WE‐A‐144‐01: The Management and Reporting of Imaging Procedure Dose 1: Interventional Radiology/Cardiology
Authors: Balter S , Schueler B , Jones A 
Published: July 2013

Stephen Balter: Issues in Interventional Fluoroscopy Procedures

Some fluoroscopically‐guided interventional procedures (FGI) require the use of a substantial amount of radiation for their completion. Radiation can be regarded as a toxic agent in the same sense that contrast‐media and drugs can be toxic if inappropriately used. The interventional radiologist should have reasonable knowledge of the toxic effects of radiation on patients at dose levels that may occur during IR procedures. These include short‐term tissue reactions on the skin, hair loss, and radiogenic cataracts. Longer term effects such as cancer induction are of importance for some patients. Because radiation is potentially toxic, its risks should be appropriately discussed during the informed consent process. The display of reference air kerma and kerma area product provide risk information to the radiologist while performing a procedure. This is intended to provide ongoing inputs into a continuous evaluation of benefit‐risk.

Learning Objectives:

1. Be able to describe effects on patient's skin, hair, eyes, and other tissues resulting from fluoroscopically‐guided interventional procedures.

2. Be able to adequately communicate FGI radiation risk as part of the informed consent process.

3. Understand the use of real‐time displays of radiation quantities and their relation to radiation risks.

Beth Schueler: Measurements and Dose Calculations

The measurement of patient dose during fluoroscopically‐guided interventional procedures is an important tool for assessment of individual patient radiation risk. Moreover, the display of patient dose is valuable as feedback to the operator to aid in optimization of radiation exposure. Many different methods of measuring fluoroscopy dose have been developed, including direct methods (dosimeters and film) and indirect methods (fluoroscopy time, dose‐area‐product meters and reference point air kerma estimation). This presentation will review the advantages and limitations of each of these methods, along with common dose metrics that fluoroscopy operators, medical physicists and technologists should be familiar with. In addition, we will discuss skin dose mapping methods that are currently being developed.

Learning Objectives:

1. Review methods of measuring patient radiation dose during fluoroscopically‐guided interventional procedures.

2. Compare the advantages and limitations of dose measurement methods.

3. Understand parameters that are used to describe patient entrance dose.

4. Learn about new methods for skin dose calculation and recording. Kyle Jones: Establishing an Interventional Radiology Patient Radiation Safety Program

An interventional radiology patient safety program is essential to better educate patients who are scheduled to undergo fluoroscopically guided interventional radiology procedures; monitor radiation doses delivered during procedures and reduce the risk of tissue effects; ensure appropriate medical management of patients experiencing significant peak skin doses; and for practice quality improvement through analysis of procedural data and exceptional cases. The program combines pre‐procedure evaluation and counseling, intra‐procedure monitoring, and post‐procedure documentation and counseling consistent with guidelines from the National Cancer Institute and the Society of Interventional Radiology. Implementation of a patient safety program is straightforward, requires little infrastructure and few resources, and can be applied in most interventional radiology practices.

Learning Ojbectives:

1. List the radiation dose descriptors that should be recorded at the conclusion of a fluoroscopy‐guided procedure.

2. Describe the actions that may be taken during the three phases of a fluoroscopy‐guided procedure to enhance patient safety.

3. Discuss how to recognize cases that are outside the normal control limits of an interventional radiology practice.