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RADIASI
- 1. Oleh : Agung Nugroho. O, Dipl.Rad, ST, MSi
- 2. Kelengkapan Pesawat Sinar X Intervensional : 1. Control table Pengaturan kondisis expose 2. X Ray tube Produksi X ray 3. Image Intensifier Mengubah sinar x menjadi image dan memerkuat image 4. Display screen
- 3. Basic X Ray intervensional positioning : • Posisikan tube pada posisi yang terkecil radiasi hambur pada sekeliling area radiasi • Posisikan pasien sedekat mungkin II dengan sejauh mungkin sumber radisasi • AOTRAUMA, 2011
- 4. X-ray tube position • AOTRAUMA, 2011 Staff exposed to increased radiation Staff exposed to reduced radiation
- 5. Absorption and scatter • Dari 1000 photons x ray : • ~20 : image detector • ~100–200 : scattered • ~ 800 : di absorbsi pasien • Radiasi hambur meningkat, pada posisi tube di samping image intensifier x-ray tube • AOTRAUMA, 2011
- 6. Pengaruh diameter Image Intensifier terhadap dosis pada pasien (IAEA) : Intensifier diameter Relative patient entrance dose mSv/h 12’ (32 cm) Dose 100 9” (22 cm) Dose 150 6” (16 cm) Dose 200 4.5” (11 cm) Dose 300 Semakin kecil diameter image intensifier , semakin besar dosis pada pasien
- 7. Pengaruh pergerakan tube terhadap dosis pada pasien (IAEA) :
- 8. Radiasi hambur disekeliling tube C-arm Radiasi hambur pada posisi tube di atas
- 9. Radiasi hambur dari beberapa konfigurasi peralatan. Daerah isoexposure ditunjukkan dalam satuan millirad/jam. A : fluoroskopi konvensional, B : tabung sinarX di atas, C : fluoroskopi Carm/ Uarm proyeksi posteroanterior, D : fluoroskopi Carm/ Uarm proyeksi lateral.
- 10. D: fluoroskopi Carm/ Uarm proyeksi lateral.
- 11. Reduksi paparan radiasi hambur oleh permukaan (2,8 R/menit paparan pada kulit) A: fluoroskopi vertikal tanpa perisai, B: fluoroskopi oblique (450) tanpa perisai, C: fluoroskopi vertikal dengan luas perisasi 25 x 15 cm (0,75 mm ekivalen Pb), D: fluoroskopi oblique (450) dengan dilengkapi perisai.
- 12. Radiasi hambur disekeliling tube C-arm
- 13. Interventional Radiology CT Radiography RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY , IAEA.
- 14. Prinsip proteksi radiasi Waktu (semakin pendek waktu interaksi dengan radiasi, semakin kecil kemungkinan terpapar radiasi) Jarak prinsip kuadrat jarak terbalik (inverse square law) Penahan radiasi (shielding)
- 15. Proteksi radiasi pesawat sinar x Intervensional
- 16. Radiation: protective clothing Gloves 60–64% protection at 52–58 KV Eye protection 0.15 mm lead-equivalent goggles provide 70% attenuation of radiographic beam Thyroid collar 2.5-fold decrease in scattered radiation Leaded apron AP: 16-fold decrease in scattered radiation Lateral: 4-fold decrease in scattered radiation
- 17. Extremity dose monitor Geometri Extremity dose monitor
- 18. Masalah yang lebih sering diperbincangkan tentang dosis serap mata sebab risiko radiasi yang dapat menyebabkan katarak. Efek biologi timbul pada batas ambang tertentu, apabila sekitar 600 rad diterima dari paparan sinarX diagnostik maka beberapa minggu setelah kejadian akan mengakibatkan katarak
- 19. Katarak pada mata pekerja radiasi intervensional . (Photograph from Vañó et al. (1998) ICRP 85.
