How to set up and apply reference levels in fluoroscopy at a national level

Area of Science:

• Medical Imaging
• Radiology
• Cardiology

Background:

• Fluoroscopy is crucial in numerous diagnostic and interventional procedures.
• Establishing national reference levels (RL) is essential for optimizing radiation dose and ensuring consistent image quality.

Purpose of the Study:

• To investigate fluoroscopy utilization across diverse medical departments.
• To establish national reference levels (RL) for dose-intensive radiological and cardiological procedures.

Main Methods:

• A 2-year nationwide survey involving 5 radiology and 9 cardiology departments.
• Data collection on fluoroscopy time (T), number of frames (N), and dose-area product (DAP) for 12 examination types (6 diagnostic, 6 interventional).
• Statistical analysis of T, N, and DAP to determine distributions and establish RL values, pooling data for improved statistics.

Main Results:

• Significant variability observed in radiation dose and image quality for comparable examinations.
• Example: Skin dose rate for abdominal examinations ranged from 10 to 45 mGy/min for similar image quality.
• Established Dose-Area Product (DAP) RLs for specific procedures, including angiography, biliary interventions, and angioplasty.

Conclusions:

• Wide variability in radiation dose and image quality necessitates the establishment of national reference levels.
• The established RLs provide benchmarks for optimizing fluoroscopy procedures and reducing patient dose.
• Findings highlight the need for standardized practices in dose-intensive interventional procedures.