S.

Balter1

Technical note:
Stray radiation in fluoroscopy

Appropriate Fluoroscopists and their assistants are exposed to room is determined by the mechanical
management of stray radiation fields as they work. An under- arrangement of the imaging system.
the working standing of stray radiation permits better man-
environment agement of the working environment. This X-rays are produced when the X-ray tube is
reduces the article reviews some basic physics and presents energized. A small quantity of radiation leaks
exposure of measurements obtained in a cardiac fluoroscopic through the lead-lined shield surrounding the
fluoroscopists environment. X-ray tube. A fraction of the useful beam that
and their assist- strikes the patient is scattered. Under clinical
ants to stray The intensity of the stray radiation field depends conditions, the scattered radiation will generally
radiation. on the X-ray factors and beam size. The spatial be much more intense than the leakage
distribution of stray radiation in a fluoroscopy radiation.
Fig. 1.
1 2a
The two main
sources of stray
radiation are
leakage from the
X-ray tube, and mA mA
scatter from the
patient.

kVp kVp

Fig. 2 a.
Stray radiation: the
effects of changing
mAs and kVp.
Baseline.

Fig. 2 b.
2b 2c
Increased mA.

mA mA

kVp kVp
Fig. 2 c.
Increased kVp.

1Senior Medical
Physicist, Philips
Medical Systems
N.A., Shelton,
CT, U.S.A.

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36 medicamundi March 1997
When the radiation geometry (source-skin
distance and field size) is constant, the amount
of scatter will depend on the primary X-ray dose
at the patient’s skin. Changing the primary skin
dose by changing the mAs value (Fig. 2 b) cre-
ates a proportional change in leakage and scatter.
Changing the primary skin dose by changing the
kVp (Fig. 2 c) causes a nonlinear change in
leakage and scatter.
When the collimator on an energized X-ray tube
is completely closed (Fig. 3 a), the only radiation
reaching the meter is leakage from the tube.
When the collimator is partially opened
(Fig. 3 b), the meter reading increases because
it is exposed to the same leakage radiation from
the tube, and additional scattered radiation from
the patient.
The amount of scattered radiation depends on
the total number of X-ray photons striking the
3a
patient. A fully opened collimator (Fig. 3 c) Some of the
allows more X-ray photons to strike the patient. projections used
This creates more scattered radiation. The read- in cardiovascular
ing of the stray radiation meter further increases. procedures can
expose operators
Diagnostic X-rays are uniformly scattered in all to high stray
directions. The amount of scatter that can be radiation fields.
measured outside the patient depends on both
the amount of scatter that is produced and
on the attenuation of scatter by the patient’s
tissues.
The amount of scatter produced in a small block
of tissue is proportional to the amount of
primary radiation reaching that block. The
primary X-ray beam is attenuated as it passes
through the patient, so that more scatter is
produced in the highly irradiated blocks of tissue
near the X-ray tube, while much less scatter is
produced in the lightly irradiated blocks of tissue
near the image intensifier (Fig. 4).
Fig. 3 a.
3b
Stray radiation: the
effects of changing
field size.
Collimator closed:
leakage radiation
only.

Fig. 3 b.
Small field: leakage
and a small amount
of scatter.

Fig. 3 c.
3c
Larger field: leakage
and a larger
amount of scatter.

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March 1997 medicamundi 37
 The primary goal Scatter is emitted in all directions. Like the
of staff radiation primary beam, it is attenuated as it passes
management is through the patient. However, there is relatively
to reduce the little tissue in a position to attenuate the large
effective dose amounts of scatter produced at the entrance
received by staff surface near the X-ray tube and directed back
members. toward the X-ray tube (backscatter). There is
more tissue in a position to attenuate the scatter
produced at the entrance surface which is
directed toward the image intensifier (Fig. 5).
The asymmetric distribution of scatter is
important to fluoroscopists. Gastrointestinal
systems are often designed with the X-ray tube
under the patient. In this geometry, the intense
backscatter is directed toward the floor.
Cardiovascular procedures require many
different beam orientations. Projections such as
the cardiac LAO-90 (Fig. 6) can expose
operators to high stray radiation fields.
Fig. 4 a.
4a
Scatter: the effect
of primary beam
intensity. A high
primary beam
intensity creates
a large amount
of scatter.
The attenuation of primary and scatter radiation
by the patient reduces the stray radiation field on
the image-intensifier side of the table by more
than a factor of ten in comparison with the field
on the X-ray tube side of the table.
The stray radiation field on the X-ray tube side
of the table has steep gradients due both to the
inverse-square law and to attenuation of scatter
by the patient. To provide optimum patient care,
the primary operator must usually stand at
position A (Fig. 6 c). The radiation field at point
B, 50 cm further towards the patient’s feet,
about one-quarter as intense as that at point A.
The actual intensity at point A is highly
dependent on the projection angle, but the ratio
between points A and B is essentially independ-
ent of the projection angle.
The stray radiation field on the image-intensifier
tube side of the table is much less intense. In the
4b

Fig. 4 b.
A low primary
beam intensity
creates a small
amount of scatter.

Fig. 5 a. Scatter: the

5a 5b
effect of attenuation
on production and
emission of scattered
radiation. More
scattered radiation is
produced by the un-
attenuated primary
beam near the en-
trance surface than
by the attenuated
primary beam near
the exit surface.

Fig. 5 b.
More scattered
radiation leaves the
primary beam
entrance surface
than the exit surface.

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38 medicamundi March 1997
 Fig. 6 a.
6a 6b
Staff exposure to
0.25 0.25 stray radiation in
a cardiovascular
system using the
LAO-90 projection.
Typical fluoroscopic
stray radiation
levels from LAO-90
projection at a
8.00 height of 100 cm
from the floor.

00
4.
1.00

00

00
2.
0.50

1.
8.00 Fig. 6 b.

50
25 0 The stray radiation
1.0

0.
0.

intensity on the

00
25
0.2

4.
5
beam entrance side

00
0.
Scale 50 cm

00
2.

1.
is more than
mR/h for a 'Typical' patient
10 times the inten-
sity on the exit side.

Fig. 6 c.
extreme example shown, an assistant standing at 6c Staff exposure to
position C will be much less exposed than the stray radiation
individual standing at point B. This difference changes with
position relative to
will become less as the X-ray tube angulation C the beam.
decreases toward the PA projection. In RAO
projections, there will be more radiation at
position C than position B. Individuals working
in fluoroscopy rooms are typically exposed to
non-uniform radiation fields.
A B
In Figure 6 c, there is a difference of a factor of
three between the left and right sides of the
individual standing in position A. There are
smaller gradients at positions B and C. For any
place in the room, the intensity and gradient of
the field vary widely with projection geometry.
This complicates accurate personnel monitoring 10–20. This attenuation reduces the exposure of
and dose assessment. the shielded tissues and thus reduces the ED.

The primary goal of any safety program is to
reduce risk. For staff radiation management, this
means reducing the Effective Dose (ED) received
by staff members. A single surface measurement,
such as a film-badge reading on the operator’s
collar, will usually overestimate the ED. This is
due to both the field gradients and attenuation
of the stray radiation field by the operator’s
superficial tissues. Protective clothing typically
provides an additional attenuation factor of
The many things that can be done to minimize
staff ED could fill another article. There should
also be a balance between radiation and other
risks. For example, doubling the weight of a lead
apron might produce a small decrease in ED at
the cost of increasing the probability of back
injury. Ultimately, there has to be a balance
between patient and staff safety. The reasonable
application of basic knowledge will certainly
help in the fulfilment of these goals.

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