Benjamin Clark Jacobs MD, Presenter: Nothing to Disclose

James R. Duncan MD, PhD, Abstract Co-Author: Nothing to Disclose

Mandie Street ARRT, Abstract Co-Author: Nothing to Disclose

David Murray, Abstract Co-Author: Nothing to Disclose

Continuous quality improvement requires developing systems that allow measurement, analysis and re-assessment. We recently installed a multicamera recording system to routinely record image-guided procedures. We now report how such information can be used to identify methods of optimizing radiation use during pediatric interventional procedures.

A newly constructed pediatric angiography suite was equipped with an audiovisual recording system that included three ceiling-mounted cameras, a microphone and the ability to capture live fluoroscopy images at full resolution. A dedicated audiovideo multichannel recorder (SimCapture, B-Line Medical, Inc) facilitated synchronized capture and review. Over 70 procedures have been recorded and three representative cases (percutaneous transhepatic cholangiogram, renal angiography and peripherally inserted central catheter placement) were selected for detailed examination. That analysis examined the dynamic association between radiation use and intraprocedural decisions. For this, data on cumulative radiation dose, fluoroscopy mode, projection, and field of view was extracted from these video recordings. This data was then plotted and displayed on the procedure timeline.

Plots of radiation dose along the procedure timeline allowed reviewers to quickly assess which portions of the procedure were associated with the most rapid increases in cumulative dose. We were then able to review these points of the video to identify the possible rationale for the increased dose. This was then used to begin assessing the risk/benefit ratio of these decisions. These results have been incorporated into procedure debriefings. Analysis of these recordings also showed several shortcomings in the dataset such as the need for additional recording angles and at least one wide angle view of the procedure room.

Routine audiovisual recording of pediatric interventional radiology procedures facilitates continuous quality improvement efforts. Procedure debriefings and ongoing analysis continues to identify multiple methods of optimizing the risk/benefit ratio during image guided procedures.

These techniques should improve the risk/benefit ratio of ionizing radiation during pediatric procedures. We expect these recordings will also be useful for education and studying team dynamics.

Jacobs, B, Duncan, J, Street, M, Murray, D, Optimizing Radiation Use during Pediatric Interventional Radiology Procedures: A Continuous Process Improvement Project.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8010756.html