- 20. Hasil pengukuran paparan radiasi pesawat fluoroskopi (15 Mei 2011) Hasil (µSv/jam) Titik Tempat Pengukuran Vertikal Ukur 90 kV 50 mA a Mata dokter 5 b Thyroid dokter 4 c Gonad dokter 2 d Gonad + apron dokter 0 e Mata asisten dokter 100 f Thyroid asisten dokter 98 g Gonad asisten dokter 76 h Gonad + apron asisten dokter 0 1 R. kontrol 0 2 Koridor A 0 3 Kamar dokter 0 4 Koridor B 0 R. 5 USG 0
- 21. Keamanan radiasi di ruang pemeriksaan intervensional : Southport & Ormskirk Hospital, 2011
- 23. UU 44 tahun 2009 tentang Rumah Sakit Pasal 16 (1) Persyaratan peralatan sebagaimana dimaksud dalam Pasal 7 ayat (1) meliputi peralatan medis dan nonmedis harus memenuhi standar pelayanan, persyaratan mutu, keamanan, keselamatan dan laik pakai. Pasal 16 (2) Peralatan medis sebagaimana dimaksud pada ayat (1) harus diuji dan dikalibrasi secara berkala oleh Balai Pengujian Fasilitas Kesehatan dan/atau institusi pengujian fasilitas kesehatan yang berwenang
- 24. Kesimpulan : Posisikan tube pada bagian bawah meja pemeriksaan Tube harus diberi tambahan perisai radiasi (shielding) Ruang pemeriksaan sebaiknya diberi tambahan Lead Glass Arm (kaca Pb dengan tangkai awal di pasang pada plafon) yang mudah digerakkan Selama bekerja dengan radiasi, Alat Pelindung Diri dan Film / TLD Badge HARUS selalu digunakan Sebelum dioperasikan, pesawat harus dilakukan uji kesesuaian pesawat sinar x, sesuai UU No 44 tahun 2009 pasal 16 (2)
- 25. Daftar Pustaka • National Council of Radiation Protection and Measurements: Basic Radiation Protection Criteria. NCRP Report No. 39. Washington, DC, 1971 • National Council on Radiation Protection and Measurements: Medical X Ray and Gamma Ray Protection for Energies up to 10 Mev. NCRP Report No. 33. Washington, DC, 1968 • National Council on Radiation Protection and Measurements: Structural Shielding, Design and Evaluation for Medical Use of Xrays of Energies up to 10 Mev. NCRP Publication No. 49. Washington, DC, 1976 • Bushong SC: Radiologic Science for Technologists: Physics, Biology, and Protection. St. Louis, CV Mosby, 1984 • Pizzarello DJ, Witcosfski RC: Medical Radiation Biology. Philadelphia, Lea & Febiger, 1982 • Marpaung, Togap, Proteksi Radiasi dalam Radiologi Intervensional, Seminar Keselamatan Nuklir 2006 • www.AOTRAUMA.com, 2011 • Kepmenkes RI No 432/MENKES/SK/IV/2007 tentang Pedoman Manajemen Kesehatan dan Keselamatan Kerja (K3) di Rumah Sakit • UU No 44 tahun 2009 tentang Rumah Sakit
- 26. TERIMA KASIH
Notes de l'éditeur
- Not all x-rays pass through the object on which they are focussed. Some are reflected or refracted as they penetrate through an object, resulting in scatter. This scatter is potentially hazardous to surgical staff. Maximum scatter reflects from the side of the patient that is closest to the x-ray source. Therefore, the x-ray beam should be directed in such a way that the scatter is directed towards the floor. In practice, this means placing the x-ray beam under the patient. As the amount of scatter produced increases with the size of the area irradiated, it is desirable to restrict the field size to the area requiring imaging. The image intensifier screen should be kept as close as possible to the patient (as is practicable). This reduces scatter, improves image quality, and reduces radiation dose for the patient. In distal locking of IM nails the surgeon must be able to position the drill and drill bit between the image intensifier and the patient, and in this situation scatter is inevitable.
- It is important to know the effect of the x-ray tube position. The cornea is the most vulnerable part of the body to radiation exposure (radiation cataracts). With a standard x-ray exposure, doubling the distance between the surgeon and the patient from 0.5 m to 1 m reduces exposure considerably. If the x-ray tube is positioned above the patient at a distance of 1 m (left), the surgeon’s/ORP’s eyes receive a dose of 2.2 milisieverts per hour (mSv/h). If the C-arm is turned and the x-ray tube is below the patient (right), the surgeon’s/ORP’s eyes will be exposed to just 55% of the scattered radiation, so 1.2mSv/h. Therefore, the x-ray tube position is of paramount importance.
- The main source of radiation to the staff in the OR is scatter reflecting from the patient. Most of this is reflected back towards the x-ray source. Therefore in the lateral position, staff should be positioned behind the image intensifier side and NOT on the side of the x-ray source.
- The smaller the diameter of the image intensifier the greater the entrance dose of radiation. Laser aiming devices on modern image intensifiers enable accurate targeting and allow for smaller image intensifier diameters to be used.
- This illustration shows the dose rate of scattered radiation around a C-arm. The further away the surgeon/ORP is/are from the x-ray tube, image intensifier, and the patient, the lower the dose of scattered radiation. The 'inverse square law' states that the dose is reduced by the power of 2 of the distance to the x-ray source, ie, when the distance between source and surgeon/ORP is doubled, the dose of radiation is reduced by a quarter. Distance from the source is the best radiation protection. When the C-arm is in the lateral position, image intensification should occur for the shortest possible time, as scattered radiation is higher in this position than when the C-arm is in the AP position. The emission of scattered radiation when the C-arm is in the lateral position is at its maximum diagonally and laterally in the direction of the x-ray tube.
- It is very important to use protective clothing when operating the C-arm, to protect the hands, eyes, thyroid, and body from exposure to radiation. The hands have the greatest exposure risk (during reduction and checking reduction). Radiation-protective gloves give a 60-64% decrease in exposure with 52 – 58 KV. The eyes are the most sensitive area of the body to radiation, and the first determinant of workload (radiation cataracts). Goggles with 0.15 mm lead-equivalent attenuate radiographic beams by 70%. A thyroid collar decreases the scattered radiation a further 2.5-fold. One study has shown that 85% of papillary carcinomas are radiation-induced. (Source: Devalla KL, Guha A, Devadoss VG (2004) The need to protect the thyroid gland during image intensifier use in orthopaedic procedures. Acta Orthop Belg ; 70 (5): 474-477.) An apron in the AP position decreases scattered radiation by 16-fold and in the lateral position by 4-fold.