Mission: To enhance cooperation among Gastroenterologists & Endoscopists on radiation safety in

procedures that utilize ionizing radiations

Newsletter
Radiation Protection for Gastroenterologists and
Endoscopists in the Americas

Newsletter
Issue No. 5


From the Editors Desk
Dr. Asadur Jorge Tchekmedyian
asadur@adinet.com.uy

Estimados colegas y amigos,
Seguimos adelante con las
novedades en radioproteccin
en endoscopia digestiva,
encontrndonos con nuevos
desafos.
Es con gran placer que les
comunicamos que a partir de este mes, el grupo de
trabajo se denominar Network of
Gastroenterologists & Endoscopists in Radiation
Protection in the Americas y ser realizado en el
marco del Comit de Educacin de la Sociedad
Interamericana de Endoscopia Digestiva (SIED).
Como actividad continental publicaremos artculos
tanto en espaol, ingls y/o portugus.
El Organismo Internacional de Energa Atmica
(OIEA) nos continuar apoyando en la difusin del
boletn y como siempre en el soporte acadmico.
En este aspecto, agradecemos al Dr. Alejandro
Nader por su permanente apoyo.
De esta manera el objetivo de llegar a quienes
practican intervencionismo endoscpico bajo
fluoroscopia da un paso adelante.
Agradecemos al Dr. Zagalsky, chairman del Comit
de Educacin de SIED el permitirnos avanzar en
este aspecto y los invitamos a leer su columna ms
adelante en este boletn.
Por otra parte, en marzo de 2013, se realiz el V
Curso Internacional de Endoscopa Teraputica y
Endosonografa, en la Clnica Alemana de Santiago
de Chile.
Este curso, organizado por los Dres. Roque Senz y
Claudio Navarrete reuni a colegas de todo el
continente en un excepcional encuentro sobre
endoscopia teraputica. En el mismo se introdujo
por vez primera el tema radioproteccin en
endoscopia.


Grupo participante del Curso de Endoscopia en Santiago
de Chile, Marzo 2013.

Continuando con la formacin en esta disciplina, en
mayo se realiz en Montevideo, Uruguay el
Segundo Taller Regional sobre la Implementacin
de las Nuevas Normas Bsicas Internacionales de
Seguridad (NBS) GSR Parte 3: Proteccin
Radiolgica y Seguridad de las Fuentes de
Radiacin. En este taller se abordaron diversos
temas, siendo uno de ellos la radioproteccin en
intervencionismo.
Les recordamos que este ao es el Congreso
Panamericano de Gastroenterologa y Endoscopia
Digestiva en Buenos Aires, Argentina. Su sitio web
es http://www.gastro2014.com
Es con satisfaccin que observamos la difusin de la
radioproteccin en Latinoamrica. Congreso tras
congreso, evento tras evento, la radioproteccin se
ha convertido en un tema obligado en nuestra
especialidad.
An nos resta camino por recorrer. Este camino se
construye da a da y nos obliga a trabajar cada vez
ms por nuestros pacientes y por nosotros mismos.
Hasta el prximo nmero!

*****************






Mission: To enhance cooperation among Gastroenterologists & Endoscopists on radiation safety in
procedures that utilize ionizing radiations

Newsletter
Radiation Protection for Gastroenterologists and
Endoscopists in the Americas

Newsletter
Issue No. 5

Radiation protection in the Endoscopy Suite
Dres. Asadur Tchekmedyian, Everson Artifon, Jean-Marc
Dumonceau, Todd Baron, Roque Saenz

Cummulative risk associated to advanced GI
endoscopy procedures related to radiation
exposure (ERCP, stenting, dilatations, etc) is a major
issue for those medical GI endoscopy associations,
WEO (World Endoscopy Organization) and SIED
(Sociedad Interamericana de Endoscopia Digestiva),
giving directions to avoid damage, not only for the
patients (pregnancy for instance), but also for the
endoscopist himself and the staff personnel.

The involvement of endoscopists in procedures that
use fluoroscopy is increasing day by day as
endoscopy moves from being solely a diagnostic
procedure to a more complex, demanding and
interventional technique.

