Radiation Safety and Fluoroscopy: Protecting Patients and Staff

P R E S E N T E D B Y
K R I S H N AD AS B AN E R J E E P h D , FAC R , FAAP M
E n d u r i n g M a t e r i a l C r e a t e d f r o m a l i ve p r o g r a m
J U N E 2 9 , 2 0 1 0
J AM E S O N H E ALT H S Y S T E M
1 AM A C M E C R E D I T u p o n c o m p l e t i o n o f t e s t a n d e va l u a t i o n
E x p i r e s Au g u s t 3 0 , 2 0 11
Radiation Safety and Fluoroscopy
1

Dr. Banerjee and the CME have no real or apparent
conflicts of interest.
Send exam and evaluation to Lori Graham –
Library/CME or fax to 724-656-4267 (4267
internal) or email at lgraham@jamesonhealth.org
Exam and evaluation are in two forms: 4 pages or
slides number 45-52, either version can be turned in.
2

 Objectives:
 At the conclusion of the presentation, the participant should be able to:
 Summarize the basic properties, and units of measurement of radiation.
 Review the sources of radiation and the methods of radiation protection.
 Document the biological effects of radiation exposure.
 Summarize the types of X-ray equipment, imaging recording and
processing.
 Recommend the proper patient exposure and positioning for a particular
radiation related procedure.
 Review the procedures, the Quality Assurance Program, and the related
radiation safety regulations.
3

 The following topics will be covered in accordance to 25 PA Code 221.11
 1. Basic radiation properties
 2. Units of measurement
 3. Sources of radiation
 4. Methods of radiation protection
 5. Biological effects
 6. X-ray equipment
 7.Imaging recording and processing
 8. Patient exposure and positioning
 9 Procedures
 10. Quality Assurance Program
 11. Regulations.
4

 Radiation terminology
 Air Kerma: The kinetic energy or kerma per unit mass of air.
Represented by the unit Gray (Gy).
 C/Kg or R: Coulombs per kilogram, formerly R or roentgen, an SI
unit representing exposure.
 Dose: term used for the quantity of absorbed radiation per unit
mass
 “Dose equivalent”: term of quantity of absorbed dose in tissue
as modified by certain risk factors dependent upon the type of
radiation to which one is exposed.
 Dose rate: Absorbed does delivered per unit of time.
 Radiology Students.com Dictionary of Radiological Terms and Abbreviations.
www.radiologoystudents.com accessed June 21, 2010
5

 Radiation terminology
 RAD: Radiation Absorbed Dose. Unit of dose or energy absorbed
per unit mass in materials including tissue.
 International unit is the Gray (1 Gy = 100 rad)
 REM: Roentgen Equivalent Man. Unit of effective dose that
corrects absorbed rate for the risk from high energy particles .
 International unit is the Sievert (1Sv = 100 rem)
 Roentgen: The unit to measure ionization in air as a result of
exposure to x- or gamma rays; there is no international equivalent
term.
Radiology Students.com Dictionary of Radiological Terms and Abbreviations. www.radiologoystudents.com
accessed June 21, 2010
6

 What is Radiation?
 Transfer of energy like a battery transfer energy to a ball.
 Exist in bundles of electromagnetic waves.
 Ionized Radiation
 Some forms of radiation can create ions.
 Radiation contains sufficient energy to break chemical bonds
by removing electrons from an atom or molecule.
 These ions has the potential to cause damage to the molecules
in the human body.
 Other types of radiation, like laser, ultrasound and
microwave, do not ionize and are safe if used properly.
Landauer basic radiation safety. Ver. 1.02. Glenwood, IL: Lauder, c1997.
7

 Common Ionizing Radiation Sources
 X-Ray
 Penetrating electromagnetic radiation usually generated by equipment.
 Gamma Rays
 Very penetrating electromagnetic radiation, emitted from the nucleus of
atoms in radioactive materials.
 Example: Cobalt -60 used in radiation therapy
 Alpha particles
 High mass, double charged with low penetrating power. Stopped by paper
or skin thus the most dangerous
 Example: Radium – 226 and Radon – 222 Gas
8

 Common Ionized Radiation Sources
 Beta particles
 Low mass, single charge electrons having more penetration than Alpha.
Stopped by light shielding material.
 Example: Phosphorus-32
 Neutrons
 No change (neutral), medium mass atomic particles, emitted from the
nucleus of an atom, which can easily penetrate many materials.
 Example: Americium -241 : Berylium as used in moisture gauges, or as
stray radiation created by high energy linear accelerators used in
therapy.
9

