X-RAY ROOM DESIGN & SHIELDING RADIATION SHIELDING - TYPICAL ROOM LAYOUT

一 NCRP 147 X-ray Room Designs and Shielding Calculations A to G are points used to calculate shielding.
一 Center for Device Regulation Radiation Health and Research
(CDRRHR) under BFAD and DOH

PURPOSE OF SHIELDING
1. To protect:
a. Patients
b. X-ray department staffs
c. Visitors
d. General public
e. Persons working adjacent or near the x-ray
facility RADIATION SHIELDING - CALCULATION
● Based on NCRP report no. 147, structural shielding
RADIATION SHIELDING - DESIGN CONCEPTS design for medical x-ray imaging facilities (2004)
Data required consideration of: ● Assumptions used are conservative, so over-shielding is
1. Type of x-ray equipment common.
2. Usage (workload) ● Software is available giving shielding in thickness of
3. Positioning various materials.
4. Whether multiple tubes or receptors are being used RADIATION SHIELDING PARAMETERS
5. Primary beam access (vs. scatter only) P - design dose per week
6. Operator location ● Usually based on 5 mSv per year for occupationally
7. Occupancy of surrounding areas exposed persons (25% of dose limit), and 1 mSv for the
public.
RADIATION SHIELDING - SHIELDING DESIGN ● Occupational dose must only be used in controlled
Equipment areas, i.e., for radiographers, radiologists, and other
1. What equipment is to be used? radiation workers.
a. General radiography ● Film storage areas (darkrooms) need special
b. Fluoroscopy considerations.
c. Dental (Oral, Cephalometric, or OPG) ● Long periods of exposures will affect the film, but
d. Mammography much shorter periods (i.e., lower doses) will fog film in
e. CT cassettes.
The type of equipment is very important for the following reasons: ● A simple rule is to allow 0.1 mGy for the period the
1. Where the x-ray beam will be directed film is in storage - if this is 1 month the design dose is
2. The number and type of procedures performed 0.025 mGy/week.
3. The location of the radiologic technologist (operator) ● Remember we must shield against three (3) sources of
4. The energy (kVp) of the x-rays radiation. These are:
Usage: ○ Scattered radiation (from the patient)
● Different x-rays have very different usage. ○ Primary radiation (the x-ray beam)
● For example, a dental unit uses low mAs and low kVp ○ Leakage radiation (the x-ray tube)
(~70), and takes relatively few x-rays each week U - use factor
● A CT scanner uses high (~130) kVp, high mAs, and ● Fraction of the time primary beam is in a particular
takes very many scans each week. direction i.e., the chosen calculation point.
● The total mAs used each week is an indication of total ● Must allow for realistic use for all points, sum may
x-ray dose administered. exceed 1.
● The kVp is also related to dose, but also indicates the ● For some x-ray equipment the x-ray beam is always
penetrating ability of the x-rays. stopped by the image receptor thus the use factor is 0 in
● High kVp and mAs means more shielding is required. other directions i.e., CT, fluoroscopy, mammography.
Number of x-ray tubes: ● For general radiographic and fluoroscopic equipment
● Some x-ray equipment may be fitted with more than the primary beam is usually intercepted by the image
one tube. detector. This reduces shielding requirements.
● Sometimes two tubes may be used simultaneously, and ● For radiography, there will be certain directions where
in different directions. the x-ray beam will be pointed:
● This naturally complicates shielding calculation. ○ Towards the floor
RADIATION SHIELDING - POSITIONING ○ Across the patient, usually only in one
The location and orientation of x-ray unit is very important: direction
● Distances are measured from the equipment (inverse ○ Toward the chest Bucky stand
square law will affect dose) ● The type of tube suspension will be important, e.g.,
● The directions the direct (primary) x-ray beam will be ceiling mounted, floor mounted, C-arm, etc.
used will depend on the position and orientation. T - occupancy
RADIATION SHIELDING - DESIGN DETAIL ● T = fraction of time a particular place is occupied by
Must consider: staff, patients, or public.
1. Appropriate calculation points, covering all critical ● Has to be conservative
locations. ● Ranges from 1 for adjacent offices and work areas, to
2. Design parameters such as workload, occupancy, use 1/20 for public toilets, and 1/40 for outdoor areas with
factor, leakage, target dose. transient traffic.
