Quality Initiatives: Establishing an Interventional Radiology Patient Radiation Safety Program

Abstract

The Interventional Radiology Patient Radiation Safety Program was created to better educate patients who are scheduled to undergo high-dose interventional radiologic procedures about the risks of radiation, better monitor the delivered doses, and reduce the risk for deterministic effects. The program combines preprocedure evaluation and counseling, intraprocedure monitoring, and postprocedure documentation and counseling with the guidelines of the National Cancer Institute and the Society of Interventional Radiology. Between July 2009, when the program was implemented, and September 2010, over 3500 interventional radiologic procedures were monitored and documented, and 63 procedures with an adjusted cumulative dose of more than 3 Gy were identified and further analyzed; four procedures were found to be outside the control limits. Additional review of these four procedures resulted in practice modifications. Anecdotal feedback from physician assistants and attending physicians indicated that the program had another positive effect: Patients who required postprocedure counseling about the potential for radiation-induced skin injuries were no longer surprised by this information. Implementation of this program is straightforward, requires little infrastructure and few resources, and may be applied in most interventional radiology practices. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.321115002/-/DC1.

How accurately can the peak skin dose in fluoroscopy be determined using indirect dose metrics?

“…If the calculated peak skin dose is greater than or equal to 5 Gy, patient follow-up should be initiated. 22,26 The results presented here likely do not apply to procedures performed using different geometries, such as interventional cardiology and neuroradiology procedures, and these procedures must be studied separately.…”

2020 Clinical Practice Guideline for Percutaneous Transthoracic Needle Biopsy of Pulmonary Lesions: A Consensus Statement and Recommendations of the Korean Society of Thoracic Radiology

“…In a recent multicenter retrospective cohort study, the use of CT and cone-beam CT guidance reduced the diagnostic failure rate of PTNB (60), along with lowering the incidence of hemoptysis compared to fluoroscopic guidance (46). As fluoroscopy, CT, cone-beam CT, and CT fluoroscopy guidance are inevitably accompanied by ionizing radiation exposure to patients and/or interventionists, radiation exposure should be monitored and minimized during the procedure as much as possible (61,62).…”

Computed tomography and patient risk: Facts, perceptions and uncertainties

“…With increased prevalence of radiologic investigations, patient education regarding the risks of radiation exposure needs to be tackled by the medical community in order to accurately convey potential risk. The Interventional Radiology Patient Safety Program among others have issued guidelines resulting in practice modifications where excessive radiation doses were being delivered intra-procedurally[150,151]. Incorporating audit as standard into radiology departments can also help to decrease the dose delivered to each patient[152,153] and will also help when discussing these scans with our patients.…”