ACPSEM guideline: recommendations for a fluoroscopic system quality assurance program

Fluoroscopic systems are increasingly used for complex image-guided procedures across medical disciplines in Australia and New Zealand. The associated radiation exposure risks to patients and staff necessitate robust quality assurance (QA) programs. However, no national guidance has previously existed for a standardised fluoroscopy QA program in the Australia and New Zealand context. To provide evidence-informed recommendations for the quality assurance of fluoroscopic systems in Australia and New Zealand, addressing the absence of national standards and supporting consistent, high-quality clinical practice. This guideline was developed by the ACPSEM Fluoroscopy QA Working Group, established in February 2019 by the ACPSEM Radiology Specialty Group. Recommendations were informed by an expert-driven review of international standards and protocols, including those from the AAPM, IAEA, EFOMP, and IEC, adapted for Australia and New Zealand practice through working-group discussions and reviews. The draft guideline underwent stakeholder consultation, including circulation to ACPSEM members and relevant professional organisations. The guideline outlines recommended QA tests for medical physicists at acceptance, commissioning, and periodic intervals, along with routine quality control procedures for radiographers. Key areas include radiation dose output assessment, automatic dose rate control verification, image quality evaluation, personal protective equipment integrity testing, and clinical dose audits. A quality review meeting framework is also provided. This guideline establishes a nationally consistent framework for fluoroscopy QA that complements local regulatory requirements. Its adoption will support patient safety, staff radiation protection, and optimal equipment performance across healthcare facilities in Australia and New Zealand.