Online Training on the Safe Use of Fluoroscopy Can Result in a Significant Decrease in Patient Dose

Frederick-Dyer, Katherine; Faulkner, Austin R.; Chang, Ted T.; Heidel, R. Eric; Pasciak, Alexander S.

doi:10.1016/j.acra.2013.07.008

Cited by 20 publications

(22 citation statements)

References 12 publications

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“…P KA for specific interventional procedures is not normally distributed and often approximates a lognormal distribution . Variations in P KA are due to differences in patient body habitus, fluoroscopy technology, operator skill and training, and the complexity of individual cases of a given procedure …”

Section: Discussionmentioning

confidence: 99%

“…75,76 Variations in P KA are due to differences in patient body habitus, fluoroscopy technology, operator skill and training, and the complexity of individual cases of a given procedure. 28,33,[77][78][79][80][81] When considering the relationship between P KA values and associated estimates of E, it is important to remember that P KA is defined to exclude backscatter. An unknown and variable amount of backscatter contributes to absorbed dose, and thus to the uncertainty of E. It is also essential to realize that the international safety standard for fluoroscopy equipment specifies that an overall uncertainty of up to 35% in displayed values of P KA is acceptable.…”

Section: A Uncertaintiesmentioning

confidence: 99%

See 1 more Smart Citation

Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures

Miller

2020

Medical Physics

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Purpose To provide current data on average air kerma‐area product (PKA) and effective dose (E) for noncardiac interventional fluoroscopy procedures and suggested values of dose coefficients (DCE) for conversion of PKA to estimates of effective dose. Methods A PubMed literature search covering the time period from 2006 to August 2019 was performed to obtain recent data on PKA, E and DCE for interventional fluoroscopy procedures. Results There is very wide variation in the reported values of PKA, E, and DCE in the literature. A number of factors are involved in this variability and the resultant uncertainty in average values of these dose quantities. Conclusions The values of PKA, average E and suggested DCE presented here can be of use for comparison of the radiation detriment from different procedures and may be useful for categorizing detriment within an order of magnitude or so. They do not represent actual or expected radiation dose or detriment from any specific procedure or for a specific patient and should be not be used as such.

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Section: Discussionmentioning

confidence: 99%

Section: A Uncertaintiesmentioning

confidence: 99%

Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures

Miller

2020

Medical Physics

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“…In our experience, a kinesthetic format is not needed on an annual basis for individuals who have already had kinesthetic education or for which routine practices have incorporated the applicable safe practices. 12,13 Class room presentations are given annually by a QMP build on the kinesthetic training and thus generally follow similar content. See attached slide presentation content ( Figs.…”

Section: Discussionmentioning

confidence: 99%

Sample content of kinesthetic educational training: Reducing scattered X‐ray exposures to interventional physician operators of fluoroscopy

Pavlicek

Sensakovic

Zhou

et al. 2019

J Applied Clin Med Phys

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Content used by Medical Physicists for fluoroscopy safety training to staff is deliverable via several formats, that is, online content or a live audience slide presentations. Here, we share one example of a kinesthetic (live, hands-on simulation) educational program in use at our facility for some time (~10 years). In this example, the format and content specifically target methods of reducing physician operator exposures from scattered x rays. A kinesthetic format identifies and promotes the adoption of exposure-reducing behaviors. Key kinesthetic elements of this type of training include: physician hands-on measurements of radiation levels at locations specific to their standing positions (e.g., primary arterial access points) in the room using handheld exposure rate meters, measurement of exposure rate reduction to physicians provided by using personal protective equipment, that is, wearable aprons, hanging lead drapes, and pull-down shields. Physician choice of procedurespecific tableside selectable controls affecting exposure rate from optional fluoroscopy, Cine or digital subtraction angiography (DSA), along with comparative measured contribution to physician exposure is demonstrated. The inverse square exposure rate reduction to physicians when stepping back from the table during DSA is a key observation. Kinesthetic simulations in the rooms used by physicians have been found to provide the highest level of understanding giving rise to adoption of practices that are impactful for physicians. Specific training scripts are in place for physician sub-specialization in interventional radiology, cardiology, neurosurgery, vascular surgery, and gastroenterology. This training is used for new physician staff while classroom presentations (whose content mimics in room training) are used with staff who have had previously had in room training.

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“…All efforts to reduce pediatric radiation exposure should be made. Effective fluoroscopic safety training can result in a significant decrease in patient dose; this is coupled with the added benefit of reduced operator exposure [18]. …”

Section: Discussionmentioning

confidence: 99%

Radiation exposure and safety practices during pediatric central line placement

Saeman

Burkhalter

Blackburn

et al. 2015

Journal of Pediatric Surgery

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Purpose Pediatric surgeons routinely use fluoroscopy for central venous line (CVL) placement. We examined radiation safety practices and patient/surgeon exposure during fluoroscopic CVL. Methods Fluoroscopic CVL procedures performed by 11 pediatric surgeons in 2012 were reviewed. Fluoroscopic time (FT), patient exposure (mGy), and procedural data were collected. Anthropomorphic phantom simulations were used to calculate scatter and dose (mSv). Surgeons were surveyed regarding safety practices. Results 386 procedures were reviewed. Median FT was 12.8 seconds. Median patient estimated effective dose was 0.13 mSv. Median annual FT per surgeon was 15.4 minutes. Simulations showed no significant difference (p = 0.14) between reported exposures (median 3.5 mGy/min) and the modeled regression exposures from the C-arm default mode (median 3.4 mGy/min). Median calculated surgeon exposure was 1.5 mGy/year. Eight of 11 surgeons responded to the survey. Only three reported 100% lead protection and frequent dosimeter use. Conclusion We found non-standard radiation training, safety practices, and dose monitoring for the 11 surgeons. Based on simulations, the C-arm default setting was typically used instead of low dose. While most CVL procedures have low patient/surgeon doses, every effort should be used to minimize patient and occupational exposure, suggesting the need for formal hands-on training for non-radiologist providers using fluoroscopy.

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Online Training on the Safe Use of Fluoroscopy Can Result in a Significant Decrease in Patient Dose

Cited by 20 publications

References 12 publications

Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures

Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures

Sample content of kinesthetic educational training: Reducing scattered X‐ray exposures to interventional physician operators of fluoroscopy

Radiation exposure and safety practices during pediatric central line placement

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