child_hospitalProtecting the clinical team from radiation dose should be a priority, too.

By John Racadio, MD

Seeing is believing. It’s an unfortunate truth in life, and none more so than when you consider how devastating the consequences can be if the truth is ignored.

The truth about radiation is that it is necessary to help diagnose and treat different medical conditions, but routine exposure can also be harmful.

When it comes to patients and radiation, there are, and have been for years now, efforts to educate and raise awareness about the effects of too much exposure. Campaigns such as Image Gently, established for pediatric dose awareness—and started here in Cincinnati almost 10 years ago—and also Image Wisely, a campaign focused on the concerns of radiation exposure for adults, have made a difference in the way healthcare providers prescribe tests and treat patients. These campaigns have also increased the patient’s awareness and knowledge of their own dose.

But what about the cumulative effects of radiation on the clinical staff?

John Racadio, MD

John Racadio, MD

At Cincinnati Children’s Hospital Medical Center, we provide a range of exams and procedures—from general x-rays to fluoroscopy and digital subtraction angiography (DSA)—that require the use of radiation. For the children in our care we use best practices and the utmost precautions to keep their dose as low as possible. We have also made our physicians and clinical staff a priority with a new measure to enable them to protect themselves in real time.

Shedding Light on What You Can’t See

Data and research are the cornerstones to support any technology, and so at Cincinnati Children’s, when we learned about a new technology to help clinical staff lower their radiation exposure, we embarked on our own study.

In an effort to lower dose exposure we initiated a two-part study at the hospital to evaluate real-time dose monitoring. We took six real-time dose monitoring badges and assigned one to each of the clinical staff involved in the procedure— the attending, fellow, interventional nurse, interventional technologist, circulating nurse and anesthesiologist. For the blind study, while we were collecting and monitoring the data behind the scenes, the clinical team did not have real-time feedback during the procedure. The monitor displaying the real-time dose data was turned off.

The next phase of the study was to turn on the monitor so everyone could see how much dose exposure they were receiving in real time. There was a statistical difference in decreased dose in the open phase for the interventional radiologist. Additionally, other members of the clinical team including the anesthesiologist—to their surprise—experienced some decrease in dose.

The Real-Time Effect

As a children’s hospital, it’s in our nature to take safety a step further than we need to. It’s what we do to provide the highest level of care and assurance to our patients and their families. At Cincinnati Children’s, it’s our culture to also go a step further for the safety of our staff. In this instance, through our study, we learned that we could be doing even more. The live real-time dose monitoring made the clinical team much more aware of the reality of radiation exposure, so that behavior change could be evoked.

While a standard lead glass shield, when used properly, offers adequate protection, the key is that it needs to be used properly and at all times. What we found was that human behavior was inconsistent and often times the shield was not used by the anesthesiologist, for instance, until they saw the real time dose monitoring results. Seeing the radiation levels, in real time, had an effect on behavior, and ultimately lowered dose.

In addition to lowering dose, we also observed an increase in greater collaboration in the lab in terms of team awareness. One person would alert another about dose exposure and even bring in a shield or angle the tube differently to lower the dose for a colleague.

The Balancing Act: Achieving Patient and Staff Safety

It is a delicate balancing act to capture a quality image while keeping the dose low, but it can be done. Advancements in technology allow us to improve upon what we do.

It is also helpful that forward-thinking consumers, our patients, are becoming more aware that x-rays can cause problems. They are asking questions, which can potentially bring about change.

Around the same time of our study, an article about cataracts and the connection to radiation exposure was circulating and gaining much attention. This combined impact has inspired even greater action at our own facility. Soon after, anesthesiologists began asking for and wearing lead glasses. In fact, after the results of the tests came out, everybody wanted to use one and wouldn’t do the work without it.

The same correlation should be expected industry wide. If dose is in the forefront of people’s minds, change will happen.

Accelerating the use of much-needed protection in the industry will depend on three things:

  • A healthy competition between vendors to provide cost-effective quality images with low dose capability
  • Academic competitiveness to achieve quality results with low dose procedures
  • A push from peers for passion and compassion not only for patients but also for fellow physicians and themselves.

In the pediatric world, we are vigilant about purchasing dose conscious equipment, not only for the benefits of patients but for the physicians as well.

When you know x-rays can cause harm, it’s selfish but selfishly you should want to protect yourself. The fact that you can’t see it, can’t smell it or touch it, makes it hard to always be aware of radiation exposure. Real-time dose monitoring allows you to see your individual exposure level and make the appropriate adjustments right away.

I want to be around for my kids. I do worry about dose and I try to practice and protect myself as much as possible. When I go to an optometrist there is a little bit inside of me wondering is this when they are going to find my cataracts?

The results from our study were truly eye opening and it taught us something we already know: There is always room for improvement.


 John Racadio, MD is Division Chief of Interventional Radiology, Department of Radiology and Medical Imaging at Cincinnati Children’s Hospital Medical Center.