Fluoroscopic Sentinel Events in Neuroendovascular Procedures: How to Screen, Prevent, and Address Occurrence

Abstract

SUMMARY: Radiation-induced skin injury during fluoroscopic procedures has been recently addressed by The Joint Commission, which defined prolonged fluoroscopy resulting in a cumulative peak skin dose of Ն15 Gy to a single field as a sentinel event (FSE). Neuroendovascular procedures can be associated with a high radiation skin dose and present risks such as potential FSEs. Managing these risks is the responsibility of the interventional neuroradiologist. In this review, we discuss hospital policies needed for screening and preventing FSEs, methods for minimizing radiation-induced skin injury, and actions necessary to address potential FSEs once they have occurred.ABBREVIATIONS: FSE ϭ fluoroscopic sentinel event; FT ϭ fluoroscopy time; K a,r ϭ reference air kerma; P KA ϭ kerma-area product; RCA ϭ root cause analysis; TJC

Practical techniques for reducing radiation exposure during cerebral angiography procedures

“…Ka,r, also known as reference point air kerma and formerly called cumulative dose4 or cumulative air kerma, is the dose to air at the interventional reference point, which is 15 cm from the isocenter toward the x-ray tube. Ka,r is a cumulative approximation of the total radiation dose to the skin, summed over the entire procedure,3 and is a useful metric for the real time monitoring of doses incurred during fluoroscopic procedures and for monitoring of fluoroscopic sentinel events 5. The PKA, which reflects the total radiation energy entering the patient, is an indicator of stochastic risk for the patient, correlates with operator and staff dose, and is a surrogate measure for skin dose, although a limitation of this value is that the same PKA may be generated by a large dose delivered to a small skin area or by a small dose delivered to a large skin area.…”

Diagnostic quality and accuracy of low dose 3D-DSA protocols in the evaluation of intracranial aneurysms

“…More recently, attention has been devoted to screening, preventing, and dealing with fluoroscopic sentinel events during neuroendovascular procedures, with an emphasis on the interventionalist's responsibility for reducing radiation exposure to patients and staff 27. This further underscores the need for the design and implementation of protocols and techniques that maintain diagnostic image quality while reducing radiation exposure 20.…”