 Sources of Radiation Exposure
 Exposure to primary x-ray beam
 X-ray fields near a bare x-ray tube are very intense.
• For this reason, regulations do not allow the use of instruments
without a protective tube housing or shield.
• The x-ray tube housing contains one or more ports which provide a
narrow beam of useful x-rays. The x-ray dose rate at the beam port
may be several thousand rad per second (several tens of gray per
second). Inadvertent placement of fingers at the beam port
for even a second can result in serious burns.
• As a further precaution, current regulations require a shutter for all
beam ports on the tube housing. The shutters must automatically
close unless a collimator, camera, or other equipment is attached to
the beam port. Use of a beam collimator greatly increases safety of
analytical x-ray equipment on two ways.
Appendix A: Radiation Hazards of Analytical X-Ray Equipment. Arizona State University. Office of Radiation Safety.
http://www.asu.edu/radiationsafety/x-ray/appn_A.html accessed June 18, 2010.
10

 Exposure to primary x-ray beam
 The dose rate at the hand of 10 cm collimator is reduced to several
thousand rad per minute (several tens of gray per minute).
 In addition, the dimensions of the collimated beam are usually on the
order of 1 mm2
 The possibility of receiving a high dose to any portion of the skins is
unlikely under these conditions. Natural movement of the hand will
ensure that the same 1 mm2 area of the skin is not irradiated for any
significant amount of time.
 The intensity of the x-ray beam decreases very rapidly as the distance
from the tube increases. The dose rate as a function of the distance
from the tube follows the well known inverse square relationship.
11

 The intensity of the x-ray beam decreases very rapidly as the distance from
the tube increases. The dose rate as a function of the distance from the tube
follows the well known inverse square relationship.
 Possible Radiation Intensity Near Analytical X-Ray Equipment.
12
Location Dose Rate
Primary beam at beam port Several tens of gray per second.
Primary beam at end of 10 cm
collimator
Several tens of gray per minute .
Scattered radiation near sample several milligray per hour
Scattered radiation near table
edge
1 milligray per hour

 Scattered Radiation
 A hazard may also exist from exposure to scattered radiation. Scattered
radiation is produced when the primary beam strikes collimators,
samples, beam stops or shielding. The intensity of the scattered
radiation is a couple of orders of magnitude less than that of the
primary beam. It is possible for these scattered radiation fields to result
in exposures, which exceed regulatory limits, however.
• Scattered Radiation may exceed regulatory exposure limits.
 Leakage Radiation
 Are x-ray photons that escape through the protective housing.
They result in unnecessary exposure to the patient and
technologist, and do not contribute any diagnostic information
to the resultant image.
13

Effective Doses for X-Ray and Nuclear Medicine Procedures
Radiographs Doses in
Mrem
Abdomen (KUB) 53
Chest (2 views) 4
Pelvis (AP) 70
Dental -- biteview 0.4
Mammogram 13
CT – Abdomen 1000+
Nuclear Bone Scan 400
Tumor Localization 1220
Nuclear renal scan 310-520
Barium Enema 700
Medical procedures and X-ray doses. Global Dosimetry Solutions, 2003. (pamphlet sheet)
14

 Methods of radiation protection
 Time, distance, and shielding
(measures minimize your exposure to radiation in much the same way as
they would to protect you against overexposure to the sun .)
 Time: For people who are exposed to radiation in addition to natural
background radiation, limiting or minimizing the exposure time reduces
the dose from the radiation source.
 Distance: Just as the heat from a fire is less intense the further away you
are, so the intensity and dose of radiation decreases dramatically as you
increase your distance from the source.
Minimize your exposure. United States Nuclear Regulation Commission. http://www.nrc.gov/about-
nrc/radiation/protects-you/protection-principles.html accessed June 21, 2010.
15

 Shielding: Barriers of lead, concrete, or water provide protection from
penetrating radiation such as gamma rays and neutrons. This is why
certain radioactive materials are stored under water or in concrete or
lead-lined rooms, and why dentists place a lead blanket on patients
receiving x-rays of their teeth. Similarly, special plastic shields stop beta
particles, and air stops alpha particles. Therefore, inserting the proper
shield between you and a radiation source will greatly reduce or eliminate
the dose you receive.
Minimize your exposure. United States Nuclear Regulation Commission. http://www.nrc.gov/about-
nrc/radiation/protects-you/protection-principles.html accessed June 21, 2010.
16

