HealthCare Business News interviewed Dr. Lori M. Weir and Dr. John Racadio on the topic of radiation safety for radiologists. Weir is a partner in L&M Radiology and serves on the L&M Operations Committee. She is also the Radiology representative to the Lawrence General Hospital Cancer Committee. Racadio has been practicing interventional radiology for 18 years and has been the division chief of interventional radiology at Cincinnati Children’s Hospital Medical Center for the past 13 years.
 
HCB News: Tell us about your day-today and how frequently you are using / being exposed to radiation.
Dr. Lori M. Weir: I have about 10 cases a day that use fluoroscopy or radiation. If I have an eight-hour workday I probably spend about 5 to 6 hours using fluoroscopy intermittently.
 
HCB NEWS: How do you see the culture of radiation safety changing or evolving? How different is it from when you started, to this time in your career?
LMW: I do think it is evolving and there is more focus on not just the patient but the physicians and technologists in the room as well. It does depend on where you are. I work at two hospitals. There is more attention to exposure at one hospital and less at the other hospital. At one hospital there is a focus on the patient and the entire team. At the other hospital staff radiation safety seems to be an afterthought. They follow required regulations, but go no further.
 
HCB NEWS: How do forums such as RSNA impact this culture/discussion around radiation safety? Do you anticipate a focus on radiation safety during RSNA?
LMW: RSNA is physician focused, and there are always discussions and lectures about radiation safety. I expect they will continue to focus on radiation safety. I think part of the ongoing problem is that the issue remains more on the forefront on the part of physicians. I know that when I am in the room, there is a focus on radiation safety. But that focus needs to come from both sides. In my setting, it’s largely physician- driven. However, the culture has been changed at one hospital by the introduction of a real-time dose monitoring system. I spearheaded getting that technology at one of the hospitals, and it has created a change in the behaviors of people who work with radiation. It’s time to make administration pay attention. Broader organizations where the decisions are not made locally have more of a challenge. There needs to be the administration piece. Administration needs to pay attention, they need to care about their staff and make changes to protect them.
 
HCB NEWS: What challenges do you face every day?
LMW: At one institution, if I don’t ask for the hanging shield they remind me. If I’m distracted and don’t bring the detector close to the patient, then someone on the team reminds me. At the other institution, I’m the only person thinking of it. I did get the other hospital to buy lead-lined scrub hats, but most people are not wearing them unless I tell them to put them on. The administration isn’t really plugged in on this issue. I feel like I discuss it all the time and I’m not getting anywhere with it. It’s really something that shouldn’t be on my mind, it should be automatic. I shouldn’t have to think about it. Short of something catastrophic occurring, for example a coworker having possibly radiation-induced cancer, I think the culture won’t change without a real-time radiation dose monitoring device that shows them the reality of what is happening visually. At the hospital where they have the real-time radiation dose monitoring device, everyone’s behavior has changed dramatically. I think seeing is key.
 
HCB NEWS: Do you have a radiation safety officer?
LMW: Technically, we do, yes. At the one hospital with the issues, I believe it’s the nuclear medicine physician. But that person is not involved in the day-to-day radiation environment other than nuclear radiation. I’ve actually asked to be the radiation officer at the hospital where the dose monitoring system is used. The radiation officer is not known or visible to others and does not provide ongoing education and awareness. We do have thyroid shields, but it’s important to make sure people are wearing them. If the radiation officer is actively around, and teaching people about safety, change for the better may happen.
 
HCB NEWS: Where does the responsibility for radiation fall? Individual? Radiation safety officer? Administration?
LMW: It is a collective effort. The largest part of the burden falls to the physician who is performing the case. It is part of our job, but it should be everybody’s job since everyone is equally invested and involved. Technologist, nurse, physician, hospital admin, are all equally invested in the safety of employees. It shouldn’t fall to me alone because I’m the conscientious nice guy. It should be part of the culture.
 
HCB NEWS: Do you have a sense of personal responsibility and has that changed from when you started to this time in your career?
LMW: It’s always been more physician-driven than anything else. The shift I’m seeing is hospitals waking up. I started practicing 10 years ago, and there has been a gradual change over the last 10 years, but physicians still bear the greatest burden.
 
HCB NEWS: What is your perspective on real-time dosimetry in the discipline of minimally invasive vascular surgery?
LMW: I knew right away when I saw real-time dosimetry that it would make a difference. That is why I got it right away. We have the numbers, and we see that it made a tremendous change. It also changed the camaraderie in the room, to where everyone is watching out for each other. That does something for morale. At the other hospital it is not implemented despite me trying; there has been no change. Real-time dosimetry is going to make the difference because you can see it. I see the difference every day.
 
