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"In some states, the certification of the operator is mandatory,
such as in Texas and California," says Richard L. Morin, PhD, a
professor of radiologic physics at the Mayo Clinic in Jacksonville,
Fla., as well as the chair of the American College of Radiology's
Dose Index Registry and co-chair of the "Image Wisely" initiative
(
imagewisely.org
). "But most often it is the facility that sets the
rules."
No matter their size, facilities must maintain the same standards
as large hospitals or academic institutions, says Dr. Morin. The C-
arm's operator must be trained and certified in radiation safety,
and facilities must appoint an in-house staffer or an outsourced
consultant to the position of radiation safety officer. "This person
is responsible for ensuring that safety protocols are being fol-
lowed," says Jason Launders, MSc, a researcher at the ECRI
Institute in Plymouth Meeting, Pa. They also monitor employees'
exposure, manage the equipment's service and inspection, and
educate staff.
2. Proper positioning
Equipment positioning influences exposure risks. Most C-arms
are built to place the X-ray tube under the patient for a reason. "If
the tube is above and the detector beneath, you're potentially
exposed to 100% of the backscatter," says Dr. Morin. "If the tube is
beneath the patient, you only get 1%."
Plus, the scattered radiation, which comes not from the tube but
from the patient, and which is not reflected like light but diffused
in all directions — "Imagine a patient glowing X-rays," describes
Mr. Launders — emerges primarily from the side of the body
where it went in.
Positioning can help to minimize the radiation dose delivered to
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