RE: Avoiding Fluoroscopic skin injury

[Tom Payne <payne@allina.com>]

Reply:

Based on our policy set up by the Radiation Safety Committee; we would NOT have discontinued the study.  We are not able to accurately determine the patient entrance exposure during the study.  We would estimate it based on the time(amount) of X-ray exposures and the output of the machine.  Once this is done, one can go to 600 rad(6Gy) without any special consideration.  The limit for stoping or modifying a procedure is 1000 rad.  Even then it is NOT an absolute limit but rather a point at which an outside medical consultant (Chairman of the RSC, Chair of Radiology or Chair of Cardiology) will be called in to assist with the case.

Tom Payne PhD
RSO  Abbott Northwestern Hosp.

---------------Original Message---------------
A physician recently terminated an endoscopic proceedure to remove
[or possibly to break up] gall stones due to concern about the amount
of radiation the patient had received in the procedure and an earlier
one a few days prior.  The total estimated absorbed dose was 137 rad
[1.37 Gy].  Twelve of 13 stones were eliminated in the two procedures.
He wants to get the last stone and said the surgical alternative is
pretty "invasive".  I would assume it is normally good to use reasonable
alternatives to surgery.
 
My initial response was that it seemed likely after we estimated the
dose that the last stone could be taken care of without exceeding the
threshold.  The risk of transient erythema would seem preferable to
the risks of surgery.  The physician proposed waiting about a month and
asked me how long a wait would reduce the risk.
 
I am not aware of any guidance relating to this situation.  Can anyone
out there help me?  References or contacts should maybe be sent to me
direct at vernig.peter@forum.va.gov.  Anybody who has information and/or
an opinion can share with the group or not as s/he sees fit.
 
Peter G. Vernig, VA Medical Center, Denver


----------End of Original Message----------

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Tom Payne, PhD
e-mail: payne@allina.com
phone:  612-863-5171
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It's important to attend other peoples' funerals, cause if you don,t, they won't come to yours.

                   Yogi Berra