HCB NEWS: What sort of basic safety features are used in the discipline, how does radiation dose monitoring add to this?
LMW: We have all the standard personal equipment, vests, shields, skull caps and lead googles. Radiation dose monitoring adds to this by encouraging people to be more diligent in using the equipment and more diligent in using patient and equipment positioning and coning.
 


Interview with Dr. Racadio:
HCB News: Tell us about your day-to-day, and how frequently you are using/being exposed to radiation.
Dr. John Racadio: Interventional radiologists who have a standard 5-day work week are exposed to radiation every day for the majority of each day. On call responsibilities add to the frequency of exposure. As chief of interventional radiology, I’m not in the interventional lab every day because of my administrative duties.
 
HCB NEWS: How do you see the culture of radiation safety changing or evolving? How different is it from when you started, to this time in your career?
JR: I do see the culture of radiation safety changing and evolving. It’s been evolving for some time. In particular, in the last 8 years it has changed a lot. The Image Gently campaign that is focused upon pediatrics and the Image Wisely campaign which focuses on adults, have increased awareness for radiation safety, and this increased awareness continues to grow. When I started my career 18 years ago in a pediatric facility there was a strong focus and awareness on dose, because children are more susceptible to the effects of radiation.
 
Even though we were aware, and did what we could to decrease radiation, there has been a more recent focus on creating specific protocols to minimize dose. In the past we accepted the constraints of the equipment of major vendors and their commercial settings, which were typically tailored to the adult-sized patient. We worked to limit what we could. Now we have become more proactive in working with the companies to modify these settings to make them more appropriate for our pediatric patients.
 
In general, I think the major imaging companies want to do the right thing. I have noticed increased interest in addressing pediatric needs when it comes to dose reduction. Not only is it the right thing to do from a patient care standpoint, but I think that industry views this as an opportunity to set one’s company apart from its competitors. And they likely see the benefits from a marketing standpoint, too. In general, treating children is good PR.
 
HCB NEWS: How do forums such as RSNA impact this culture/ discussion around radiation safety? Do you anticipate a focus on radiation safety during RSNA?
JR: RSNA is a big opportunity for industry to showcase their latest technology advancements. There is healthy competition. From an industry standpoint they can boast how they are different and better than their competitors. One focus is on decreasing dose. It is a great forum because everyone is there to compare and contrast industry and innovations, including dose lowering technologies.
 
HCB NEWS: What challenges do you face every day?
JR: Both protecting yourself from X-ray exposure and “getting the job done” can sometimes be difficult to accomplish at the same time. Performing non-vascular procedures on the pediatric abdomen is particularly challenging. The interventional radiologist must be close to the patient and with a small patient that means close to the X-ray tube. It’s cumbersome to work around the hanging lead shield and guide a needle where it needs to go. Even with the best ergonomically designed lead, sometimes it is too awkward to use that shield during critical parts of the case. And sometimes it’s just hard to remember to use the lead shield when caught up in the moment of a challenging procedure. It takes a team approach to remind you to use the lead shield whenever possible
 
HCB NEWS: Do you have a radiation safety officer?
JR: Yes. The officer is shared with the University of Cincinnati to make sure all necessary testing and equipment is appropriate.
 
HCB NEWS: Where does the responsibility for radiation fall? Individual? Radiation safety officer? Administration?
JR: I think it’s always a combined team effort and responsibility. The team is greater than each individual. The team can always have a greater impact. However, as the leader of the procedure the interventional radiologist needs to take responsibility to set the tone that it’s OK and a good thing for people to speak up about radiation safety.
 
HCB NEWS: Do you have a sense of personal responsibility, and has that changed from when you started, to this time in your career?
JR: I’ve always felt it was my responsibility, and that attitude hasn’t changed. Having the dosage monitoring system that we have now makes it easier for that responsibility to be shared among the entire IR team. That culture of awareness is ingrained in our interventional department.
 
HCB NEWS: What is your perspective on real-time dosimetry in the discipline of minimally invasive vascular surgery?
JR: It increases everyone’s awareness. X-rays are something you don’t see. It’s more difficult to be aware of something that is invisible. The visual display increases everyone’s awareness.
 
HCB NEWS: What sort of basic safety features are used in the discipline, how does real-time radiation dose monitoring add to this?
JR: We have the basic lead aprons/vests/skirts, table side and hanging lead shielding, and leaded lenses for glasses. Companies also equip systems with buzzers or bells to go off to alert you of prolonged fluoroscopy exposure times. Unfortunately, some places disable this feature because it becomes an annoyance. And even if it’s not disabled, it can become easy to “tune out.” It’s like a car alarm. When car alarms were new it caught your attention. Now it’s just part of the background noise.