In 2007, the Association of periOperative Registered Nurses (AORN) updated their recommendations for reducing radiologic exposure in the OR. The most effective method is by understanding the ALARA principle: As Low As Reasonably Achievable. By following ALARA and the principles of protection: time, distance, and shielding, exposure to radiation can be kept to a minimum.1
Minimizing the amount of time spent in the radiation field or area will greatly limit the amount of radiation exposure. Maximizing the distance from the source of radiation will reduce radiation exposure. By doubling the distance from the source of radiation, the amount of radiation exposure will decrease by 25%. Taking one step away from the radiation source will decrease your exposure to radiation.2
Maximize the amount of shielding used as well as using the appropriate shielding correctly can provide up to 90% protection from radiation compared with not using any shielding at all.3
Recommended practices
The following are the AORN's Recommended Practices for Reducing Occupational Exposure in the OR4:
* Stop fluoroscopy exposure when the image on the monitor isn't in use. The less radiation emitted, the less exposure to patients and staff.
* A wraparound apron is recommended if staff need to have their back to the radiation source. Thyroid shields and leaded safety glasses are necessary if staff members are scrubbed in or unable to step away from the source of radiation.
* When the C-arm is in the lateral view, stand on the image intensifier (II) side whenever possible. The II is the flat, round part of the C-arm that collects the radiation particles passing through the patient to produce an image. This decreases scatter radiation (radiation that is scattered throughout the room when a radiation beam hits and passes through a patient, but isn't absorbed by II).
* Keep the tube side of the C-arm as far away from the patient as possible and the II side as close to the patient as possible.
* Collimate, a method used to reduce or enlarge the area being viewed, down to the area of interest to reduce scatter.
* Place a warning outside the OR door that X-ray equipment is in use and that personal pro-tective wear should be on before entering.
* Staff regularly exposed to radiation should wear a personal monitoring device, such as a dosimeter.
* Occupational dose to pregnant staff must not exceed 0.5 rem throughout pregnancy. For this limit to be enforced, the pregnancy must be declared in writing to a supervisor or radiation safety officer and signed.
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