Answer to Question #8775 Submitted to "Ask the Experts"

Q

In the process of reading answers about shielding and radiation safety, I was surprised to find the recommendation to have pet owners hold/restrain their animals during radiography when necessary, as a method of reducing exposure to veterinary staff. I was taught that clients/owners/nonradiology or veterinary staff are forbidden to be present in the radiology rooms during exams. As I read most state regulations, this is the requirement in both human and veterinary medical facilities.

(An example from the Colorado Department of Public Health and Environment Web site in the radiation regulations section:

"6.3.1.1.5 .....only the staff and ancillary personnel required for the medical procedure or training shall be in the room during the radiographic or fluoroscopic exposure.")

Is this not the case? Would clients be allowed to be present when necessary as long as lead aprons/shielding is used? Is this how/why parents are enlisted to hold their children when restraint is necessary?

A

The issue hinges on whether the individual in the x-ray room is necessary for the procedure that is being performed.

The National Council on Radiation Protection and Measurements (NCRP) makes several recommendations in NCRP Report 148, Radiation Protection in Veterinary Medicine, issued 30 December 2004. The report indicates that mechanical supporting and restraining devices or sedation should be used; only those persons whose presence is necessary shall be in the x-ray room during the exposure; no person should routinely hold patients during diagnostic x-ray examinations; if it is necessary that someone hold the patient, that individual shall be protected with appropriate shielding devices (lead aprons and gloves); and pregnant women and persons under the age of 18 shall not be permitted to hold the patient.

NCRP also made a recommendation in Report No. 48, Radiation Protection for Medical and Allied Health Personnel, issued 1 August 1976. In that report, the following recommendations were made:

"Tape is often used to help position patients and many commercial immobilizers are available, but these are sometimes not adequate and it may be necessary for someone to hold or restrain the patient. No person shall be employed specifically to hold patients, nor should members of the Radiology Department who are classified as radiation workers be asked to do so. If the patient must be held during the x-ray exposure, aides, orderlies, nurses, or members of the patient's family should be enlisted for this duty. Such persons shall be provided with protective apron and gloves, and be positioned so that the unattenuated useful beam does not strike any part of the body. A few assignments of this kind need cause no concern; efforts should be made to limit the number of times any one person is called upon to do such work."

If restraint is necessary, and there is no other way to provide that except by having an individual assist in the procedure, then that ancillary person's presence in the room would be justified. However, this is not to be considered a routine practice.

The state regulation that you cite goes on to indicate that ancillary persons shall take protective measures, such as positioning outside the useful beam and using protective shielding like apron and gloves, and that no individual shall be used routinely to hold film or patients.

You should always be aware of the applicable local requirements and regulations, as you seem to be. If there is a concern that these requirements are not being met, you should consult your facility's radiation safety officer.

Joseph DeCicco, CHP
Cynthia Jones, PhD, ATE Editor