October 2023

Refresher on Radiation Safety Awareness and Lowering Your Exposure Using Manual and Non-Manual Restraint

By Julia Bitan, RVT

Founder, Hands-Free X-Rays

In this VETgirl online veterinary continuing education blog, Julia Bitan, RVT provides us a refresher on radiation safety awareness with a focus on limiting your exposure to radiation using manual and non-manual restraint methods.

Radiography is an integral part of our daily routine in the veterinary clinical world. It offers a quick and efficient method to gain insight into our patients’ anatomy, aiding in illness or injury diagnosis. Despite how easy it is to take an image, much like pressing a button on a smartphone, it is crucial to recognize that invisible forces are at play, which can pose risks if radiography is not taken seriously and responsibly.

So, What is the Big Deal?

To produce the x-ray image we see on the monitor, high-energy and high-frequency electromagnetic waves (also known as ionizing radiation) are generated inside the tube head, pass through the collimator, and travel through the patient onto the sensor to create the image. Although there are no visual cues, smells, or sounds indicating this high-energy presence, it is in the beam coming from the x-ray tube and has the proven ability to damage cells and tissues if safety protocols are not followed.

Proximity to the primary beam significantly influences how much ionizing radiation we are exposed to—the closer we are, the greater the amount of scatter radiation we encounter.

Generally, in veterinary medicine, we are more concerned with secondary (or scatter) radiation produced by the primary beam. x-rays can “scatter” off the patient’s body, and when standing near the patient during x-ray exposure, this secondary radiation can affect us.

 

Figure 1. Scatter radiation.

Regulatory Requirements

Veterinary radiation workers, or team members working directly with an x-ray source, are required to minimize their exposure to ionizing radiation as much as possible to ensure their personal safety. Some of the key requirements include adhering to the ALARA principle, which stands for “As Low As Reasonably Achievable.” This involves:

  • Time: Minimize the time spent near the x-ray source during exposure and use lower time settings to reduce overall exposure.
  • Distance: Increase your distance from the radiation source to reduce exposure.
  • Shielding: Use personal protective equipment (PPE) and other barriers to block or reduce exposure to ionizing radiation.

Monitoring exposure levels is also necessary to track and measure ionizing radiation exposure in the workplace. Dosimeters are assigned to each radiation worker or team member working around a radiation source, ensuring their exposure levels remain within safe limits. The placement and number of dosimeters required varies based on jurisdiction.

 

Figure 2. Veterinary technician with PPE wearing a dosimeter.

What Else Can We Do to Reduce Exposure in the X-ray Room?

  1. Collimate: Collimation reduces the size of the beam, lowers scatter radiation, and improves image quality. Always collimate down to include only the anatomy needed for the image.
  2. Wearing PPE: Always wear available PPE when remaining in the room during exposure. It is your responsibility to protect yourself, even if it feels inconvenient. This equipment is designed to block and reduce secondary radiation and protect you — so use it!
  3. Caring for PPE: Proper storage and regular testing of PPE ensures there are no damages, cracks, or holes that could allow radiation to pass through.
  4. Caring for your x-ray machine: Regular testing and maintenance by a professional (as recommended by the manufacturer) ensure that the collimator, table, and generator are functioning correctly, minimizing exposure and repeat imaging.
  5. Positioning methods: The chosen method — manual restraint versus hands-free positioning — affects how close we stand to the x-ray source during exposure and the resulting level of ionizing radiation exposure.
  6. Reduce retakes/repeats: Plan ahead, know your anatomy, recognize rotation markers, ensure patient comfort, and work efficiently to minimize retakes.

Figure 3. Lead gloves as PPE should not be in the x-ray beam.

Manual Restraint vs. Hands-Free Positioning

The traditional method for keeping a patient in place during x-rays involves two team members physically restraining the patient during exposure (see Figure 4.). Manual restraint often results in close proximity to the patient and primary beam, leading to increased secondary scatter exposure for the team members. For many years, this was the standard technique for acquiring images of small animals.

Figure 4. Manual restraint for an abdominal radiography with PPE.

Over the past 7-8 years, a gradual shift toward hands-free positioning has emerged in small animal veterinary hospitals worldwide (see Figure 5.). The popularity of new x-ray equipment, the transition to digital imaging (which has resulted in more exposures), increased online information availability, and overall radiation safety awareness have all contributed to this change. Hospitals adopting hands-free positioning have demonstrated that it is both practical and achievable, resulting in improved imaging efficiency despite being a relatively new concept.

 

Figure 5. Hands-free restraint for radiographs.

The Basics of Hands-Free Positioning
Basic positioning devices are crucial for hands-free techniques. These devices replace the need for manual restraint, keeping the patient in position and allowing staff to step away during exposure. Ensuring patient comfort is essential—uncomfortable patients may move, leading to non-diagnostic images, longer processing times, and repeats. Simple and effective tools such as soft, half-filled sandbags, Velcro-like stretchy extremity straps, foam troughs, and wedges can help achieve diagnostic images without the need for manual restraint (see Figure 6.).

Figure 6. Hands-free restraint materials.

Staying in the Room with the Patient

Hands-free positioning can involve one operator remaining in the room with the patient, wearing full PPE and a dosimeter, while maintaining a safe distance during exposure (see Figure 7.). Even a small increase in distance reduces exposure.

Figure 7. Hands-free restraint while maintaining in the room.

Combining Manual Restraint with Hands-Free Techniques

Devices used for hands-free positioning can also be employed during manual restraint. For example, soft extremity straps can be used to move limbs away from the desired anatomy, allowing the operator to increase their distance while holding the straps (see Figure 8.). In certain scenarios, one team member can be replaced by a sandbag to reduce their proximity to the primary beam.

Figure 8. Combined manual restraint with hands-free techniques.

Summary

This article aims to educate and encourage you to consider your own health when performing x-rays. Busy days filled with surgeries, patients, client interactions, and administrative tasks often lead us to prioritize patient care over our own safety. However, it is essential to use all available PPE, consider hands-free techniques, and maintain a healthy workplace environment — both mental and physical. Start by engaging in positive discussions with your team about hands-free positioning, combining techniques, and using all available positioning tools. Plan ahead for each x-ray patient, and most importantly, lead by example. Protecting our health is a priority and it is our responsibility.

Download the job aid below HERE!

Check out her blog on What You Need to Know About Hands-Free Radiology in Veterinary Medicine HERE

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