3. These must be either assumed or taken from actual data.
4. Use a reasonable, worst case scenario (conservatively
high estimates), since under-shielding is worse than
over-shielding.
 ● Gypsum or high atomic number (Z) plasterboard
● Concrete block
● Leaded glass or acrylic
ROOM SHIELDING - CONSTRUCTION PROBLEMS
● Brick walls - mortar joints
● Use of lead sheets nailed to timber frame
● Lead inadequately bonded to backing
W - workload ● Joints between sheets with no overlap
● A measure of radiation output in one week ● Use of hollow core brick or block
● Measured in mA - minutes ● Use of plate glass where lead glass specified
● Varies greatly with assumed maximum kVp of x-ray PROBLEMS IN SHIELDING - BRICK WALLS AND
unit MORTAR JOINTS
● Usually a gross overestimation ● Bricks should be solid and not hollow
● Actual dose / mAs can be estimated ● Bricks have very variable x-ray attenuation
● For example: a general radiography room ● Mortar is less attenuating than bricks
● The kVp used will be in the range 60-120 kVp ● Mortar is often not applied across the full thickness of
● The exposure for each film will be between 5 mAs and the brick
100 mAs. PROBLEMS IN SHIELDING - LEAD INADEQUATELY
● There may be 50 patients per day, and the room may be BONDED TO BACKING
used 7 days a week. ● Lead must be fully glued (bonded) to a backing such as
● Each patient may have between 1 and 5 films. wood or wallboard
Estimating W: ● If the lead is not properly bonded, it may peel off after a
1. Assume an average of 50 mAs per film, 3 films per few years
patient ● Not all glues are suitable for lead (oxidation of the lead
2. Thus, W = 50 mAs x 3 films x 50 patients x 7 days surface)
= 52,500 mAs per week PROBLEMS IN SHIELDING - JOINTS BETWEEN SHEETS
= 875 mA - min per week WITH NO OVERLAP
We could also assume that all this work is performed at 100 kVp. ● There must be 10-15 mm overlap between adjoining
EXAMPLES OF WORKLOAD sheets of lead
● Without an overlap, there may be relatively large gaps
for the radiation to pass through
● Corners are a particular problem
● Penetrations for electrical boxes and ducts are of
concern
PROBLEMS IN SHIELDING - USE OF PLATE GLASS
● Leaded glass or acrylic should be used for windows
● Laminated layers of plate glass can be used where
radiation levels are low, e.g., for the wall at the foot of a
WORKLOAD - CT CT scanner
● CT workloads are best calculated from NCRP 147 ROOM SHIELDING - CONSTRUCTION
● Remember that new CT spiral units, or multi-slice CT, ● Continuity and integrity of shielding is very important
could have higher workloads. ● Problem areas:
● A typical CT workload is about 28,000 mA - min per ○ Joints
week ○ Penetration in walls and floor
TUBE LEAKAGE ○ Window frames
● All x-ray tubes have some radiation leakage - there is ○ Door and frames
only 2-3 mm lead in the housing. PENETRATIONS
● Leakage is limited in most countries to 1 mGy hr-1 at 1 ● Means any hole cut into the lead for cables, electrical
meter, so this can be used as the actual leakage value connectors, pipes, etc.
for shielding calculations. ● Unless the penetration is small (~2-3 mm), there must
● Leakage is specified at the maximum rated continuous be additional lead over the hole, nails and screws used
tube current, which is about 3-5 mA at 150 kVp for to fix bonded lead sheets to a wall do not require
most radiographic x-ray tubes. covering.
WINDOW FRAMES
● The lead sheet fixed to a wall must overlap any lead
glass window fitted
● It is common to find a gap of up to 5 cm, which is
unacceptable
SHIELDING DOORS AND FRAMES

ROOM SHIELDING - MULTIPLE X-RAY TUBES

● Some rooms will be fitted with more than one x-ray
tube (maybe a ceiling mounted tube, and a floor
mounted tube)
● Shielding calculations must consider the total radiation
dose from the two tubes.