Fluoroscopy results in radiation exposure to both
staff and patients. In all circumstances in which
fluoroscopic and/or x-ray equipment is used,
endoscopists should minimize risks to patients,
themselves, and other staff members. It is essential
to establish the appropriate indication for the use
of radiation in all circumstances, in order to avoid
unnecessary exposure of patients and staff to
potentially harmful radiation.

Despite these concerns voiced from expert centers
around the world, there are still places where
endoscopists have no formal training in radiation
safety due to a lack of universal framework and/or
educational support.

A recent survey in Latin America
1
conducted by part
of our team found that radiation protection
measures (physical and personal dosimetry) are
underutilized in Latin America, except for the use of
lead aprons. There is low attendance to training
courses and virtually no institutional or legal
benefits for personnel who are exposed to radiation
in our specialty.

Our aim is to spread the voice and increase
knowledge wherever endoscopists perform
procedures under fluoroscopy.
Basic tips are not use radiation if not needed, use
protective implements for those exposed to
radiation, use maximal collimation and adequate
technique, cover the lower part of the endoscopy
table, avoid radiation from this source & follow
ALARA principle.

The International Atomic Energy Agency (IAEA) has
conducted several training courses for non-
radiologists and non-cardiologists that includes, in
addition to gastroenterologists, orthopedic
surgeons, urologists, gynecologists, vascular
surgeons and neurosurgeons.

We need to act to prevent overexposure to harmful
radiation. Wisdom demands preventive action
before accidents create a critical situation and
every action requires teamwork in order to be
effective.

We have been working on this since 2010, when a
network of gastroenterologists was established for
Latin-America. This newsletter is the evolution of
our original newsletter published solely in English
and distributed by IAEA.

At the IAEA web site
2
information on radiation
protection and useful links can be found in English,
Spanish and Portuguese due to our cooperative
work.
Our wish is that this message reaches GI
endoscopists worldwide. Our hope is that we can
contribute to provide safety and excellence in our
practice.
As always, know it, teach it, and follow it.
Ref:
1. Tchekmedyian A, Trigo T, Rodrguez M, Blanco D, Artifon E. Encuesta
latinoamericana de radioproteccin en endoscopia digestiva. Revista
de Gastroenterologa de Mxico 2012;77(Supl 2):47-8
2.http://rpop.iaea.org/RPOP/RPoP/Content/InformationFor/HealthProf
essionals/6_OtherClinicalSpecialities/gastroenterology/index.htm

******




Mission: To enhance cooperation among Gastroenterologists & Endoscopists on radiation safety in
procedures that utilize ionizing radiations

Newsletter
Radiation Protection for Gastroenterologists and
Endoscopists in the Americas

Newsletter
Issue No. 5

Dr. David H. Zagalsky.
Chairman del Comit de Educacin de SIED
dudyzaga@gmail.com

El Dr. D Prez entr a la sala de Rayos.
Inconscientemente se agach al
pasar por debajo del sector del
cielo raso donde las ltimas
lluvias torrenciales haban
producido la cada de yeso y
materiales.
Entr a la sala de Comando del
equipo telecomandado y pens:
qu lindo sera poder trabajar desde aqu como lo
hacan hace 30 aos los Radilogos al efectuar
Seriadas o Colon x enemas.
Tomo los 8 delantales plomados disponibles y puso
un juego de llaves sobre la mesa. Prendi el
colimador y lo centr en las llaves. Uno a uno
desde el comando protegido por paredes y vidrio
plomado- fue poniendo los delantales plomados de
manera que cubrieran las llaves. Todos
demostraban una transparencia preocupante. Salvo
uno. Lo mir con cario. Lo haba comprador
durante un congreso de Radiologa, y despus de
tenerlo colgado en su garaje y usarlo muy
ocasionalmente, decidi llevarlo al Hospital. Era el
nico que ocultaba las llaves.
Hizo pasar a la embarazada de 3 meses a la que
haba que efectuarle una CPRE y tap con cuidado
su abdomen para evitar la irradiacin
imprescindible que pudiera producirse al utilizar el
tubo.
Luego hizo la CPRE utilizando en total 3 segundos
de radiacin ionizante

