Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5196_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 16 Radioisotopes and Radiation Protection
337
After an explosion of a dirty bomb, some individuals would be contaminated with dust and debris, some
of which could contain radioactive materials. The procedure for decontamination is surprisingly simple.
Removal of contaminated clothing and immersion in
a shower comprise the best method. If a wound contains radioactive material, a simple rinse of the area is
usually sufficient to allow medical personnel to provide medical attention. Most hospitals are stocked
with Geiger–Müller (GM) detectors (described in
Chapter 5), and emergency personnel are trained to
provide guidance concerning contamination levels.
The facility’s radiation safety officer would also be
available to assess contamination levels.
It is unlikely that a dirty bomb would cause contamination with so much radioactive material that a
victim could not receive medical attention. The key here
is that the same personnel need not be near patients for
any length of time. Most emergency room treatments
do not require the staff to be near patients for as long as
an hour. Even if a GM detector shows readings of two to
five times natural background radiation, this means an
effective dose rate of only 0.03 to 0.15 mSv/hr would be
experienced by a physician who is in direct contact with
the patient. Therefore, a physician could treat this patient under these circumstances without exceeding normal dose limits. Normal dose limits do not apply in radiation crisis situations.
The Environmental Protection Agency (EPA) sug-
gests that during such an emergency, individuals engaged in non-lifesaving activities work under a dose
limit of 50 mSv (5 rem) per event. For individuals engaged in lifesaving activities, the dose limit is permitted
to rise to 250 mSv per event.9 Because it may be difficult
to monitor all workers involved in a radiation emergency, a dose rate criterion is often used. In this case, if
the dose rate in the area is less than 0.1 mSv/hr, emergency personnel may enter an area to perform critical
tasks. If the dose rate exceeds 0.1 mSv/hr, emergency
personnel should await specific instructions from radiation experts on how to proceed.
10
Cleanup of a Contaminated Urban Area
The EPA sets limits for radioactive contamination that
assume that a 1 in 10,000 risk of causing a fatal cancer is
unacceptable. This type of regulation requires hospitals,
educational facilities, and industries to control accidental
exposures so that the health of the population cannot be
measurably affected. It also assumes that many other
carcinogens are present and that all are regulated to a
similarly low level.
However, if radioactive contamination were to result
from a dirty bomb, it is hoped that a more realistic
evaluation of actual risk would be used. Unnecessary
use of resources to clean a large inhabitable area (e.g., at
the heart of a major city) to unreasonably stringent
standards would be an unfortunate outcome requiring
the expenditure of vast resources that could be used
to benefit the public elsewhere. For example, a 1 in
10,000 probability of causing a fatal cancer corresponds
approximately to a 2 mSv (200 mrem) effective dose.
Recall from Chapter 2 that the annual effective dose
resulting from average natural background radiation is
approximately 3 mSv. Therefore, cleanup of a contaminated site to levels associated with normal radiation
protection standards would require heroic measures,
such as:
• Removal of topsoil
• Digging up of roadways
A practical compromise should be made to allow
land use after a reasonable cleanup.
Medical Management of Persons Experiencing Radiation Bioeffects
If surface contamination is suspected, personnel
should wear gowns, masks, and gloves when working
with the patient. The same procedures that control the
spread of infection are useful to prevent the spread of
radioactive contamination. The clothing of individuals
who have been contaminated should be placed in plastic containers and set aside for later evaluation. Removal of surface contamination involves removal of
the patient’s clothing and the use of a shower to
cleanse the skin.
The various stages of ARS were discussed in Chapter
8. A complete discussion of procedures for handling
ARS is beyond the scope of this text. The interested
reader is referred to recent publications on this sub-
11,12
ject.
