The impact of peer-based training on reducing radiation doses from x-ray operations in an interventional pain management clinic.

The purpose of this paper is to describe the measurement and characterization of the radiation exposure to the staff, patients, and the general public as a result of the operation of an interventional pain management (IPM) clinic, as well as the effectiveness of a peer-based fluoroscopy training program to keep doses as low as reasonably achievable (ALARA). During the last decade, pain management has evolved into an essential part of patient care. IPM, a subfield of pain management, uses fluoroscopic imaging in its procedures. As a result, there are 3 separate populations who could possibly receive exposure to ionizing radiation as a result of an IPM radiographic procedure: staff, patients, and the general public. Staff doses, as well as doses to the general public, are easily measured with radiation dosimetry. Conversely, it is very difficult to characterize the radiation dose to a patient during a fluoroscopic procedure and realistically it is not possible to measure patient dose directly. However, it is plausible to infer relative patient exposure from direct measurement of the physician s dose. The most common and practical way to measure the dose to members of the general public is to monitor the ambient radiation levels within a medical treatment facility and extrapolate these measurements to the general public. Ultimately, the goal is to maintain all doses (patient, physician, and the general public) using the ALARA principle. Using a Panasonic thermoluminescent dosimetry system, it was determined that a peer-based fluoroscopy training program effectively reduced the cumulative dose to clinic staff by approximately 50 percent. It was also determined that the standard building materials used in our facility provide enough shielding to keep doses to members of the general public below acceptable limits.