Vivimos en un mundo contrastante. Por un lado se
adquieren Resonadores de alta potencia que
permiten imgenes anatmicas que parecen salidas
de los libros de Ciencia ficcin de Huxley o Asimov.
Por el otro en Latinoamrica sobre todo, los
controles y regulaciones sobre radio proteccin son
escasos. Y habiendo sido testigo del accionar de
reconocidos colegas que hacen ciruga mini
invasiva y acceso percutneo a la va biliar, me
queda claro que en su formacin el nivel de
instruccin sobre radio proteccin ha sido en el
mejor de los casos escaso.
Consideramos que mediante la difusin del Boletn
a travs de SIED, colaboramos a difundir el tema,
promoviendo las actividades de la Comisin de
Educacin. Para todos aquellos que en algn
momento requerimos el uso de ese increble aliado
que son los Rayos ponemos a disposicin el Boletn.
Para finalizar, simplemente recordarles que si no
nos protegemos nuestro aliado puede ser un
enemigo silenciosoy mortal.

**********

Timely publication for
gastroenterologists on radiation
protection
Madan M Rehani, PhD
Expert, International Atomic Energy Agency,
Vienna, Austria
madan.rehani@gmail.com

I am very happy that under the
leadership of Dr. Asadur Jorge
Tchekmedyian, this newsletter is
now being pursued by
professionals, after being a part
of the network that I facilitated
creation under IAEA project. It is
truly the spirit of IAEA actions that Member States
should achieve self-sufficiency and there should be
sustainability of actions without IAEA support. I am
extremely happy to see this happening as it is only
in Feb 2011 that the first issue of the newsletter
was issued. Congratulations to Asadur.
It is further nice to see timely interest on part of
gastroenterologists in radiation protection. I wish to
draw attention of readers of this newsletter
towards a paper that has just been published in Am
J Gastroenterology. It is available online from 20
May 24, 2014. This paper reviews the current
evidence for such risk, and aims to inform the
gastroenterologist of dosages of radiation
associated with commonly ordered procedures and
diagnostic tests in clinical practice. The use of
medical radiation must always be justified and must




Mission: To enhance cooperation among Gastroenterologists & Endoscopists on radiation safety in
procedures that utilize ionizing radiations

Newsletter
Radiation Protection for Gastroenterologists and
Endoscopists in the Americas

Newsletter
Issue No. 5

enable patients to be exposed at the lowest
reasonable dose. Recommendations provided
herein for minimizing radiation exposure are based
on currently available evidence and Working Party
expert consensus.

Ho IK, Cash BD, Cohen H, Hanauer SB, Inkster M, Johnson
DA, Maher MM, Rex DK, Saad A, Singh A, Rehani MM,
Quigley EM. Radiation Exposure in Gastroenterology:
Improving Patient and Staff Protection. Am J
Gastroenterol. 2014 May 20. doi: 10.1038/ajg.2014.122.
http://www.ncbi.nlm.nih.gov/pubmed/24842339

Further resources of interest to gastroenterologists
are:
10 Recomendaciones para proteccin de pacientes
en fluoroscopa
10 Recomendaciones para la proteccin del staff en
fluoroscopa
Information for staff and patient protection in
English, Spanish and Portugese
Joint ASGE/IAEA/WGO guideline


**********




















RADIATION PROTECTION
Highlight (from IAEA posters)

Tips for radiation protection of the staff in
fluoroscopy:

Keep X ray tube under the patient
table and not over it
Use undercouch systems


ASK DR. REHANI

Si tienes una duda o consulta sobre radioproteccin, envanos un e-mail a
newsletterradioprotection@gmail.com y con gusto el
Dr. Madan M Rehani, PhD, experto del Organismo Internacional de Energa Atmica te
contestara en el prximo boletn.

If you have any doubts or concerns about radiation protection, send us an email to
newsletterradioprotection@gmail.com and
Dr. Madan M Rehani, PhD, expert from the International Atomic Energy Agency will answer
you in the next newsletter.

Se voc tiver quaisquer dvidas ou preocupaes sobre a proteco contra as radiaes,
envie-nos um e-mail newsletterradioprotection@gmail.com
Dr. Madan M Rehani, PhD, um perito da Agncia Internacional de Energia Atmica em
responder-lhe no prximo boletim.