In dealing with patients with ARS, some estimate of the amount of exposure they have received
helps predict the clinical course of the syndrome (Table
16.2). There are many methods other than ARS symp-
toms that may be used to determine the amount of
radiation dose received during acute exposure. Biodosimetry is a general term used to refer to analysis of biological fluids such as blood and urine to look for actual
338
TABLE 16.2 Dose Effect Relation After Acute Whole-Body Radiation From Gamma Rays
CHAPTER 16 Radioisotopes and Radiation Protection
or X-Rays
Whole-Body (Gyt) Absorbed Dose Effect
0.05 No symptoms
0.15 No symptoms but possible chromosomal aberrations in cultured peripheral blood
lymphocytes
0.5 No symptoms (minor decreases in white blood cell and platelet counts in a few persons)
1 Nausea and vomiting in approximately 10% of patients within 48 hr after exposure
2 Nausea and vomiting in approximately 50% of persons within 24 hr, with marked decreases
in white blood cell and platelet counts
4 Nausea and vomiting in 90% of persons within 12 hr and diarrhea in 10% within 8 hr; 50%
mortality in the absence of treatment
6 100% mortality within 30 days because of bone marrow failure in the absence of treatment
10 Approximate dose that is survivable with the best medical therapy available
.10–30 Nausea and vomiting in all persons in less than 5 minutes; severe gastrointestinal damage;
death likely in 2 to 3 weeks in the absence of treatment
.30 Cardiovascular collapse and central nervous system damage, with death in 24 to 72 hr
Data from Gusev I, Guskova AK, Mettler FA Jr, eds: Medical management of radiation accidents, ed 2, Boca Raton, FL, 2001,
CRC Press.
internal contamination, changes in blood components,
and for genetic analysis. Physical dosimetry methods
include analysis of physical components of the body
and surroundings. These include optically stimulated
luminescence of teeth, implanted ceramics, plastic
cards, and even fabric samples. These techniques may be
used to provide information to aid in triage immediately after an accident or to modify treatment by refining dosimetry estimates at a later time. They have been
compiled recently by the International Council on Radiation Protection and Units.13 For exposures localized
to specific regions of the body, medical management
involves the prevention of infection and control of pain
and potential skin grafts. If beta-emitting radioactive
material settles on a patient’s skin, the dose is superficial, and skin grafts may be successful. Gamma-emitting
materials can produce a deeper dose that could interfere
with healing.
During the first 48 hours of ARS, symptoms such as
nausea and vomiting occur. Medical management at
this time is simply to treat the symptoms and try to
prevent dehydration. The bone marrow becomes depleted (leukopenia and thrombocytopenia) after a few
weeks. Bone marrow transplants (such as hematopoietic
stem cell transplants) may be effective in replacing the
function of damaged bone marrow. Such activities require special expertise and, in the event of a radiation
emergency, would be coordinated by the Radiation
Injury Treatment Network.
14
In the event of internal contamination, various
strategies are used, depending on the clinical and radiologic form of contamination. Some of these methods
include:
• Dilution (forcing fluids)
• Blocking absorption in the gastrointestinal tract
(administration of emetics, charcoal, laxatives)
If the radionuclide is iodine, administration of potassium iodide to block further uptake in the thyroid is
possible if no more than a few hours have elapsed since
the contamination.
The National Library of Medicine and the National
Institutes of Health (NIH) maintain a website that contains a wealth of information on dealing with radiation
emergencies. It contains:
• Both basic and advanced methods for decontamination
• Methods to reduce exposure
• Specific medical emergency procedures for various
situations
The website may be found at www.nlm.nih.gov/
medlineplus/radiationemergencies.html.
S U M M A R Y
CHAPTER 16 Radioisotopes and Radiation Protection
339
• Isotopes are atoms that have the same number of protons within the nucleus but have different numbers of
neutrons.
• Some nuclei of isotopes have too many neutrons or
too many protons for stability.
• Radioactive isotopes spontaneously undergo changes or
transformations to rectify their unstable arrangement.
• Rapidly dividing cells that are well oxygenated are
very radiosensitive.
• When cells are radiosensitive, cancerous growths or
tumors can be either eliminated, or at least controlled,
by irradiation of the area containing the growth.
• Therapeutic isotopes generally have relatively long
half-lives compared with diagnostically employed
isotopes.
• Fast electrons are beta radiation.
• Gamma rays and x-ray photons differ only in their
point of origin.
• Iodine-125 decays with a half-life of 59.4 days by a
process called electron capture.
• The most practical radiation protection to follow for
patients having therapeutic prostate seed implants is
use of the concepts of distance and time.
• When iodine-131 is being administered to treat a
hospitalized patient for thyroid cancer, a large, up to
2.5 cm or 1-inch-thick, movable lead shield can be
positioned between the patient and any attending
personnel for protection.
