Radiation Protection Strategies for Neurointerventionalists

Core Principles and Equipment Operation

The American Heart Association recommends following the ALARA principle, which recognizes that there is no absolutely safe dose of ionizing radiation and that incremental exposures have cumulative effects, to minimize patient dose and protect the operator and clinical personnel 1, 2
Maximize distance between the X-ray tube and yourself while minimizing the distance between the patient and the image detector to reduce radiation exposure 1, 2
Activate the fluoroscopic beam only when actively utilizing dynamic information—never irradiate unless your eyes are on the monitor 1, 2
Use the last image hold feature extensively to study anatomic details without ongoing radiation exposure 1, 2, 3, 4

Minimize the number of digital subtraction angiography (DSA) runs to the minimum consistent with accurate diagnosis 1, 2, 3, 4
Limit magnification to the least degree required for accurate interpretation—dose increases substantially with magnification in conventional image intensifiers 1, 2, 3, 4
Use active collimation to limit the X-ray beam to the minimum area needed—wide-open collimators deliver unnecessary radiation to both patient and personnel 1, 2, 3, 4

Remove the grid when appropriate to reduce dose 3, 4
Reduce tube current when image quality permits 3, 4
An experienced interventionalist should perform as primary operator when possible to reduce fluoroscopy times 3, 4
Monitor fluoroscopy time and cumulative dose throughout the procedure 1, 2
Be aware that procedures exceeding 50 minutes of fluoroscopy time or delivering >4 Gy to the interventional reference point warrant patient follow-up at 1 and 3 months for radiation injury 1, 2