ROOM SHIELDING - CONSTRUCTION
● Lead sheet brick
SHIELDING - VERIFICATION environment, are reduced to the extent reasonably
● Verification of appropriate thickness and proper achievable.
installation is mandatory TYPES OF EXPOSURE SITUATIONS
● Two choices - visual or measurement 1. PLANNED EXPOSURE SITUATIONS
● Visual check (preferred) must be performed before ● situations involving the planned introduction
shielding covered - the actual lead thickness can be and operation of sources (including
measured easily decommissioning, disposal of radioactive
● Radiation measurement necessary for window and door waste, rehabilitation)
frames etc. 2. EMERGENCY EXPOSURE SITUATIONS
● Isotope source simplifies measurements ● unexpected situations such as those that may
● Measurement for walls very slow occur during of a planned situation, or from
SHIELD TESTING a malicious act, requiring urgent attention
3. EXISTING EXPOSURE SITUATIONS
● situations that already exist when a decision
on control has to be taken, such as those by
natural background radiation and residues
from past practices operated outside the
system
CATEGORIES OF EXPOSURE
1. OCCUPATIONAL EXPOSURES
● exposure of workers incurred as a result of
their work (with the exception of excluded
RECORDS exposures and exposures from exempt
● It is very important to keep records of shielding activities; medical exposure; and
calculations, as well as details of inspections and background)
corrective action taken to fix faults in the shielding. 2. PUBLIC EXPOSURE
● In 5 years, it might not be possible to find anyone who ● all exposures of the public other than
remembers what was done. occupational exposures and medical
● Shielding records should become a permanent part of exposures of patients
the facility engineering records; a copy should be stored 3. MEDICAL EXPOSURE OF PATIENTS
in a room (consider a permanent plaque on the wall in ● incurred by patients as part of their own
the room specifying the amount of shielding in each medical or dental diagnosis or treatment;
wall); and a copy should be retained by the medical volunteers helping in the support and
physicist doing the calculations. comfort of patients; and biomedical research
SUMMARY volunteers
● The design of shielding in an x-ray room is a relatively RESPONSIBILITIES (BSS 3.73)
complex task but can be simplified by the use of some Licensee shall ensure for all workers that:
standard assumptions. ● Occupational exposure be limited and optimized
● Record keeping is essential to ensure traceability and ● Suitable and adequate facilities, equipment and services
constant improvement of shielding according to both for protection be provided
practice and equipment modifications. ● Appropriate protective devices and monitoring
equipment be provided and properly used
RADIATION PROTECTION OF OCCUPATIONAL ● Appropriate training be provided as well as periodic
WORKER, PATIENT AND PUBLIC retraining and updating
● Adequate records be maintained
IAEA BASIC SAFETY STANDARDS (GSR-PART 3 ● A safety culture be provided
(INTERIM)
The Basic Safety Standards (BSS) for protecting people
APPLICATION DOSE LIMIT (1)
and the environment
● Aim to ensure the control of radiation exposure of
workers, medical patients, the public and the Occupational
environment and prevent the occurence of short term
effects from high radiation doses and to minimize risk Effective dose 20 mSv per year averaged over 5
of long term effects years (2)
● Apply internationally agreed standards
● Provide a practical guide to all involved in radiation Effective dose to the embryo 1 mSv
protection or fetus
● Are enforced in activities involving IAEA assitance and
support Annual equivalent dose in: 20 mSv averaged over 5 years (2)
THE SYSTEM OF PROTECTION AND SAFETY ● the lens of the eye 500 mSv
“The fundamental safety objective is to protect people ● the skin (4) 500 mSv
and the environment from harmful effects of ionizing radiation”. ● the hands and feet
● This objective must be achieved without unduly
limiting the operation of facilities or the conduct of 1. The limits apply to the sum of the relevant doses from
activities that give rise to radiation risks. Therefore, the external exposure in the specified period and the
system of protection and safety aims to assess, manage 50-year committed dose (to age 70 years for children)
and control exposure to radiation so that radiation risks, fromintakes of radioactive nuclides in the same period.
including risks of health effects and risks to the 2. With the further provision that the effective dose should
not exceed 50 mSv in any single year.
 3. In special circumstances, a higher value dose could be exposures, and the nature and extent of the required protection and
allowed in a single year, provided that the average over safety procedures
5 years does not exceed 1 mSv in any single year. CONTROLLED AND SUPERVISED AREA (BSS)
4. The limitation on the effective dose provides sufficient ● In a radiology facility, all X Ray rooms shall be
protection for the skin against stochastic effects. An controlled areas
additional limit is needed for localised exposures to ● Supervised areas should include parts of the facility
prevent deterministic effects. where mobile X Ray units are used, and all other parts
OPTIMIZATION OF PROTECTION other than public areas.
