Radiation Protection During Fluoroscopy

Critical Safety Principles

The American College of Cardiology recommends that all medical personnel working in an x-ray procedure room wear 0.25- or 0.5-mm equivalent lead aprons augmented with neck thyroid shields and humeral shields to ensure proper protection from radiation exposure 1, 2, 3
The American College of Cardiology states that medical personnel working in an x-ray procedure room should wear lead-equivalent aprons, thyroid shields, and eye protection to prevent radiation exposure 1, 2, 3

Scatter radiation exposure is significant and affects all personnel in the room, not just those closest to the source, though proximity increases exposure according to the inverse square law, as stated by the American College of Cardiology 1, 2, 4
The thyroid collar alone decreases effective dose to the operator by approximately one-half, making it critically important protection that cannot be omitted, according to the American College of Cardiology 1, 2, 3, 4
Lead-equivalent aprons (0.5 mm) absorb 95% of 70 kVp x-ray and 85% of 100 kVp, providing substantial protection that is non-negotiable for all room personnel, as recommended by the American College of Cardiology 1, 2, 4
Leaded eye protection with side shields is required for personnel working close to the x-ray source, as proper ceiling-mounted shields reduce operator eye exposure by a factor of 19, according to the American College of Cardiology 1, 4

The American College of Cardiology recommends that all personnel in the procedure room must don complete protective equipment, including 0.25- or 0.5-mm lead-equivalent aprons, thyroid shields, and leaded eye protection with side shields for those near the x-ray source 1, 2, 4

Circulating personnel should be positioned remotely from the x-ray source (ideally >8 feet), where they receive negligible exposure, but still require protective aprons if they remain in the room, as stated by the American College of Cardiology 3, 5
When circulating personnel need to approach close to the patient, the physician operator has a responsibility to ensure they are properly protected before continuing, according to the American College of Cardiology 3
Ancillary personnel not essential to the procedure (anesthetists, surgeons, perfusionists) should not be assumed to be knowledgeable in radiation protection and require explicit instruction, as recommended by the American College of Cardiology 6, 5

The American College of Cardiology warns against continuing the procedure with only the main surgeon leaving to don protection while others remain unprotected, as this violates the fundamental principle that all personnel in the x-ray procedure room require shielding 6, 5