Optimizing radiation use during fluoroscopic procedures: a quality and safety improvement project

Area of Science:

• Medical Imaging and Interventional Radiology
• Radiation Safety and Dosimetry
• Health Informatics and Data Analytics

Background:

• Fluoroscopically guided interventions utilize ionizing radiation, posing inherent risks to patients and staff.
• Minimizing radiation exposure while maintaining diagnostic and therapeutic benefits is a key challenge in interventional radiology.

Purpose of the Study:

• To describe a data-driven strategy for optimizing radiation use in fluoroscopically guided medical interventions.
• To systematically reduce radiation risks associated with interventional radiology procedures.

Main Methods:

• Collected radiation metrics (fluoroscopy time, kerma area product, reference point air kerma) using manual and automated systems for adult and pediatric procedures.
• Employed statistical process control tools to identify improvement opportunities and evaluate the impact of changes.
• Leveraged DICOM Structured Reporting for automated capture of radiation data from modern fluoroscopy units.

Main Results:

• Developed a reliable manual workflow for capturing fluoroscopy time, later enhanced by automated electronic record capture.
• Identified significant protocol differences between adult and pediatric imaging, leading to protocol revisions.
• Achieved a stable twofold reduction in average radiation exposure per adult procedure without adverse effects on workflow.

Conclusions:

• A systematic, data-driven approach significantly reduced radiation risk in interventional radiology procedures.
• Both manual and automated data capture methods proved effective for monitoring radiation metrics.
• Cognitive psychology and information theory principles underpinned the data analysis and improvement strategies.