 Collimation Effects
 X-ray beam collimation for radiography and fluoroscopy
projection imaging is important for patient dose and image
quality reasons. Actively collimating to the volume of interest
reduces the overall integral dose to the patient and thus
minimizes the radiation risk. Less volume irradiated will result
in less x-ray scatter incident on the detector. This results in
improved subject contrast and image quality.
Collimation effects. UPSTATE Medical University. http://www.upstate.edu/radiology/rsna/fluoro/collimation/
17

 Collimation Effects
 X-ray field collimation differs from the use of electronic
magnification in that the acquired field of view remains
constant, and there is no improvement in the resultant spatial
resolution performance . However, the use of collimation will
normally reduce the image brightness, and require a
corresponding increase in radiation entrance skin dose to the
patient, although not to the level when electronic magnification
is used, because the minification gain is unchanged.
Collimation effects. UPSTATE Medical University. http://www.upstate.edu/radiology/rsna/fluoro/collimation/
18

 Filtration
 Increasing beam quality and reducing the patient dose by
removing low energy x-rays from the useful beam with
aluminum or an aluminum equivalent.
 Filtration
 Increasing beam quality and reducing the patient dose by
removing low energy x-rays from the useful beam with
aluminum or an aluminum equivalent.
Radiology Students.com Dictionary of Radiological Terms and Abbreviations. www.radiologoystudents.com
19

 ALARA = As Low As Reasonably Achievable
 It is known the lower the dose = lower the risk
 Badge Monitoring
 Measures the amount of radiation exposed to at the workplace
20

 LIMITING YOUR EXPOSURE:
You do the math!
 Doubling your distance from the X-ray tube reduces
your exposure by a factor of four.
 Doubling that distance from the X-ray tube reduces
your exposure by a factor of sixteen!
21

 Occupational Radiation Limits by exposure and annual limit for
Adults (10 CFR 20.1201 Occupational Dose Limits for Adults and
20.1208 Dose equivalent to an embryo/fetus)
Total effective dose equivalent 5 rem/year
Sum of deep-dose equivalent
and the committed dose equivalent of any
individual organ or tissue except lens of eye 50 rem/year
Lens of eye 15 rem/year
Shallow –dose equivalent to the skin of the whole body
or skin of any extremity 50 rem/year
Fetus/embryo , dose equivalent 0.5rem/year
10 CFR 20.1201 and 20.1208 http://www.ncr.gov/reading-rm/doc-collections/cfr accessed June 18, 2010.
22

 Dose records
 Evaluation of cumulative dosage records for mandatory reports to
individuals
 10 CFR 19.13(b): licensees must provide an annual report to each
individual monitored of the dose received in that monitoring year if:
• (1) the individual's occupational dose exceeds 1 millisievert (mSv)
(100 millirem (mrem)) TEDE or 1 mSv (100 mrem) to any individual
organ or tissue; or
• (2) the individual requests his or her annual dose report.
 The criterion of 1 mSv (100 mrem) applies to the whole body, to any
individual organ or tissue, to the lens of the eye, to the skin of the
whole body, and to the skin of the extremities. If the dose to any one of
these exceeds the criterion during a monitoring year, then the licensee
must provide a dose report to the individual for that year. The agency
will also revise NRC Form 3, "Notice to Employees," to reflect the
changes to the requirements for reporting doses to individuals.
10 CFR 19. 13 http://www.ncr.gov/reading-rm/doc-collections/cfr accessed June 18, 2010.
23

 Dose records
 Maintenance of the cumulative dose records
 Jameson Health System’s policy.
• Personnel monitoring devices (film badges, TLD rings, pocket
chambers, etc.) are required to be provided to any individual whose
occupational exposure to sources of ionizing radiation has the
potential to exceed 1/10 of the MPD (Maximum Permissible Dose) of
5000 millirem annually.
• The Health System’s Radiation Protection Plan is modeled under the
ALARA (As Low As Reasonably Achievable) concept. Thresholds for
investigational levels are as follows:
1. Whole body ALARA I = 125 millirem per quarter
2. Whole body ALARA II = 375 millirem per quarter
• Annual Occupational Exposure Limits:
Whole Body : 5000 millirem
Extremities: 50,000 millirem
Medical Imaging Procedure Manual. Personnel monitoring Dept 54. http://radmanual.jameson/Department/DEPT-54.htm
24