• Residual unused nonreturned radioisotopes, as well
as radioactively contaminated items, must be held in
a secure, shielded, and posted storage area for a period of 10 half-lives of the isotope before being able
to be discarded in ordinary trash. Proper record
keeping is to be kept of storage and disposal.
• Diagnostic techniques in nuclear medicine typically
make use of short-lived radioisotopes as radioactive
tracers.
• Technetium-99m is the most common radioisotope
used in nuclear medicine.
• Positron emission tomography (PET) makes use of
annihilation radiation events.
• When matter–antimatter annihilation occurs, a positron and an electron interact destructively and disappear. Their respective masses are converted into energy that will be carried off by two photons emerging
from the annihilation site in opposite directions,
each with an energy of 511 keV.
• A neutrino is a particle that has almost negligible
mass and no electric charge but carries away any excess energy from the nucleus of the atom in processes
such as beta and positron decay.
• Fluorine-18 is the most important isotope used for
PET scanning.
• PET is an important imaging modality because it can
examine metabolic processes within the body.
• Fluorodeoxyglucose (FDG) is a radioactive tracer
that is taken up or metabolized by cancerous cells
and that reveals their location through positron
emission decay and subsequent generation of oppositely traveling annihilation photons.
• A PET-computed tomography (CT) scanner can detect the presence of regions of abnormally high glucose metabolism, thus providing evidence of cancer
metastasis to other body areas, and at the same time
can obtain detailed information about the location
and size of these lesions or growths.
• Positron emitters result in the production of highenergy radiation, and for this reason the design of a
PET-CT imaging suite involves significant radiation
safety concerns.
• Radioimmunotherapy (RIT) is a specific treatment
protocol for cancer by cytotoxic radioisotopes conjugated to specialized immune system antibodies.
• Monoclonal antibodies are antibodies that are made
by identical immune cells that are all clones of a
unique parent cell.
• Organs of the human body that are part of the immune system include organs such as the liver, thymus
gland, bone marrow, lymph nodes, spleen, and tonsils.
• Radioimmunotherapy (RIT) is a combination of radiation therapy and immunotherapy, and the success
of RIT depends on the selective accumulation of cytotoxic radioisotopes at the affected areas.
• One of the most intriguing advantages of RIT over
external x-ray beam therapy is the ability to attack
not only the primary tumor but also lesions systemically metastasizing or spreading.
• Most hospitals have elaborate crisis plans for handling emergency situations involving radioactive
contamination.
340
CHAPTER 16 Radioisotopes and Radiation Protection
• A radioactive dispersal device, or “dirty bomb,” is a
radioactive source mixed with conventional explosives, the actual long-term health effects of which
will most likely be minimal.
• If radioactive material from a dirty bomb remains in a
small area, only a few people may be seriously affected.
• Conversely, if enough explosives are used to spread
the radioactive material over a broad area, radioactivity will be diluted and may not be much higher
than background levels.
• If a dirty bomb were to explode with the same force
as the explosion at Chernobyl, the actual number of
radiation injuries could be quite small.
• The United States currently has emergency responders
who are prepared and equipped to monitor and assess
personnel exposure on-site in an emergency situation.
• After an explosion of a dirty bomb, externally contaminated individuals can be decontaminated by removal of
contaminated clothing and immersion in a shower.
• Geiger–Müller (GM) detectors may be used by
• During an emergency situation, individuals engaged
• If surface contamination is suspected, emergency
• Handling of patients with internal contamination
G E N E R A L D I S C U S S I O N Q U E S T I O N S
1. Why do isotopes that have too many neutrons or too
many protons spontaneously undergo changes or
transformations?
2. What causes cancerous growths or tumors to be
eliminated or controlled by irradiation?
3. What difference exists between gamma rays and
x-ray photons?
4. What are the best radiation safety practices to follow
for patients having therapeutic prostate seed implants?
5. While caring for a hospitalized patient receiving
iodine-131 therapy for cancer, what can hospital personnel do to minimize occupational exposure?
6. What radiation safety concerns are associated with the
design of a PET/CT imaging suite, and how is radiation protection provided to meet these concerns?
7. What is a radioactive dispersal device, or “dirty
bomb,” and what are the possible consequences if
such a device is detonated?
