What to do if doctors forget to take protective measures during a fluoroscopy and X-ray procedure for a patient with myocardial infarction (MI)?

Immediate Action for Unshielded Personnel During Fluoroscopy

All medical personnel working in the x-ray procedure room must wear appropriate radiation protection (0.25-0.5 mm lead-equivalent aprons, thyroid shields, and leaded eye protection) before any fluoroscopy begins, and the procedure should be paused immediately if this protection is not in place. 1

Critical Safety Protocol

The procedure must be stopped immediately when protective equipment is missing. The radiologist has a responsibility to halt fluoroscopy when personnel are unprotected, regardless of the clinical urgency. 1

Required Protective Equipment for All Personnel

Medical personnel working in an x-ray procedure room must wear: 1

• 0.25 or 0.5 mm lead-equivalent aprons (absorbs 95% of 70 kVp and 85% of 100 kVp x-rays)
• Thyroid collar (reduces effective dose by approximately 50% by protecting highly radiosensitive thyroid and cervical bone marrow)
• Leaded eye protection with side shields (especially for those working close to the x-ray source)
• Humeral shields for additional upper extremity protection

Distance-Based Requirements

Anyone positioned close to the x-ray source requires full shielding. 1 The inverse square law provides natural protection for personnel positioned remotely from the radiation source. 1

• Personnel at distances greater than 8 feet from the patient receive minimal exposure and may have reduced shielding requirements 1
• Circulating personnel should be positioned remotely and receive negligible exposure when properly distanced 1
• However, when circulating personnel need to approach close to the patient, they must don appropriate protective equipment 1

Proper Response Algorithm

1. Immediately pause fluoroscopy when unshielded personnel are identified 1
2. All personnel within close proximity to the radiation source must leave the field or don complete protective equipment 1
3. Verify equipment integrity - lead aprons and thyroid shields should be inspected at least annually for cracks and holes 1, 2
4. Resume procedure only after all personnel are properly shielded 1

Additional Protective Measures

Beyond personal protective equipment, the following should be utilized: 1

• Ceiling-mounted lead-impregnated shields (reduces operator eye exposure by a factor of 19)
• Under-table mounted shielding (intercepts backscatter from patient and table)
• Table-side drapes for additional lower body protection

Critical Pitfall

Never continue fluoroscopy with unshielded personnel present, even in emergent situations like MI procedures. 1 The cumulative radiation exposure to unprotected personnel can result in significant long-term health consequences, including increased cancer risk. 3 A brief pause to don protective equipment does not meaningfully compromise patient outcomes but substantially protects healthcare workers from radiation injury.

The main surgeon or any individual personnel member leaving to retrieve equipment creates unnecessary delays - instead, pause the procedure and ensure all present personnel are properly protected before resuming. 1