The Ways to Minimize Ionizing Radiation Exposure of the Radiographers to Patients - Term Paper Example

Introduction Radiologic imaging is an indispensable tool in current medical diagnoses and therapy. Despite its invaluable importance in the medical field, ionising radiation poses a potential hazard of being carcinogenic to patients (Picano et al., 2004). To curb the possibility of the potential carcinogenic hazard of ionizing radiation, staff involved with radiologic procedures ranging from the medical imaging equipment manufacturers to doctors, and the radiographers should uphold the rules of medical imaging (Andersson et al., 2008). They have a crucial obligation to ensure that the dose of ionising radiation any particular patient is exposed to is minimum and necessary to make a medical diagnosis (Lee et al., 2004). Moreover, the legislation on radiography should be well taught and updated on a frequent basis to ensure these medical technicians and any other medical staff involved in radiology is well versed and up to date on the information (Rostamzadeh et al., 2015). In the United Kingdom, the ionising radiation regulations 1999 and the ionising radiation (medical exposure) 2000 govern medical imaging (“REGULATIONS”, 2000). These rules provide protocol on the dose of the radiation used on each patient and for every procedure. It also stipulates that the equipment should frequently be maintained, and the imaging personnel should be abreast on the medical imaging trends (“REGULATIONS,” 2000). Ionising radiation dose reduction is key in protecting patients from the stochastic effects of this energy (Fazel et al., 2009). This paper will explore the ways and techniques to minimise ionising radiation exposure to patients and how the radiographers implement their role in this process. It will highlight their role in medical imaging leaning on justification, optimisation of techniques and their managerial role in imaging procedures. Justification of exposure The process of justification involves the physicians, radiologists as well as radiographers. The physicians/referrer play the role of ordering for the medical imaging procedure. The Radiographers are responsible for seeing to it that the dose, body surface exposure as well as the time of exposure is the minimum required diagnostic range by weighing the benefits of the procedure patient against the side effects of radiation. (Saia, 1999). In therapeutic radiations such as radiotherapy, the radiographers and oncologists have to assess the patient and justify the procedure using professional judgment. (Eairly, 1995). It is the role of radiographers to choose the alternative imaging modalities with less or no ionizing radiation in terms of efficacy, risk and health merits (Hermann et al., 2012). Together with other members of the medical team such as radiologists, radiographers have to undertake justification process on an individual basis considering age, anatomical area to be irradiated and the gender of the patient (Huda et al., 2008). Together with other medical personnel, radiographers reserve the right to dismiss unnecessary medico-legal procedures which might expose the patient to unnecessary ionizing radiation (Wall, 2005). For the pediatric population, the radiographers have a responsibility to perform further justification as children have a longer life span which increases the chances of stochastic manifestation (Wall & Muirhead, 2009 ). Some interventional procedures have a higher chance of inducing cancerous effects on patients. Percutaneous coronary intervention PCI requires special documented working guidelines and a very strict observation; the Radiographers are responsible for this (Rostamzadeh et al., 2015). It is the radiographer’s role to confirm that the exposure has not been done in the recent past to avoid double exposure as part of the justification protocol (Wall, 2005). The competency of the patient or the next of keen to give consent to the medical imaging procedure; as well as confirming that diagnosis cannot be achieved using another non_ionising method, hence the X-ray use, should be checked by the radiographers (Wall, 2005). Moreover, the radiographers have to ensure that the completion of the clinical examination and any other relevant procedures are satisfactory and that the referrer signs all the forms, including the request forms (Wall, 2005). These roles played by the radiographers in the justification process help them protect patient radiation exposure by canceling the inappropriate requests or by advising the referrer for a better diagnostic imaging for the patients. Radiographer’s role in the optimization process After the justification of an imaging procedure, the radiographer has to manipulate the procedure to maximize the benefits and minimize the possible harm caused to the patient during the exposure and at the same time produce quality images to satisfy the purpose of the procedure (Matin, 2007). Given the bridging position of the radiographer in medical imaging, i.e. being well informed about the clinical aspect of the medical imaging as well as the knowledge of the technology and the dose, they are solely responsible to implement the optimisation process (Early, 1995). To achieve this, the radiographers have an obligation to acquire the technological knowledge of all the imaging modalities used in medical imaging as well as fully understand their role in radiology as far as patient protection is concerned (Martin, 2007). Any medical imaging equipment is mandated to employ as low as reasonably achievable radiation dose to produce a useful medical diagnostic image (ALARA) (Dendy & Heaton, 2011). If they ensure good communication with the physicists doing the procedures, they could see to it that such manipulations are done and the better effect on images realized. The radiographers must have an in depth know how of how to initiate the optimisation of radiologic procedures and on the same note, master the fundamentals of how to achieve quality control of the various medical imaging modalities and be adept at implementing this on a daily basis (Parry et al., 1999). Radiographers should be positively familiar with the protocol and the application of best radiological practice; more importantly, they should implement this knowledge in (Martin, 2007). Since the radiographers are always present in every radiologic procedure, they can advise both the physicians and the technicians on the best techniques as well as