8. If a wound contains radioactive material, what
9. What dose level may an individual engaged in life-
10. If surface contamination is suspected, what should
11. What is radioimmunotherapy?
12. Where does the development of all cells of the immune
13. Upon what does the success of radioimmunotherapy
14. What professional individuals are usually involved
15. For what groups of patients is radioimmunother-
trained emergency personnel to monitor contamination levels.
in non-lifesaving activities are to work under a dose
limit of 50 mSv per event, whereas those persons
performing lifesaving activities have a dose limit of
250 mSv.
personnel should protect themselves by wearing
gowns, masks, and gloves while working with the
patient.
varies depending on the clinical and radiologic form
of contamination. Strategies may include dilution
and blocking absorption in the gastrointestinal tract.
Potassium iodide can be administered to block further uptake of radioactive iodine in the thyroid
gland.
should be done to decontaminate the wound?
saving activities during a radiation emergency
receive?
medical personnel wear when working with a contaminated patient?
system begin?
depend?
in radioimmunotherapy procedures?
apy an important choice?
R E V I E W Q U E S T I O N S
1. Well-oxygenated rapidly dividing cells are:
A. Very insensitive and are not damaged by
radiation
B. Very sensitive to damage by radiation
C. Moderately sensitive to damage by radiation
D. Somewhat sensitive to damage by radiation
2. Iodine-125 decays with a half-life of 59.4 days by a
process called:
A. Attenuation
B. Electron capture
C. Pair production
D. Photodisintegration
CHAPTER 16 Radioisotopes and Radiation Protection
341
3. Which of the following steps should be taken for ex-
ternal decontamination from radioactive materials?
1. Removal of contaminated clothing
2. Immersion of contaminated person in a shower
3. Monitoring of the contaminated individual
with a Geiger–Müller detector
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2, and 3
4. What dose level may an individual who is engaged in
non-lifesaving activities during a radiation emergency safely receive?
A. 10 mSv per event
B. 30 mSv per event
C. 50 mSv per event
D. 250 mSv per event
5. The clothing of individuals that has been contami-
nated should be:
A. Aired out on a clothesline to decontaminate
B. Burned immediately
C. Placed in plastic containers and set aside for later
evaluation
D. Shaken out and put back on
6. All of the following statements are true except:
A. In dealing with patients with acute radiation syn-
drome (ARS), some estimate of the amount of
exposure they have received helps predict the
clinical course of the syndrome.
B. If beta-emitting radioactive material settles on a
patient’s skin, the dose is very deep and skin grafts
will not be very successful.
C. Gamma-emitting radioactive materials can
produce a deep dose that may interfere with
healing.
D. Current strategy for an ARS patient is to admin-
ister drugs that stimulate any remaining bone
marrow.
7. Some of the strategies used to treat internal radiation
contamination include:
1. Dilution (forcing fluids)
2. Blocking absorption in the gastrointestinal tract
(administration of emetics, charcoal, laxatives)
3. Administration of potassium iodide to block
further uptake in the thyroid if the radionuclide is iodine and no more than a few hours
have elapsed since the contamination
A. 1 only
B. 2 only
C. 3 only
D. 1, 2, and 3
8. A well-designed PET/CT facility should be arranged
so that there are no areas of full occupancy immediately adjacent to a:
A. High-energy radiation source
B. Low-energy radiation source
C. Patient waiting area
D. Public corridor
9. Which of the following are almost impossible to
detect?