● Each room of the facility should only be used for its
specified work
CONTROLLED AREA
● On the basis of a safety assessment including the
planned use of each area and an evaluation of shielding,
the registrant or licensee should determine whether an
area will be maintained as a controlled or public area
● The registrant or licensee should also assess which
other areas (e.g. other patient rooms, stairwells, nursing
stations, waiting areas, toilets) should be controlled, or
public areas
Registrants and licensees shall:
RESPONSIBILITIES (BSS 3.83) ● (a) delineate controlled areas by physical means or,
Workers shall: where this is not reasonably practicable, by some other
suitable means
● follow any applicable rules for protection ● (b) display a warning symbol, such as that
● use properly the monitoring devices and the protective recommended by the International Organization for
equipment and clothing provided Standardization (ISO), and appropriate instructions at
● co-operate with the licensee with respect to protection access points and other appropriate locations within
CONDITIONS OF SERVICE controlled areas
Special compensatory arrangements ● © establish occupational protection and safety
● The conditions of service of workers shall be measures, including local rules and procedures that are
independent of the existence or the possibility of appropriate for controlled areas
occupational exposure ● (d) restrict access to controlled areas by means of
● Special compensatory arrangements or preferential administrative procedures, such as the use of work
treatment with respect to salary or special insurance permits, and by physical barriers, which could include
coverage, working hours, length of vacation, additional locks or interlocks; the degree of restriction being
holidays or retirement benefits shall neither be granted commensurate with the magnitude and likelihood of the
nor be used as substitutes for the provision of proper expected exposures
protection and safety measures to ensure compliance LOCAL RULES AND SUPERVISION (BSS)
with the requirements of the Standards Employers, registrants and licensees shall, in consultation with
Pregnant workers workers, through their representatives, if appropriate (BSS 3.94):
● A female worker should, on becoming aware that she is ● Ensure protection and safety for workers and other
pregnant, notify the employer in order that her working persons
conditions may be modified if necessary. ● Include investigation level or authorized level and
● The notification of pregnancy shall not be considered a procedure in the event that any such value is exceeded
reason to exclude a female worker from work; however, ● Make the local rules known to workers and to other
the employer who has been notified shall adapt the persons
working conditions to assure that the embryo or fetus is ● Ensure any work be adequately supervised
afforded the same level of protection as for members of ● These local rules should include procedures for
the public. wearing, handling, and storing personal dosimeters and
Alternative employment actions to minimize radiation exposure during unusual
● 3.112 Employers shall make every reasonable effort to events
provide workers with suitable alternative employment ESSENTIAL PARAMETERS INFLUENCING PATIENT
in circumstances where it has been determined, either EXPOSURE
by the Regulatory Authority or in the framework of the
health surveillance program required by the Standards,
that the worker, for health reasons, may no longer
continue in employment involving occupational
exposure.
CONTROLLED AREAS (BSS)
Registrants and licensees shall designate as a controlled area any
area in which specific protective measures or safety provisions are
or could be required for: FACTORS IN CONVENTIONAL RADIOGRAPHY
● (a) controlling normal exposures during normal 1. BEAM ENERGY
working conditions; and ● Depending on peak kV and filtration
● (b) preventing or limiting the extent of potential ● Regulations require minimum total filtration
exposures to absorb lower energy photons
In determining the boundaries of any controlled area, registrants ● Added filtration reduces dose
and licensees shall take account of the magnitudes of the expected ● Goal should be use of highest kV resulting
normal exposures, the likelihood and magnitude of potential in acceptable image contrast
 2. COLLIMATION ● Personnel who regularly operate C-arm fluoroscope
● Area exposed should be limited to area of ● Personnel who regularly in the immediate vicinity of
