions the patient and the covered detector 1
• This technique significantly reduces radiation exposure to personnel while maintaining image quality 1
• If working alone, the RT must use gloves and consider all equipment and control screen keys as contaminated, ensuring proper hand hygiene after glove removal 1

Radiation Protection Principles

Personal Protective Equipment

• The primary mode of protection for all personnel is the protective apron of at least 0.5 mm lead equivalent 1
• Protective eyewear of 0.5 mm lead equivalent with wraparound shields and thyroid shields should be considered essential when in proximity to radiation 1
• Two-piece (vest and skirt) aprons are becoming popular but require proper fitting to ensure adequate overlap when the body is extended 1

Exposure Monitoring

• All members of the laboratory staff should wear a film badge or thermoluminescent badge for radiation exposure monitoring 1
• Personnel doses correlate best with kerma area product (KAP) and less with fluoroscopy time or cumulative air kerma 2

Special Considerations for DU Perforation Procedures

Procedural Approach

• For duodenal ulcer perforation cases, portable imaging equipment is often used at the bedside, requiring strict adherence to radiation safety protocols 1
• Perforated duodenal ulcers typically require prompt surgical intervention, especially with significant pneumoperitoneum or extraluminal contrast extravasation 1
• The RT must ensure proper image quality before sending to PACS, as these images are critical for surgical decision-making in perforated ulcer cases 1

Equipment Considerations

• Cover X-ray detectors/cassettes with plastic covers or disposable cellophane wrappers and clean between each patient 1
• When using portable equipment, designate specific units for high-risk procedures to reduce transmission risk 1
• Direct digital radiography (DDR) imaging should be used whenever possible to reduce transmission risk and minimize radiographer workload 1

Common Pitfalls and How to Avoid Them

• Proximity Error: Staying too close to the radiation source increases exposure - maintain maximum distance while still ensuring proper image acquisition 1, 2
• Inadequate Shielding: Failure to use proper protective equipment significantly increases radiation exposure - always wear appropriate lead protection 1
• Poor Communication: Lack of coordination between team members can lead to unnecessary radiation exposure - clearly communicate roles before the procedure begins 1
• Contamination Risk: Touching equipment without proper protection can lead to cross-contamination - use gloves and consider all equipment contaminated 1

By following these guidelines, the RT can minimize radiation exposure while ensuring high-quality imaging for the diagnosis and management of duodenal ulcer perforation.