S.

Balter1

Technical note: Stray radiation in fluoroscopy

Appropriate management of the working environment reduces the exposure of fluoroscopists and their assistants to stray radiation.

Fluoroscopists and their assistants are exposed to stray radiation fields as they work. An understanding of stray radiation permits better management of the working environment. This article reviews some basic physics and presents measurements obtained in a cardiac fluoroscopic environment. The intensity of the stray radiation field depends on the X-ray factors and beam size. The spatial distribution of stray radiation in a fluoroscopy
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room is determined by the mechanical arrangement of the imaging system. X-rays are produced when the X-ray tube is energized. A small quantity of radiation leaks through the lead-lined shield surrounding the X-ray tube. A fraction of the useful beam that strikes the patient is scattered. Under clinical conditions, the scattered radiation will generally be much more intense than the leakage radiation.
2a

Fig. 1. The two main sources of stray radiation are leakage from the X-ray tube, and scatter from the patient.

mA

mA

kVp

kVp

Fig. 2 a. Stray radiation: the effects of changing mAs and kVp. Baseline. Fig. 2 b. Increased mA.

2b

2c

mA

mA

kVp

kVp

Fig. 2 c. Increased kVp.
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Senior Medical Physicist, Philips Medical Systems N.A., Shelton, CT, U.S.A.
Volume 41 Issue 1 March 1997

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medicamundi

3 b). 3 c) allows more X-ray photons to strike the patient. Changing the primary skin dose by changing the kVp (Fig. Fig. Stray radiation: the effects of changing field size. This creates more scattered radiation. 3 c. The reading of the stray radiation meter further increases.When the radiation geometry (source-skin distance and field size) is constant. The amount of scattered radiation depends on the total number of X-ray photons striking the 3a patient. Changing the primary skin dose by changing the mAs value (Fig. the only radiation reaching the meter is leakage from the tube. The amount of scatter produced in a small block of tissue is proportional to the amount of primary radiation reaching that block. 3c Fig. The amount of scatter that can be measured outside the patient depends on both the amount of scatter that is produced and on the attenuation of scatter by the patient’s tissues. 2 c) causes a nonlinear change in leakage and scatter. When the collimator is partially opened (Fig. Small field: leakage and a small amount of scatter. 2 b) creates a proportional change in leakage and scatter. Larger field: leakage and a larger amount of scatter. Diagnostic X-rays are uniformly scattered in all directions. 4). so that more scatter is produced in the highly irradiated blocks of tissue near the X-ray tube. Volume 41 Issue 1 March 1997 medicamundi 37 . 3b Some of the projections used in cardiovascular procedures can expose operators to high stray radiation fields. while much less scatter is produced in the lightly irradiated blocks of tissue near the image intensifier (Fig. and additional scattered radiation from the patient. 3 b. 3 a. the meter reading increases because it is exposed to the same leakage radiation from the tube. 3 a). the amount of scatter will depend on the primary X-ray dose at the patient’s skin. Collimator closed: leakage radiation only. Fig. A fully opened collimator (Fig. When the collimator on an energized X-ray tube is completely closed (Fig. The primary X-ray beam is attenuated as it passes through the patient.

6) can expose operators to high stray radiation fields. Fig. However.The primary goal of staff radiation management is to reduce the effective dose received by staff members. Scatter: the effect of primary beam intensity. The attenuation of primary and scatter radiation by the patient reduces the stray radiation field on the image-intensifier side of the table by more than a factor of ten in comparison with the field on the X-ray tube side of the table. 4 a. but the ratio between points A and B is essentially independent of the projection angle. A high primary beam intensity creates a large amount of scatter. Fig. about one-quarter as intense as that at point A. 5 a. The radiation field at point B. Scatter: the effect of attenuation on production and emission of scattered radiation. A low primary beam intensity creates a small amount of scatter. the intense backscatter is directed toward the floor. Like the primary beam. To provide optimum patient care. 4a Fig. More scattered radiation is produced by the unattenuated primary beam near the entrance surface than by the attenuated primary beam near the exit surface. Projections such as the cardiac LAO-90 (Fig. In the 4b Fig. there is relatively little tissue in a position to attenuate the large amounts of scatter produced at the entrance surface near the X-ray tube and directed back toward the X-ray tube (backscatter). 5). 5 b. Cardiovascular procedures require many different beam orientations. The stray radiation field on the X-ray tube side of the table has steep gradients due both to the inverse-square law and to attenuation of scatter by the patient. There is more tissue in a position to attenuate the scatter produced at the entrance surface which is directed toward the image intensifier (Fig. 50 cm further towards the patient’s feet. 6 c). The stray radiation field on the image-intensifier tube side of the table is much less intense. Gastrointestinal systems are often designed with the X-ray tube under the patient. the primary operator must usually stand at position A (Fig. Scatter is emitted in all directions. it is attenuated as it passes through the patient. More scattered radiation leaves the primary beam entrance surface than the exit surface. The asymmetric distribution of scatter is important to fluoroscopists. Volume 41 Issue 1 March 1997 5a 5b 38 medicamundi . In this geometry. 4 b. The actual intensity at point A is highly dependent on the projection angle.

00 0 1. 25 0. The stray radiation intensity on the beam entrance side is more than 10 times the intensity on the exit side.25 8. Individuals working in fluoroscopy rooms are typically exposed to non-uniform radiation fields. such as a film-badge reading on the operator’s collar. 6 c. there will be more radiation at position C than position B. Volume 41 Issue 1 March 1997 1. 00 Fig. Ultimately. There are smaller gradients at positions B and C. The many things that can be done to minimize staff ED could fill another article. For any place in the room. In RAO projections. The reasonable application of basic knowledge will certainly help in the fulfilment of these goals. there is a difference of a factor of three between the left and right sides of the individual standing in position A. 00 2. The primary goal of any safety program is to reduce risk. 25 C B medicamundi 39 . the intensity and gradient of the field vary widely with projection geometry. 00 Scale 50 cm 0. For staff radiation management. Typical fluoroscopic stray radiation levels from LAO-90 projection at a height of 100 cm from the floor.50 1. This attenuation reduces the exposure of the shielded tissues and thus reduces the ED. 6 a. This is due to both the field gradients and attenuation of the stray radiation field by the operator’s superficial tissues. This complicates accurate personnel monitoring and dose assessment. There should also be a balance between radiation and other risks. For example. Staff exposure to stray radiation changes with position relative to the beam. will usually overestimate the ED. Fig.6a 0. 6 b. an assistant standing at position C will be much less exposed than the individual standing at point B. this means reducing the Effective Dose (ED) received by staff members. 00 0. This difference will become less as the X-ray tube angulation decreases toward the PA projection.00 4.2 5 mR/h for a 'Typical' patient extreme example shown. there has to be a balance between patient and staff safety. Fig. 00 1. doubling the weight of a lead apron might produce a small decrease in ED at the cost of increasing the probability of back injury. In Figure 6 c.25 6b 0. A single surface measurement. 0. 50 8. Protective clothing typically provides an additional attenuation factor of 6c A 10–20. 0. Staff exposure to stray radiation in a cardiovascular system using the LAO-90 projection.0 00 4.00 2.

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