CLINICAL interest to lower dose C-arm fluoroscope
● Additional benefit is less scatter, better FLUOROSCOPY
contrast ● Contributes to the highest occupational exposure of
3. GRID diagnostic X-ray personnel.
● Reduce the amount of scatter reaching ● Personnel exposure is related directly to the X-ray beam
image receptor on time
● But at the cost of increased patient dose X-ray Tube over the table:
● Improves image contrast significantly ● Advantage: better image quality
● Typically 2-5 times: “Bucky factor” ● Disadvantage: higher personnel exposure
4. PATIENT SIZE ● Rationale: higher levels of scatter and leakage radiation
● Thickness, volume irradiated…and dose REMOTE FLUOROSCOPY
increases with patient size ● Results in low personnel exposures - Rationale:
● Except for breast (compression): no control personnel are not in the X-ray Examination with the
● Technique charts with technique factors for patient
various examinations and patient thickness ● Note: it is best to position the X-ray tube under the
essential to avoid retakes patient during mobile and C-arm fluoroscopy
● Also, patient thickness must be measured INTERVENTIONAL RADIOLOGY
accurately to use technique charts properly ● Personnel receive higher exposures
FACTORS AFFECTING DOSE IN FLUOROSCOPY ➔ Longer fluoroscopic X-ray beam on time
● Beam energy and filtration ➔ frequently absence of protective curtain on
● Collimation the image intensifier tower
● Source-to-skin distance ➔ use of cineradiography
➔ Inverse square law: maintain max distance ● DOSE LIMIT: 500 mSv/yr (50 rem/yr)
from patient MAMMOGRAPHY
● Patient-to-image intensifier ● Personnel exposures are low– Rationale: less scatter
➔ Minimizing patient-to-image intensifier radiation due to low kVp operation
distance will lower dose and improve image ● Personnel Protection:
sharpness ➔ Long exposure cord
● Image magnification ➔ Conventional or window wall
➔ Geometric and electronic magnification ➔ Does not require protective shielding
increase dose – Rationale: mammographic protective
● Grid barriers
➔ If small sized patient (less scatter) probably COMPUTED TOMOGRAPHY
not needed ● Personnel exposure are low
● No need for grids on pediatric ● Rationale:
patients ➔ CT X-ray beam is finely collimated
● Grids not necessary for high ➔ Only secondary radiation is present in the
contrast studies, e.g. barium examination room.
contrast studies SURGERY
● Beam-on time! ● Occupational exposure for nursing personnel & other
FACTORS AFFECTING DOSE IN CT working in the operating room & intensive care unit is
● Beam energy and filtration near zero
➔ 80-100 kV reduces dose for pediatric patient ● Not necessary to provide occupational radiation
➔ 120-140 kV with additional filtration monitors for such personnel
reduces adult doses (HVL can be increased MOBILE RADIOGRAPHY
to reduce dose) ● Contributes to the highest occupational exposure of
● Collimation or section thickness diagnostic X-ray personnel.
➔ Post-patient collimator will reduce slice ● Dose Limit: 50 mSv/yr (5000 mrem/yr)
thickness imaged but not the irradiated ● Smaller Hospitals, emergency centers & private clinics
thickness rarely exceeds 5 mSv/yr (500 mrem/yr)
● Number and spacing of adjacent sections ● Average Exposure: <1 mSv/yr (100 mrem/yr)
● Image quality and noise - in most facilities
➔ Like all modalities: dose increase=>noise PROTECTION OF RADIATION WORKER
decreases ● CARDINAL PRINCIPLES
RADIATION SAFETY STANDARDS FOR GENERAL PUBLIC ● PROTECTIVE BARRIER
● Justifiable sources of radiation exposures are those that ● PROTECTIVE DEVICES
result in overall net benefit to society ● OCCUPATIONAL MONITORING DEVICE
● Radiation exposures of the public from controllable ● PATIENT HOLDING
sources should be maintained ALARA. ● POSITION
● Public radiation safety standards should be based on the MONITORING PERSONNEL EXPOSURE
specified values of dose rather than hypothetical 1. Film badges
estimated risk. ● Not often used today
PROTECTION OF RADIATION WORKER, PATIENT AND ● Consist of plastic case, film, and filters
GENERAL PUBLIC ● Use of small x-ray film– Similar to dental
PERSONNEL WHO ARE REQUIRED TO WEAR AN x-ray film
OCCUPATIONAL RADIATION MONITOR ● Measure doses as low as 100 μGy (10 mR)
● Radiologic Technologist ● Metal Filters: Aluminum or Copper
● Anyone who is required to immobilize or hold patients.