the most relevant imaging procedure for every patient (Wall, 2005). This gatekeeper goal ensures that the patients are exposed to only necessary ionising radiation mandatory for their diagnosis, and the advantages of the procedure are fully maximized while ensuring that the harm is as low as possible; all these are achieved through the optimisation process (Sherer, 2002). The managerial role of radiographers in medical imaging As the coordinator in the imaging department, radiographers play a crucial managerial in patient care and reduction of radiation exposure. The radiographers have a role to ensure that the patients are shielded from unnecessary radiation exposure during the procedures (Sherer, 2002). To complete this task, they have to make sure that the appropriate shielding is done, and only the area of interest is exposed. Since every imaging modality and patient factors such as age and gender influence the choice of the modality as well as the shielding, radiographers should be familiar with these factors and ensure that the patients are adequately protected before they expose them to radiation (Wall, 2005). Radiographers often utilize the use of lead shields placed on the areas of the body not under imaging to achieve adequate shielding (Wall & Hart, 1997). It is the responsibility of the radiographers to educate the patient on the reasons for the imaging procedure and to explain why shielding is necessary for the process (Saia, 1999). On the same note, the radiographer should ensure that every justified procedure is done by IR (ME) R regulations and that the physician/referrer is well informed about the modality choice (“REGULATIONS,” 2000). They should be well versed with different sensitivities to radiation by various organs; the reproductive organs, for example, are more sensitive, and the radiographers should take special care to appropriately shield these areas lest permanent genetic mutation occurs especially if the patient is their reproductive years (Mobbs & Muirhead, 2010). The distance between the patient and the imaging equipment is another method that the radiographers can use to minimize unnecessary patient irradiation by strictly observing the provided distance as stipulated by the quality assurance and the IRR 1999 and IR (ME) R 2000). For nonstationary equipment like the mini C- arm used during extremity surgical procedures, for instance; the radiographer has the role to manipulate the equipment to allow the surgeon enough room for operation at the same time not get closer to the patient than the stipulated distance of 30 cm (Flower, 2012). To increase the clarity of tissues, the radiographer should use features such as magnification of the image, but not increase the intensity of the beam or move any closer to the patient (Bushong, 2001). The radiographer can avoid unnecessary exposure through pulse exposure on and off during the procedure, this has been shown to reduce the exposure time significantly (Dendy & Heaton, 2011). Radiographers should employ techniques such as immobilization of the patient as well as the correct position to reduce the need to redo the imaging, which would double the radiation dose to the patient (Bushberg & Boone, 2011). The radiographers should ensure that the diagnostic dose for each patient is achieved by putting a dosimeter in the area exposed and then note the amount of the dose used (Mobbs & Muirhead, 2010). To avoid these adverse effects of ionizing radiation, the radiographers play the role of patient protection through dose limitation and pre-exposure patient evaluation. The gonadal exposure dose is very drastic in that in the case of overexposure, the effects might be silent in the exposed individual, but the offsprings will suffer the consequences and the generations to come (Kalra et al., 2004). Radiographers should, therefore, beware the dosages to avoid adverse deterministic or stochastic effects of irradiation (Mettler et al., 2008). The first trimester effects are deformities as this is the time of organogenesis, the radiographers should, therefore, inquire and confirm the pregnancy status before exposing young female patients to radiation energy (Lee et al., 2004). Quality assurance regulation of medical imaging Radiographers have an obligation to ensure that patients are protected from unnecessary radiation; the legislation also plays a role in implementing the observation of the ALARA principle at all costs (Hermann et al., 2012). The quality assurance ensures that the medical imaging equipment is up to the standard (Mootz et al., 1999). The radiographers perform commissioning tests on the new machines which provide fundamental information for the QC procedures (Sherer et al., 2002).It They implement QA programs through their participation in auditing and record keeping (Martin, 2007). Senior members of the radiography team such as advanced practitioners, play a crucial role as executives in radiation protection (Mobbs & Muirhead, 2010). The verification of the RP and QC equipment and material, radiographers, can calibrate radiation output from equipment regularly. They verify physical and clinical aspects of diagnostic and therapeutic appropriateness before subjecting patients to ionising radiation (Whaits, 2010). Radiographers have a role to document relevant patient procedures and results as per the QA provisions (Wall & Hart, 1997). They implement QA programs such as a quality control to ensure that the equipment is up to date and operating optimally (Gulson, 2010). After the evaluation, the radiographers ensure that corrective measures are implemented (Mootz et al., 1991). Conclusion The use of ionising radiation in medical imaging has indeed revolutionised the medical diagnosis and therapy. Discrete use ionizing radiation is necessary due to its potential adverse effects of causing both deterministic and stochastic harm to the patients (Dowd, 1994). The manufacturer of the medical imaging equipment has to comply with the regulations stipulated by the Quality Assurance via frequent auditing (“REGULATIONS,” 2000). Even more importantly, radiographers, being the main gate keepers in medical imaging should gear their role in ensuring minimum patient exposure to irradiation (Sprawls, 1987). The radiographers can reduce patient exposure to ionising radiation by employing techniques such as optimisation of the imaging technique and the choice of the best equipment (Saia, 1999). 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