A. X-rays
B. Gamma rays
C. Positrons
D. Neutrinos
10. Patients receiving iodine-125 should significantly
limit durations of close contact (,30 cm or 1
foot) with small children and pregnant women for
a period of:
A. Six days after the implant procedure
B. Six weeks after the implant procedure
C. Six months after the implant procedure
D. Six years after the implant procedure
11. Antibodies that are made by identical immune cells
that are all clones of a unique parent cell are known as:
A. Antigen antibodies
B. Conjugated antibodies
C. Monoclonal antibodies
D. Pathogen antibodies
12. Organs of the human body such as the liver, thymus
gland, bone marrow, lymph nodes, spleen, and tonsils are part of the:
A. Circulatory system
B. Endocrine system
C. Immune system
D. Reproductive system
13. Radioimmunotherapy (RIT) is a combination of:
1. Immunotherapy
2. Chemotherapy
3. Radiation therapy
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2, and 3
14. One of the most intriguing advantages of radioim-
munotherapy over external x-ray beam radiotherapy is the ability to attack:
A. Not only the primary tumor but also lesions
systemically metastasizing or spreading
342
CHAPTER 16 Radioisotopes and Radiation Protection
B. Only the primary tumor cells
C. Only lesions systemically metastasizing or
spreading
D. Only the primary tumor cells and all the non-
cancerous cells surrounding the primary tumor
15. The success of radioimmunotherapy depends on the:
A. Energy of the diagnostic x-ray beam employed
B. Malignancies that present in free-floating cells
C. Selective accumulation of cytotoxic radioiso-
topes at affected areas
D. Tumor’s molecular characteristics
A P P E N D I X
A
Relationships Between Systems of Units
As has been shown throughout this textbook, various
quantities are necessary for describing physical processes. Well-known examples of such quantities are
length, mass, force, energy, and time. If one also includes
electric charge, then virtually all of the fundamental
characteristics of nature can be found to be included
within combinations of these physical quantities or,
more precisely, the units associated with them. The purpose of this appendix is to tabulate quantities and units,
including those that pertain to ionizing radiation that
may be encountered by the student. It should be emphasized that a concerted effort has long been under way to
just have one system of units in place throughout the
world, namely the Systeme International, or SI. There are
strong pockets of resistance to this, especially in the
United States, which is firmly wedded to the English
system. However, in official areas such as radiation protection regulations and registry and licensing examinations, SI units have become the norm, and they have
been used in this text as much as possible.
Three basic systems of physical units have been in
existence for a long time and are familiar to varying
degrees, depending on what part of the world one lives
in and perhaps one’s field of work. They are the English
system, the CGS (centimeter-gram-second) system, and
the MKS (meter-kilogram-second) or SI system. The
following tables specify for each important physical
quantity the corresponding associated fundamental
unit in each of the three systems and the relationship
among these units when possible. Boxes demonstrating
calculations for conversions among units and for equivalent and effective radiation dose are also provided.
English System
Quantity Unit
Length Foot, inch
Force (weight) Pound (lb)
Mass Slug (an object of mass 1 slug
weighs 32 lb on the surface
of the Earth)
Energy Foot-pound
Power Horsepower (hp)
Pressure Lb/in
Time Second
Electric charge Coulomb
Temperature Degrees Fahrenheit (°F)
Absorbed dose No specific unit
Exposure Roentgen
CGS System
Quantity Unit
Length Centimeter (cm)
Force (weight) Dyne (1 gm-cm/sec2)
Mass Gram (g)
Energy Erg (1 gm-cm2/sec2)
Power Ergs per second
Pressure Barye (Ba) (1 Ba 5 1 dyne/cm2)
Time Second
Electric charge Statcoulomb or ESU (ESU means
Temperature Degrees Centigrade (Celsius) (°C)
Absorbed dose Rad (1 rad 5 100 ergs/gram)
Equivalent dose Rem
2
electrostatic unit of charge)
343
344
APPENDIX A Relationships Between Systems of Units
MKS (SI) System
Quantity Unit
Length Meter (m)
Force (weight) Newton (1 N 5 1 kg-m/sec2)
Mass Kilogram (kg)
Energy Joule (1 J 5 1 kg-m2/sec2)
Power Watt (1 W 5 1 joule/sec)
Pressure N/m
2
Time Second
Electric charge Coulomb (C)
Temperature Degrees Centigrade (ºC)
(Celsius), degrees Kelvin (K)
Absorbed dose Gray (Gy) (1 Gy 5 1 J/kg)
Equivalent dose Sievert (Sv)
Relationships Among Units
Quantity Unit Conversions
Length 1 m 5 100 cm 5 39.37 inches;
2.54 cm 5 1 inch
Force (weight) 1 N 5 0.225 lb 5 105 dynes
Mass 1 kg 5 1000 g; 1 slug 5 14.6 kg
Energy 1 J 5 107 ergs 5 0.738 ft-lb
Power 1 W 5 0.738 ft-lb/sec; 1 hp 5
550 ft-lb/sec 5 746 W 5 0.746 kW
Pressure 1 N/m2 5 1.45(10)24 lb/in2 510 Ba;
1 atmosphere 5 14.7 lb/in2 5
1.013(10)5 N/m
Time 1 second 5 1/3600 hour 5
approximately 1/100,000 day
Electric charge 1 ESU 5 1 statcoulomb 5
3.34(10)
Temperature TF 5 9/5TC 1 32, TK 5 TC 1 273
Exposure 1 coulomb/kg 5 1/2.58(10)24 C/kg
per R 5 3876 R (a very large
exposure)
Absorbed dose 1 Gy 5 100 rad, 1 cGy 5 1 rad
Equivalent dose 1 Sv 5 100 rem, 10 mSv 5 1 rem
1 mSv 5 0.1 rem 5 100 mrem
210
2
C
Determining and Expressing Effective Dose
(EfD) in Rem
Example: The WR for x-radiation is 1 (see Table 4.2), and the
WT for the gonads is 0.20 (see Table 4.3). If the gonads
receive an absorbed dose (D) of 10 cGy from exposure to
x-radiation, what is the EfD in rem?
