Patient radiation dose audits for fluoroscopically guided interventional procedures.

Area of Science:

• Medical Imaging
• Radiology
• Radiation Safety

Background:

• Fluoroscopically guided interventional (FGI) procedures involve significant patient radiation exposure.
• Clinical variability in FGI procedures complicates standard radiation dose monitoring.
• Potential for deterministic injuries necessitates robust quality management.

Purpose of the Study:

• To describe a quality process for managing radiation dose in FGI procedures.
• To establish a method suitable for the inherent variability and risks of FGI procedures.
• To move beyond conventional diagnostic reference levels for FGI dose management.

Main Methods:

• Introduction of the substantial radiation dose level (SRDL) as an action level for skin injury risk.
• Collection of procedure data into a multifacility advisory data set (ADS).
• Comparison of individual facility data sets (FDS) against the ADS for dose distribution and SRDL exceedance.

Main Results:

• Illustrative examples using percutaneous coronary intervention and reference air kerma (K(a,r)).
• Identified investigation triggers: facility median K(a,r) exceeding ADS 75th percentile.
• Identified investigation triggers: FDS percentage of SRDL exceedance greater than ADS.

Conclusions:

• The proposed quality process enables better management of patient radiation dose in FGI procedures.
• Effective management reduces both deterministic and stochastic radiation risks.
• Analysis of ADS and FDS provides actionable insights for quality improvement.