Assessing and Improving Collimation during Fluoroscopically-Guided Interventions

To determine whether education and feedback might impact the use of collimation during fluoroscopically guided interventions (FGIs), an objective measure of collimation was developed and tested.

Collimation was expressed as a collimation index (CI) where more aggressive collimation results in higher CI values. The CI metric was initially developed as part of analyzing radiation use during 15 uterine artery embolizations (UAEs). It was then tested in 84 randomly selected procedures. After obtaining additional baseline data, collimation was routinely tracked. Educational sessions were held that highlighted the benefits of collimation and included feedback on collimation performance.

Results from 7,579 procedures performed over a 13-month period found that the mean CI varied substantially between procedure types and proceduralists. Some of the highest CIs occurred during UAEs, particularly the embolization segments. Reference point air kerma (K_ar) was used to divide FGIs into "simple" versus "complex" procedures. At baseline, simple FGIs had slightly more aggressive collimation than complex FGIs (P < .001). The differences in collimation between operators were most striking during complex FGIs. Following the educational interventions, the weekly mean CI for all complex cases improved from 0.155 to 0.227 (P < .05).

The results demonstrate the ability to rigorously and routinely monitor collimation. Providing frontline personnel with feedback on performance was associated with improved collimation during complex procedures. The results also suggest opportunities for further improvement.