Essay: Reader Response

A Quest for Immediate Feedback Leads to Change

Rakesh Shah, MD, Clear Lake Regional Medical Center, Webster, Texas

Rakesh Shah, MD, Clear Lake Regional Medical Center, Webster, Texas

At the Clear Lake Regional Medical Center in Texas, radiation safety has always been at the top of our minds. My colleagues and I have always been concerned about the cumulative effect of radiation exposure for physicians and clinicians to certain parts of the body. Studies have shown that physicians and clinical staff working in cath labs and exposed to radiation on a regular basis have experienced a higher risk for getting cataracts, thyroid and other cancers.   

All staff in the cath lab is required to wear dose monitor badges. The badges monitor radiation dose and reports are generated on a monthly basis, assessing cumulative radiation dose exposure. We currently use the regulated monthly legal dose monitoring badges. We are alerted to our levels every month and are required to sign off on them if we exceed a certain level of exposure.

I’ve had to sign waivers in the past in order to continue to work in the cath lab. I’ve signed them more frequently than I would like to admit. On many occasions, I have taken a long vacation to help balance the busier times when I am working. I know that is not the answer to limiting radiation exposure over the course of my career.

My colleagues and I were interested in investigating ways to monitor and minimize exposure as much possible, so we decided to find out what our real-time exposure to radiation looked like on a daily basis. 

We discovered the RaySafe i2 system (Unfors RaySafe), a real-time dose monitoring system that allows you to see your exposure as it is happening. It has changed the way we operate.

During my 15-year career, I often perform transradial catheterizations, which require the physician to be in close proximity to the patient and thereby subjects them to a higher probability of radiation exposure.

The RaySafe i2 has allowed us to have a virtual window into a previously invisible world. The monitor displays individual readings as it is relayed from badges worn by staff in the room. Monitoring dose levels in real time makes the difference. Every time I step on the floor, I look at the monitor and with a slight adjustment from where I stand, I can see an instantaneous change, especially with long peripheral procedures. Of course, it’s impossible to avoid all radiation exposure in a cath lab, but with this device, we have been able to substantially reduce it.

The real-time feedback literally changed the way I do transradial procedures. I am more conscientious of where I stand and how I position the mobile shield. With the shield in front of me, I see a significant difference in exposure.

I am quite involved in educating the staff in radiation safety. I’m adamant that they do not step in the radiation field for any reason, including to talk to patients. It’s not a safe thing for them to do.

I do remind them often to look at the screen and be aware of where they are at all times during any procedure. Scatter radiation is a reality of our work and we need to take the proper precautions. The dedicated staff I work with has reached the same conclusion; taking precautions to avoid excessive radiation exposure is necessary, but not often at the forefront of everyone’s mind.

Cath lab supervisor Jennifer Bird, RN, has shared some alarming information with me, including that as a nurse, she and many of her peers didn’t receive radiation training in nursing school.

Jennifer, who has been practicing for eighteen years and in the cath lab for the last five, said the RaySafe i2 and physician training was an eye-opening experience that allowed her and the other nurses to see in real time how effective proper shielding can be and how exposures happen. 

The mandatory radiation badges are a good tool, but connecting your radiation dose information, given to you only after many procedures over the course of a month, will not help you pinpoint where you can effectively make changes.

At our hospital, the staff is very involved and in fact, has led the way in conducting blind studies by procedure to compare the results when done with and without the RaySafe i2. Keeping the staff actively involved in the process encourages collaboration and improvements for all. 

Dr. Rakesh Shah is a cardiologist in Webster, Texas and is affiliated with Clear Lake Regional Medical Center. He received his medical degree from MCV/VCU and has been in practice for more than 20 years.