Radiation Protection During Fluoroscopy: Immediate Action Required
The procedure should be paused immediately to ensure all personnel within proximity to the radiation source don protective equipment before continuing, as medical personnel working in an x-ray procedure room must wear lead-equivalent aprons, thyroid shields, and eye protection. 1
Critical Safety Principle
All medical personnel working in the x-ray procedure room require protective shielding—not just those within 1 meter, and not just the radiologist. 1 The 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus explicitly states that "medical personnel working in an x-ray procedure room should wear 0.25- or 0.5-mm equivalent lead aprons augmented with neck thyroid shields and humeral shields." 1
Why Immediate Action Is Necessary
Scatter radiation exposure is significant and affects all personnel in the room, not just those closest to the source, though proximity increases exposure according to the inverse square law. 1
The thyroid collar alone decreases effective dose to the operator by approximately one-half, making it critically important protection that cannot be omitted. 1
Lead-equivalent aprons (0.5 mm) absorb 95% of 70 kVp x-ray and 85% of 100 kVp, providing substantial protection that is non-negotiable for all room personnel. 1
Leaded eye protection with side shields is required for personnel working close to the x-ray source, as proper ceiling-mounted shields reduce operator eye exposure by a factor of 19. 1
Appropriate Response Algorithm
Step 1: Pause fluoroscopy immediately when unprotected personnel are identified. 1, 2
Step 2: All personnel in the procedure room must don complete protective equipment:
- 0.25- or 0.5-mm lead-equivalent aprons 1
- Thyroid shields 1
- Leaded eye protection with side shields for those near the x-ray source 1
- Utilize ceiling-mounted shields and table-side drapes 1, 2
Step 3: Resume procedure only after all personnel are properly shielded. 1, 2
Personnel-Specific Considerations
Circulating personnel should be positioned remotely from the x-ray source (ideally >8 feet), where they receive negligible exposure, but still require protective aprons if they remain in the room. 1
When circulating personnel need to approach close to the patient, the physician operator has a responsibility to ensure they are properly protected before continuing. 1
Ancillary personnel not essential to the procedure (anesthetists, surgeons, perfusionists) should not be assumed to be knowledgeable in radiation protection and require explicit instruction. 1
Critical Pitfall to Avoid
Do not continue the procedure with only the main surgeon leaving to don protection while others remain unprotected. This violates the fundamental principle that all personnel in the x-ray procedure room require shielding, and it is the operator's responsibility to prevent unnecessary x-ray exposure to all staff. 1, 3
Context for MI Patients
While the patient has an acute MI requiring urgent intervention, the brief pause to ensure proper staff protection does not compromise patient outcomes and prevents serious long-term occupational radiation injury including cataracts, skin changes, and malignancies documented in inadequately protected medical personnel. 4, 2, 5