 Dose records
 Maintenance of the cumulative dose records
 Jameson Health System’s policy
• As an employer, Jameson Health System Inc. is required to be compliant
with a Radiation Protection Plan consistent with 10 CFR 10.1101 provisions
for monitoring occupational dose.
• When an individual exceeds the ALARA II investigational level, that person
receives a written notice and is interviewed by Radiation Safety Officer to
determine factors contributing to the excessive dose rate. Suggestions will be
offered to reduce the dose rate in the future.
• When the limit of 5000 mrem limit is exceeded, the individual will
no longer be able to practice the remaining of that calendar year.
This is in compliance with
PA DEP Bureau of Radiation Protection.
Medical Imaging Procedure Manual. Personnel monitoring Dept 54. http://radmanual.jameson/Department/DEPT-54.htm accessed
June 21, 2010
25

 Personal Dosimetry
 Jameson Health System’s policy – position of dosimeters
 For your guidance in the issuance and selection of appropriate dosimeters, the
following criteria have been established.
 1.Whole body film badges should be worn by all persons working with medical
or dental x-ray and gamma-ray equipment (diagnostic or therapeutic).
• a. For support personnel, monitoring requirements are based on the
radiation dose they are likely to receive (see above).
• b. Persons wearing lead aprons should wear the badge at collar level outside
the apron (to estimate eye exposure). A second badge may be considered to
monitor exposure of areas covered by the apron.
• c. Persons whose hands might be placed unprotected in a direct x-ray beam
should wear finger dosimeters.
 [2]. 3. Personnel working with radionuclides should wear whole body badges
when working with gamma-emitting sources. Extremity badges for beta and
gamma-emitting radionuclides should be used.
Medical Imaging Procedure Manual. Personnel monitoring Dept 54.
http://radmanual.jameson/Department/DEPT-54.htm accessed June 21, 2010
26

 Personal Dosimetry
 Types
 Clip on’s – many shapes and sizes
• Rectangle used at Jameson
 Ring -- for on your finger
 Wrist
27

 Biological effects of Radiation
Biological Effects
 Effects of Radiation – two types
 Threshold Effects or Deterministic Effects
 Effects that will occur given enough exposure
 Examples include:
• Cataracts in the eyes
• Skin erythema (skin reddening)
• Hair loss
 Chance Effects or Stochastic Effects
 Effects that have higher chance of occurring
as you receive higher amounts of exposure
 Examples include:
• Cancer
• Genetic mutations
• Effects on the embryo or fetus
28

Somatic Effects
 Effects of radiation limited to the exposed individual, as
distinguished from genetic effects, that may also affect subsequent
unexposed generations.
 Prompt – Skin burns & Cataracts (below 5,000 rad and 500 rad)
 Delayed – Cancer
Electronic Reading Room > Basic References > Glossary > Somatic effects of radiation
http://www.nrc.gov/reading-rm/basic-ref/glossary/somatic-effects-of-radiation.html Accessed June 22, 2010
29

Genetic effects
 High radiation doses tend to kill cells, while low doses tend to damage or alter the
genetic code (DNA) of irradiated cells. High doses can kill so many cells that tissues
and organs are damaged immediately. This in turn may cause a rapid body response
often called Acute Radiation Syndrome. The higher the radiation dose, the sooner the
effects of radiation will appear, and the higher the probability of death.
 Genetic effects and the development of cancer are the primary health concerns
attributed to radiation exposure. The likelihood of cancer occurring after radiation
exposure is about five times greater than a genetic effect (e.g., increased still births,
congenital abnormalities, infant mortality, childhood mortality, and decreased birth
weight).
 Genetic effects are the result of a mutation produced in the reproductive cells of an
exposed individual that are passed on to their offspring. These effects may appear in
the exposed person's direct offspring, or may appear several generations later,
depending on whether the altered genes are dominant or recessive.
Fact Sheet on Biological Effects of Radiation. USNRC. 2004. http://www.nrc.gov/reading-rm/doc-collections/fact-
sheets/bio-effects-radiation.html accessed June 22, 2010.
30

Genetic effects
31

Relative tissue radiosensitivities
32

Dose-effect relationships
33

Special considerations
 Dental
 Radiographic, fixed, portable, mobile units
 Fluoroscopy
 All fluoroscopy equipment transforms x-rays exiting the patient into real-
time visual images. This transformation is made possible by either an
image intensifier or a flat panel digital detector.
34

Special considerations
 Mobile fluoroscopy
 Cine fluoroscopy
 Digital fluoroscopy
 CT/CT fluoroscopy
35

X-ray Equipment and Minimizing Patient Exposure
 Exposure factors
 kVp
 mAs
 Shielding
 Rationale for usage
 Types of devices
 Placement of devices
36

