Meeting The Joint Commission’s Fluoroscopy Training Requirements

Satish Nair Ph.D, CHP, DABMPCertified Health Physicist

Certified Medical Physicist

F. X. Massé Associates, Inc.Health and Medical Physics Consultants

Gloucester, MA

fxmasse.com

Part II: Safe operation of different equipment types

20th Annual SRPE Educational Conference, Las Vegas, NV        April 2019

Outline

• Portable C‐arms   (GE/OEC, Philips, Siemens,  Ziehm)

• Fixed C‐arms (Philips,  GE, siemens, Toshiba)

• Mini C‐arms  (GE, Fluoroscan, Orthoscan)

• Undertable and Overhead Fluoroscopes (Siemens, Philips)

• O‐Arm and G‐arm

• CT Fluoroscopy

- Scatter distribution- ‘Buttonology’- Typical operating parameters and skin doses- How long it takes to reach a dose estimation threshold (200 rad, 2000 mGy)

Disclosure statement: FX Massé Associates provides physics consulting services to Hologic and Medtronic

Phantoms:mm Al 19 38 57 76 + 2 mm Pb

30 cmbelow II

All C-Arms (SID equals, or set to 100 cm)

CL = 30 cmabove II

Mini C-Arm

Data for 5 cmabove ImagingAssembly

Undertable Fluoro

30 cmbelow IA 30 cm

Above TT

Overhead Fluoro

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Information Presented Portable C-arm

Typical operating parameters:

~ 60 kV to 120 kV max~ 1 to 10 mA max

ESE: 0.2 to 3 R/min (Sm to Lg)

To get to 200 rad (2000 mGy) skin dose: 1000 min to 80 min beam-on time (~ 1 hr to several hours)

GE / OEC example shown: 9900 Elite GE / OEC example shown: 9900 Elite

Boost vs NormalAvg. Pt.

75 %

80 %

90 %95 %

60 %

Pulse vs ContinuousAvg. Pt.

Philips example shown: BV Pulsera Philips example shown: BV Pulsera

Siemens example shown: Arcadis Varic

Acardis Avantic

Siemens example shown: Arcadis Varic

Ziehm Imaging example shown: Solo Ziehm Imaging example shown: Solo

Fixed C-arm

Typical operating parameters:

~ 60 kV to 125 kV max~ 2 to 15 mA max Fluoro~10 to 1000 mA Cine

ESE: 0.02 to 8 R/min (Sm to XL) Fluoro2 to 200 R/min (Sm to XL) Cine

To get to 200 rad (2000 mGy) skin dose, avg pt: ~30-50 min fluoro to 4 -10 minutes of cine beam-on time

Philips example shown: Allura Xper FD 10

Philips example shown: Allura Xper FD 10

Cine dose = 10 to 15x Fluoro Dose

GE Innova example shown: 3100

Cine dose = 10 to 40x Fluoro Dose

Siemens example shown: Axiom Artis Siemens example shown: Axiom Artis

Siemens Artis Zee:dose spike for largest mags

Siemens example shown: Axiom Artis

Cine dose = 10 to 40x Fluoro Dose

Toshiba example shown: Infinix

Toshiba example shown: Infinix

Cine dose = 10 to 20x Fluoro Dose

Mini C-arm

Typical operating parameters:

~ 50 kV to 80 kV max~ 2 to 15 µA (microA) max

ESE: 0.01 to .05 R/min Fluoro

To get to 200 rad (2000 mGy) skin dose, avg pt: Will need several HOURS of beam-on time

GE OEC examples shown: MiniView 6800 and Elite MiniView Hologic Fluoroscan examples shown: InSight-2 and InSight-FD

Orthoscan examples shown: HD, FD Pulse and Mobile DI Undertable and Overhead Fluoroscopes

Typical operating parameters:

~ 60 kV to 120 kV max~ 2 to 50 mA max

ESE: 0.1 to 7 R/min Fluoro

To get to 200 rad (2000 mGy) skin dose, avg pt: Will need > 1 hour of beam-on time

Siemens example shown: Luminos Agile

Undertable Fluoroscope (R&F Room) Philips example shown: Super 80-CP with Easy Diagnost

Overhead Fluoroscope (Cysto Room)

Siemens example shown: Uroskop Omnia

O-ArmMedtronic examples shown: O-arm1000

Least Scatter

Isodose Profile

G-ArmWhale Imaging example shown: GXi2

CT Fluoroscopy

1000 – 2000 mR/hIn front of apron

50 – 10 mR/h to torsoBehind apron

< 1 mR/hNext to gantry

Leaded eye protection and thyroid collar are recommended

Single axial sans (Philips and older GE)Continuous beam (Toshiba, Siemens and newer GE)

Typically 120 kV~30 to 50 mAs

To get to 200 rad (2000 mGy) skin dose, avg pt: Will need several minutes of beam-on time