Answer to Question #2008 Submitted to "Ask the Experts"
Category: Medical and Dental Patient Issues — Diagnostic X Ray and CT
The following question was answered by an expert in the appropriate field:
Q
What are the safety rules for x-ray technicians who work with portable pediatric x-ray machines (15mA, 70 kV)? What is the safe distance from the machine? Should the technicians wear protective clothing?
A
While this question refers to portable x-ray machines, it may be helpful to review the safe operating procedures requirements for both fixed and portable x-ray units. Since the question asked did not specify in which state the unit was located, my response is intended to satisfy rules in Ohio, Kentucky, and Indiana, but most should be satisfactory in many states.
Fixed Radiographic Equipment- All radiographic procedures are order by a licensed practitioner.
- All radiographic exams are performed by a licensed practitioner or a technologist licensed in the state.
- The technologist is required to use all required safety protection for himself/herself and the patient.
- State radiation protection rules are located in the x-ray office files.
- Occupational dose shall not exceed 5 rem/year (whole body), 15 rem/year (lens of eye), or 50 rem/year (skin, extremities).
- All technologists are required to wear a dosimeter at waist or neck level. All radiation exposure reports are kept in an office file or are posted.
- The radiation beam is to be restricted to the body part being radiographed by automatic collimator or coned down manually to concerned body part, while the x-ray beam is accurately aligned with the patient and image receptor.
- When applicable, the patient shall be shielded with gonad apron or adult lead apron for any radiographic procedure performed unless the shielding interferes with obtaining necessary diagnostic information. Gonadal shielding should never be used as a substitute for adequate beam collimation and alignment.
- During any exposure, no person or persons shall be permitted in the x-ray room except patients being radiographed or, if necessary, persons assisting in holding the patient with proper shielding attire (lead apron and gloves as necessary).
- Patient positioning/restraint devices should be used whenever possible, instead of having persons holding the patient.
- No individuals exposed to occupational radiation shall hold a patient during exposure except during an emergency. If a patient must be held, the individual is to have the proper shielding, and no body part is to be placed in the useful beam.
- The technologist is to stand behind the control area shield during exposures.
- The exposure switch is mounted on the x-ray control panel. At no time is this to be removed to make an exposure. If it is removed the technologist and exposure switch are to remain behind the lead wall.
- Special care shall be taken to ensure adequate filtration in multipurpose machines, if applicable.
- Lead aprons and shields should be placed on holders designed for this purpose when not in use instead of folding. This will help prevent damage to the shield and reduce the chance of a decrease in shielding properties.
Mobile & Portable Radiographic Equipment (if applicable)
- Recommendations for fixed radiographic units apply to mobile and portable radiographic equipment except for persons in the room, control area shield, and fixed exposure switch.
- The operator should use the maximum source-skin distance (SSD) consistent with the considerations of the radiographic examination; distances less than 12" (30 cm) shall not be used; distances less than 15" (38 cm) should not be used.
- The operator shall stand as far as possible (at least 6') from the patient, the tube, and the useful beam; he/she should wear a protective apron or stand behind a suitable shield.
- Mobile or portable equipment should only be used for examinations where it is impractical to transfer patients to permanent radiographic installations.
- The responsible medical supervisor should assure himself/herself that operators of mobile or portable equipment understand the proper use and limitations of the equipment so as to avoid unnecessary exposure of the patient and other persons in the vicinity; the operator shall verify that no one except the patient is in the direct or useful beam.
- Anyone assisting shall also wear a protective apron and stand as far as possible from the patient. In the close confines of the operating room or the intensive care unit it is sometimes difficult for everyone to be several feet from the patient. Often, a nurse or an orderly must hold uncooperative, unconscious, or mentally agitated patients or those otherwise incapacitated and assist others in maintaining difficult or uncomfortable positions. In such situations, the assistant will be required to be in contact with the patient. The assistant shall be provided with a protective apron and gloves. In all cases, the direct beam should be avoided. Other persons who must be near the patient should be provided with protective clothing (lead apron and gloves) or be located behind a protective screen. In such circumstances, the main exposure to personnel will be radiation scattered in all directions by the patient's body.
Ken "Duke" Lovins, MS, CHP
Health Physicist
Answer posted on 30 May 2002. The information and material posted on this Web site is intended as general reference information only. Specific facts and circumstances may alter the concepts and applications of materials and information described herein. The information provided is not a substitute for professional advice and should not be relied upon in the absence of such professional advice specific to whatever facts and circumstances are presented in any given situation. Answers are correct at the time they are posted on the Web site. Be advised that over time, some requirements could change, new data could be made available, or Internet links could change. For answers that have been posted for several months or longer, please check the current status of the posted information prior to using the responses for specific applications.