 Beam restriction
 Purpose of primary beam restriction
 Effects on scatter
 Types
 Filtration
 Effect on skin and organ exposure
 Effect on average beam energy
37

 The intensity of light (or X-ray beam) observed from a source
of constant intrinsic luminosity falls off as the square of the
distance from the object. This is known as the inverse square
law for light intensity.
 Thus, if I double the distance to a light source the observed
intensity is decreased to (1/2)2 = 1/4 of its original value.
Generally, the ratio of intensities at distances d1 and d2 are
Inverse-square law . Wikpedia. http://en.wikipedia.org/wiki/Inverse-square_law accessed June 30, 2010.
Intensity: the Inverse Square Law. http://csep10.phys.utk.edu/astr162/lect/light/intensity.html accessed
June 30, 2010.
38

Inverse-square law . Wikpedia. http://en.wikipedia.org/wiki/Inverse-square_law accessed June 30, 2010.
Intensity: the Inverse Square Law. http://csep10.phys.utk.edu/astr162/lect/light/intensity.html accessed
June 30, 2010.
39

 Example math: A source is producing an intensity of 456 R/h at one foot from
the source. What would be the distance in feet to the 100, 5, and 2 mR/h
boundaries.
1. Convert Rem per hour to mRem per hour
456R/h x 1000 = 456,000 mR/h
2. Rework the equation to solve for D2
Plug in values and solve:
Answer: D2= 67.5 feet
 Using this equation the 100mR/h boundary would be 68 feet, the 5mR/h boundary
would be 301.99 feet, and the 2mR/h boundary would be 477.5 feet.
Radiographic Inspection - Formula Based on Newton's Inverse Square Law. NDT Education Resource Center, Brian
Larson, Editor, 2001-2010, The Collaboration for NDT Education, Iowa State University, www.ndt-ed.org.
http://www.ndt-ed.org/GeneralResources/Formula/RTFormula/InverseSquare/InverseSquareLaw.htm Accessed June 30,
2010
40

 Solid-state image receptors
 Image Processing
 Processing efficiency as related to patient dose
 Film artifacts and corrective actions
 Image quality as related to patient exposure
41

Procedures also exist for and you should be familiar with:
 Operation of Equipment
 Identification of controls
 Function of each control
 Technique chart usage
 Radiation Emergency (part of the HEICS plan)
available on the Jameson Portal page
potentially have to treat individuals who are injured,
contaminated, or both.
 Quality Assurance Program
activities performed by QC Technologist
Annual survey by Radiation Health Physicist.
42

Continuing Education in Radiation Safety
 Annual requirements – Pennsylvania
 Physicians and Dentists in the Low Risk Category:
 4 contact hours, every 4 years.
 Physicians in the High Risk Category:
 3 contact hours, every 3 years.
DEP Technical guidance of medical X-ray procedures operator training guide 25 Pa
Code 221.11 “ Document No. 291-4200-001, FINAL February 7, 2009 PA DEP.
Bureau of Radiation Protection. Pg. 3.
43

General Resources:
DEP Technical guidance of medical X-ray procedures operator training guide 25 Pa Code
221.11 “ Document No. 291-4200-001, FINAL February 7, 2009 PA DEP. Bureau of
Radiation Protection.
http://www.dep.state.pa.us/dep/subject/advcoun/rpac/2006/10-18-06%5C291-
4200-001%20Medical%20X-
ray%20Procedures%20Operator%20Training%20Guide%20-%20augmented.pdf
Pennsylvania. Department of Environmental Protection. Bureau of Radiation Protection.
http://www.dep.state.pa.us/brp/Nuclear_Safety_Division/Nuclear_Safety_Homepage.htm
United States Nuclear Regulatory Medicine Commission http://www.ncr.gov
THE NEXT SLIDES 45-52 ARE THE TEST AND EVALUATION. ONLY THE
SLIDES 45-52 OR THE 4 PAGE TEST AND EVALUATION NEED TURNED
IN FOR CREDIT. COMPLETED FORMS SEND TO: LORI GRAHAM
44

Radiation Safety and Fluoroscopy Enduring Material Please indicate your answers as clearly.
Name (Please print): Date:
1. What is the method of radiation protection that is recommended and most effective?
a. Limiting the time of exposure
b. Using lead shielding.
c. Distancing oneself from the radiation source.
d. All the above.
2. REM is the unit effective dose that corrects absorbed rate for the risks from high energy particles.
a. True
b. False
3. What is the annual exposure limits according to the Pennsylvania Dept. of Environmental Protection,
Bureau of Radiation?
a. 5000 millirem whole body per calendar year
b. 500 millirem whole body per calendar year
c. 50,000 millirem extremities per calendar year
d. 5000 millirem extremitites per calendar year
e. Both a and c
45