Answer:
EfD 5 D 3 WR 3 W
T
5 10 3 1 3 0.20
5 2 rem
5 2/100 5 0.02 Sv 5 20 mSv
Traditional and SI Equivalents
1 roentgen (R) equals 2.58 3 1024 C/kg of air
1 milliroentgen (mR)
equals
1 rad equals 100 erg/g
1 millirad equals 1023 rad
1 rem equals
1 millirem equals
1
1000
R or 1023 R
1
100
J/kg
1
100
Gy
1 cGy
1
100
J/kg (for x-radiation,
Q 5 1)
1
100
Sv
1 cSv
10 mSv
1
1000
rem
A P P E N D I X
B
Image Gently Pledge and Image Wisely Pledge
Pledges begin on January 1 of each year and expire on
December 31 of the same year. It is up to the radiographer to renew the pledges each year.
IMAGE GENTLY PLEDGE
Yes, I want to image gently.
Recognizing that every member of the health care team
plays a vital role in caring for the patient and wants to
provide the best care, I pledge:
• To make the image gently message a priority in staff
communications this year
This certificate is completed online by the individual (named here) who has
pledged to “image gently.” In doing so, he/she pledges:
to make the image gently message a priority in staff communications this year
to review the protocol recommendations and, where necessary, implement adjustments to practice processes
to respect and listen to suggestions from every member of the imaging team on ways to ensure changes are made
to communicate openly with parents
The Alliance for Radiation Safety in Pediatric Imaging thanks those who commit to the goal to “image
gently” in the imaging of children. Spread the word in your department, practice, hospital or clinic.
• To review the protocol recommendations and, where
necessary, implement adjustments to our processes
• To respect and listen to suggestions from every member of the imaging team on ways to ensure changes
are made
• To communicate openly with parents
Thank you for committing to the goal to image gently
when you image or treat children.
Spread the word in your department, practice, hospital,
or clinic.
Take the pledge at https://radsociety.wufoo.com/forms/
image-gently-pledge/
Name/Practice Address Date
The Image Gently Campaign is a message from the Alliance for Radiation Safety in Pediatric Imaging.
This certificate is not an accreditation document from the Image Gently campaign. It is a sign of the voluntary pledge taken by the named individual.
Visit the website at www.imagegently.org for more information
From The Image Gently Alliance, www.imagegently.org.
345
346
APPENDIX B Image Gently Pledge and Image Wisely Pledge
IMAGE WISELY PLEDGE
Pledge for Imaging Professionals
Yes, I want to image wisely.
I wish to optimize the use of radiation in imaging patients
and thereby pledge:
1. To put my patients’ safety, health, and welfare first by
optimizing imaging examinations to use only the radiation necessary to produce diagnostic-quality images
2. To convey the principles of the Image Wisely program to
the imaging team in order to ensure that my facility
optimizes its use of radiation when imaging patients
3. To communicate optimal patient imaging strategies to
referring physicians and to be available for consultation
4. To routinely review imaging protocols to ensure that
the least radiation necessary to acquire a diagnosticquality image is used for each examination
5. To monitor examination radiation dose indices to enable comparison to established diagnostic reference
levels
Take the pledge at http://www.imagewisely.org/Pledge/
Imaging-Professionals-Pledge