 ➔ Help identify the type of ● Projections
radiation ● equipment
➔ Allow estimation of x-ray energy PREGNANT RT
● Advantages ● Should notify her supervisor
➔ Inexpensive ● Should be provided with a second personnel monitoring
➔ Easy to handle device positioned under the protective apron
➔ Easy to process ● Red: collar badge
➔ Reasonably accurate ➔ Above the protective apron
➔ They have been used for several ● Yellow: waist level
decades ➔ Under the protective apron
● Disadvantages ➔ Indicates exposure to the fetus
➔ Cannot be reused (Rationale: ● Should not be terminated or given an involuntary leave
because they incorporate film as of absence
the sensing device) ● Should be reassigned to areas where exposure is likely
➔ Cannot be worn for longer than 1 to be lower
month (Rationale: possible ● Disadvantage: places additional radiation exposure
fogging due to temperature & burden on fellow workers
humidity) ● Should not be advised to participate in brachytherapy
➔ Sensitive to temperature & applications
humidity ● Should be provided with a wrap-around aprons
➔ Exposures less than 10 mR (100 ➔ – 0.5 mm Pb
μGy) cannot be measured ➔ 90% attenuation at 75kVp
2. Thermoluminescent dosimeters (TLDs) ➔ Additional or thicker lead aprons normally
● The emission of light by a thermally are not required
stimulated crystal following irradiation ● Should handle only small quantities of radioactive
● Material: lithium fluoride (LiF) material
➔ Chips, discs, rods, powder ● Should not elute radioisotope generators or inject
● Used for both patient & personnel radiation millicurie quantities of radioactive
monitoring ● Should be provided with a radiation monitor during
● Advantages pregnancy
➔ Size ● note
➔ Reusable ➔ Back problems during pregnancy constitute
➔ Unaffected by temperature and a greater hazard than radiation exposure
humidity ➔ The dose at waist level under a protective
➔ Can be worn for longer periods apron is less than 10% of the collar dose
than film badges ➔ The DL during pregnancy refers to the fetus
➔ Rugged not to the radiologic technologist
● Disadvatage DOSE LIMIT FOR EMBRYO
➔ TLDs and equipment used to
read them are expensive
➔ Does not give immediate results
3. Optically Stimulated Luminescence (OSL)
● Developed by Laundauer in late 1990s
● Material: Aluminum oxide (Al2O3)
● Measures exposures as low as 10 μGy (1
mR)
● Exposures below 10 μGy (1 mR)
– reported as minimal
● Advantage over TLD PREGNANT PATIENT
➔ More sensitive – 1 mrad or 10 ● The potential pregnancy status of all female patients of
μGy childbearing age should always be determined
➔ Can be reanalyzed multiple ● He/she should not be examined unless a documented
times, if necessary decision to do so has been made
➔ Wide dynamic range ● Examination should be done with precisely collimated
➔ Excellent long-term stability beams & use high-kVp technique
➔ Relatively unaffected by ● Examination should be done with properly positioned
temperature and humidity protective shields
➔ Can be worn 3 months at a time ADMINISTRATIVE PROTOCOLS
● Used to ensure that we do not irradiate pregnant
PROTECTION OF PATIENT patients
● Beam limitation ● types:
● Filtration ➔ Elective booking
● Exposure factor ➔ Patient questionnaires
● Film screen ➔ Posting
● Combinations 10-DAY RULE
● Grid ● A guideline used to minimize the possible exposure to
● Repeat exposure an embryo in the earliest days of a pregnancy
● Communication ● Elective abdominal x-ray exams of fertile women
● Positioning should be postponed until the 10-day period following
● Gonadal shielding the onset of menstruation
 ● Considered obsolete
● Rationale:
➔ Because the egg for the next cycle reaches
maximum sensitivity during the 10-day
period
➔ The application of this has always proven
difficult
ELECTIVE BOOKING
● Elective scheduling
● he most direct way to ensure against irradiation of an
unsuspected pregnancy
● Requires that clinician, radiologist or radiologic
technologist determine the time of the patient’s previous
menstrual cycle
INFORMATION FORM
● Must be completed before undergoing examination
● Example: x-ray consent or patient questionnaires
● An alternative procedure is to have the patient herself
indicate her menstrual cycle.
POSTING
● Posting signs of caution in the waiting room
● Are you pregnant or could you be? If so, inform the
radiologic technologist,” or “Warning—special
precautions are necessary if you are pregnant,” or“
Caution—if there is any possibility that you are
pregnant, it is very important that you inform the
radiologic technologist before you have an x-ray
examination.”