PRECONDITIONS

Prior to implementing X-ray services or installing new equipment, it is essential to:

• Inquire about national radiation regulations as this may impact; equipment selection, X-ray room design, radiation safety requirements, licensing, HR staffing requirements etc
• Contact the Diagnostic Imaging Working Group (diagnostic-network@msf.org) for support and to:
• select the most appropriate x-ray equipment or assess the functioning of existing equipment
• organize the installation, implementation, maintenance and technical support
• assess the x-ray room and the need for general and personal protective equipment
• arrange training and implementation of MSF policies and procedures
• assess and/or provide training on appropriate clincal indications (use of X-ray) & X-ray interpretation for the medical team

GENERAL RADIOPROTECTION MEASURES

Staff and patients’ attendants protection

• Time, distance and shielding are the fundamentals of radioprotection measures
• Time
• Where appropriate reduce the time near the X-ray source. Limit access to the x-ray room to only those people absolutely necessary.
• Distance
• One of the most simple and effective measures. Increase your distance from the X-ray machine and patient when taking radiographs - in particular when using a mobile X-ray to decrease your dose (inverse square law).
• Shielding
• Fixed X-ray rooms are designed to protect the operators by providing a protective barrier (e.g. lead lined walls and lead glass window).
• Operators using a mobile X-ray wear radioprotective clothing (lead or lead equivalent material apron & thyroid protection).
• Extra
• Any person staying beside patient when taking a radiograph must:
• stand as far as away from the radiation beam
• wear individual radioprotective clothing (lead or lead equivalent material apron & thyroid protection).

Protection of patients

• Justification: only x-ray a patient when it is clinically indicated. See MSF X-ray indications.
• Optimization - ALARA, use the lowest reasonable dose for the specfic patient / examination that produces a quality image. See MSF X-ray exposure chart (requires trained radiographers).
• Ensure appropriate radiographic technique is used for each examination, including restricting the X-ray beam to the area of interest (collimation), correct X-ray equipment use, patient communication and positioning supports are available.
• Ensure an appropriate policy is in place for screening potentially pregnant patients prior to performing X-ray imaging.

MEASUREMENT OF RADIATION DOSES

Before starting an x-ray program, it is essential to:

• Inquire about national regulations concerning radioprotection
• Check if there is a national organisation in charge to monitor x-ray doses by dosimetry and try to install a similar monitoring system

For more information, contact the Diagnostic Imaging Working Group (diagnostic-network@msf.org).

SELECTING AN X-RAY MACHINE

The most appropriate X-ray equipment will depend on the specific project requirements. The WHIS-RAD or MULTI-RAD x-ray unit is generally preferred as the primary option for MSF hospital based projects, but may not be suitable in all scenarios. Before ordering an x-ray unit, please contact the Diagnostic Imaging Working Group (diagnostic-network@msf.org) for advice, and to discuss radiation safety requirements, human resources requirements, servicing and necessary accessory equipment.