Principles of Radiation Exposure

Even as nurses, we're exposed to radiation-- particularly in critical care areas. X-rays can be taken by a portable machine in the ER and ICU for patients that are too sick to move. Taking critically ill patients to radiology for CT scans who need to be monitored closely during transport and during their procedure. Patients getting reductions of fractures and dislocations in the ER where they bring a different type of x-ray machine that can take successive pictures and the picture can stay on for several seconds. We call it a C-arm but I'm sure it has another technical name.

Let me just say one of the most challenging places to code a patient is in radiology. Particularly if you have to pull them out of scanner which I have had to do on occasion.

But I digress.

I-stock Photo

As nurses, we have to think about protecting ourselves and our patients from extra exposure to radiation. We can benefit our patients in a number of way by advocating for:

1. X-rays NOT to be done portably. Portable x-ray machines tend to expose the patient to a higher amount of radiation than taking them to the radiology department.

2. Advocating for lower level films or for no films. There are a couple of situations in pediatrics that are very specific to this. Let's look at abdominal pain. The single biggest cause of abdominal pain in pediatrics is constipation-- yes, I said it-- poop. You can actually tell how constipated a patient is by doing a basic abdominal x-ray which is one of the lowest radiation exposures. I like it because it rules out something simple and likely first. If the patient is constipated-- alleviate that and see if their pain improves. If not-- further testing may be indicated. Versus sending them straight to the CT scanner for abdominal/pelvis films looking for appendicitis which is lower diagnostically on the list. Abdominal/pelvic CT's also have one of the highest radiation exposures.

Another example of not using CT scans is in the case of minor head trauma and/or concussion. Lots of parents bring their children to the ER over concern for concussion expecting a CT to be done. A CT is not necessary to diagnose concussion-- we can do that based on signs and symptoms.

A CT in this example is really used to diagnose a bleed that might require surgery. So we look for more specific clinical signs that might indicate a bleed. Persistent vomiting (three or more episodes), diminished level of consciousness, or a focal neuro deficit (like the patient can't use their arm). Then CT scanning is more indicated.

We are becoming more concerned in pediatrics about lifetime radiation exposure. A baby/child who has multiple CT scans has a much longer life to live to worry about developing later cancer versus an adult who has the same amount of scanning.

3. Provide protection. In our department, this might be using lead aprons to cover reproductive organs while a pediatric patient is getting an arm fracture reduced. Screening for pregnancy if a girl is menstruating.

When we think of radiation exposure-- four factors must be considered.

1. Time: The length of the exposure.
2. Dose: What was the level of radiation at the time?
3. Distance: How close was the patient to the exposure?
4. Shielding: Was the patient protected in any way?

Check this link for further information on the basics of radiation exposure.

Also a GREAT article: Everything You Ever Wanted to Know About Radiation and Cancer. 

What do you think about radiation exposure? Have you ever used it in a story line?