4. All but one is a biological effect of radiation exposure. Select the one that is not a biological effect of
radiation exposure.
a. Cataracts in the eyes
b. Skin reddening and burning
c. Eczema
d. Hair loss
5. Where can the Radiation Emergency Procedure for Jameson Memorial Hospital be found?
a. Located in the Physician’s Lounge
b. Online Manual page on the Jameson Portal under Radiation Manual
c. Online by searching Google.com
d. On the PA DEP’s website
6. What does ALARA stand for?
a. As Low As Reasonably Achievable
b. As Low As Requirement Allows
c. As Low As Registration Allows
d. As Low As Restrictions Allow
46

7. Skin burns and cataracts can occur below 5,000 rad and 500 rad.
a. True
b. False
8. According to the inverse square law, if one doubles the distance from the source, the intensity of the
source is ¼ or (½)2.
a. True
b. False
9. When working with radiation equipment, which of the following procedures should you be familiar with?
a. Operation of the equipment
b. Radiation Emergency of the Institution
c. Functions of each control
d. Shielding for the operator and patient specific to the equipment
e. All of the above
10. Genetic effects occurs when low doses of radiation damage or alter the genetic code, whereas, Acute
Radiation Syndrome is a rapid body response from high radiation doses.
a. True
b. False
47

Evaluation must be completed and turned in for certificate.
Program Title: Radiation Safety and Fluoroscopy Enduring Material
Creator, Consulting and Reviewing Physician :Dr. Banerjee
Date/Time: June 29, 2010 Expiration: August 31, 2011
Learning Objectives: At the conclusion of the presentation, the participant should be able to:
a. Summarize the basic properties, and units of measurement of radiation.
b. Review the sources of radiation and the methods of radiation protection.
c. Document the biological effects of radiation exposure.
d. Summarize the types of X-ray equipment, imaging recording and processing.
e. Recommend the proper patient exposure and positioning for a particular radiation related procedure.
f. Review the procedures, the Quality Assurance Program, and the related radiation safety regulations.
 Please rate the following…
Excellent Good Fair Poor
 Overall activity…    
 Clarity of session content…    
 Relevance of content to you…    
 Quality of visual aids/handouts…   
48

49
Evaluation must be completed and turned in for certificate
Statement of changes this program has made on your practice.
Some questions allow for more than one answer.
1. This activity will assist in improvement of:
 Competence
 Performance
 Patient Outcomes
 Patient Safety
2. I plan to make the following changes in my practice by:
 Modifying treatment plans.
 Changing my screening/prevention practice.
 Incorporating different diagnostic strategies into patient evaluation.
 Using alternate communication methodologies with patient and families.
 Other. Please state:
 None. This activity validated current practices.
3. What is your level of commitment to making the changes stated above?
 Very committed
 Somewhat committed
 Not very committed
 Do not expect to change practice

50
4. What are the barriers you face in your current practice setting that may impact patient outcomes?
 Lack of evidence-based guidelines
 Lack of applicability of guidelines to current practice or patients
 Lack of time
 Organizational or Institutional
 Insurance or Financial
 Patient Adherence or Compliance
 Treatment related to adverse events
 Other: Explain
5. This activity supported achievement of the learning objectives.
 Strongly Agree
 Agree
 No Opinion
 Disagree
 Strongly Disagree

51
6. The material was organized clearly for learning to occur.
 Strongly Agree
 Agree
 No Opinion
 Disagree
7. The content learned from this activity will impact my practice.
 Strongly agree
 Agree
 No Opinion
 Disagree
8. The activity was presented objectively and free of commercial bias.
 Strongly agree
 Agree
 No Opinion
 Disagree

52
If you answered Disagree or Strongly Disagree to any of the statements above, please explain your
disagreement with the statement(s) in space below. Any other comments about today’s program can
be made here also.
Name Specialty
Be sure that both evaluation and test are turned in. Slides 45-52 or the 4 page paper version. Be sure to
send inner office to Lori Graham – Library /CME, or FAX 724-656-4267 or EMAIL:
lgraham@jamesonhealth.org

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Radiation Safety and Fluoroscopy: Protecting Patients and Staff