How should a Radiologic Technologist be positioned during imaging procedures involving a nasogastric tube to minimize radiation exposure?

Radiation Protection for Radiologic Technologists During Nasogastric Tube Imaging

Radiologic technologists should position themselves as far as possible from the radiation source, keep the image receptor close to the patient, use appropriate lead shielding, and minimize exposure time during nasogastric tube imaging procedures to reduce radiation exposure.

Optimal Positioning to Minimize Radiation Exposure

• Position the image receptor (detector) as close as possible to the patient to reduce radiation scatter and minimize patient dose 1
• Maximize the distance between yourself and the primary beam, utilizing the inverse square law - doubling your distance from the radiation source reduces exposure to one-fourth the original level 2
• Stand behind portable shielding whenever possible, particularly ceiling-mounted lead-impregnated shields which can reduce eye exposure by a factor of 19 2
• Avoid standing on the side of the X-ray tube during lateral projections, as operator dose rates are approximately 1.78 times higher compared to posterior-anterior projections 3

Essential Protective Equipment

• Wear 0.25-0.5 mm lead-equivalent aprons that wrap around the body, covering the torso completely and extending to mid-thigh 2
• Always use thyroid shields, which can decrease effective dose to the operator by approximately 50% by protecting the thyroid and cervical bone marrow 2
• Use leaded eye protection with side shields when working close to the X-ray source 2
• Utilize under-table mounted 0.5-mm lead-equivalent shielding to intercept backscatter from the patient and X-ray table 2

Operational Techniques to Reduce Exposure

• Minimize the field size using proper collimation, which reduces scatter radiation and improves image quality 2, 1
• Use the lowest-dose fluoroscopy program and slowest pulse rates that yield appropriate quality images 2
• Avoid unnecessary magnification, as dose increases proportionally (approximately 1.7 times higher in 7-inch mode compared to 9-inch mode) 2, 1
• Employ radiation-sparing tactics including "last image hold" and virtual collimator position adjustment 2
• Optimize table positioning with the procedure table at the optimal distance from the X-ray tube 2

Monitoring and Safety Protocols

• Wear radiation monitoring badges (film badge or thermoluminescent badge) during all procedures 2
• Be aware of real-time values for air kerma dose rates and cumulative exposure throughout procedures 2
• Ensure that X-ray equipment undergoes periodic inspection and calibration to verify it operates within appropriate specifications 2
• Follow the pdO-DST principle: patient dose Optimization, Distance, Shielding, and Time 4

Special Considerations for Nasogastric Tube Imaging

• During nasogastric tube verification, position yourself on the opposite side of the patient from the X-ray tube when possible 3
• For portable procedures, maintain at least 6 feet (2 meters) distance from the radiation source when exposure is made 2, 4
• Consider that digital subtraction acquisitions account for a large fraction of personnel doses, so minimize their use when possible 3
• If you must remain in the room during exposure, use mobile "door" shields for additional protection 2

Common Pitfalls to Avoid

• Elevating the image receptor too far above the patient can increase radiation dose by as much as a factor of 4 1
• Failing to reposition ceiling-mounted shields when C-arm position changes significantly reduces their effectiveness 2
• Neglecting to inspect lead aprons and shields at least annually for cracks and holes compromises protection 2
• Standing unnecessarily close to the patient during exposure dramatically increases radiation exposure due to the inverse square law 2, 4