Interventional Radiology Patient Radiation Safety Program

PURPOSE 1. To identify, inform and appropriately consent patients undergoing potentially high radiation exposure procedures. 2. To develop interactive, real-time dose monitoring and communication between the technologist and attending IR physician. Such communication would lead to dose limiting technical modifications or termination of the study when necessary. 3. To establish a follow up program to track any patient receiving over 3Gy during a single procedure. METHODS A single-center prospective program was initiated on July 20, 2009 to improve patient safety by monitoring and decreasing radiation exposure during complex interventional procedures. The ongoing program consists of three parts: pre-procedure evaluation, intra-procedure monitoring and post-procedure counseling. Using the findings from the RAD-IR study [1] and recent Dauer paper [2], patients undergoing procedures of potentially high radiation dose were identified when the study was ordered, or the interventional radiology consult was received. These patients underwent additional consent to inform them of increased deterministic risk (skin burns, hair loss). During the performance of all interventional cases utilizing fluoroscopy, technologists continuously monitored the cumulative dose to the patient. As predetermined dose thresholds were met (2000mGy, 3000mGy, etc), the primary operator was made aware and given the option to continue, modify or terminate the case. Upon completion of the interventional procedure the following data were recorded and placed into an IR dose database: 1. Cumulative dose 2. Dose area product 3. Total fluoroscopy time 4. Number of dynamic CTs (rotational angiography) 5. Number of acquisition runs and spot images Those patients with over 3000mGy of cumulative dose were counseled about the increased risk of deterministic effects and provided additional information as recommended by the SIR[3] and NCRP. An information form was developed and presented to the patient. Follow up phone calls and/or clinic visits were performed and documented in the electronic medical record. All cases in the database were reviewed and analyzed for trends in exposure levels, technologist compliance (manually loading the data) and deterministic effects. RESULTS Data were collected from 1923 cases performed between July 20, 2009 and March 31, 2010. Fifty-three cases exceeded the 3000mGy threshold, and all these patients underwent post procedure counseling and follow-up. No deterministic effects were seen. Using a control chart (XmR), the 53 cases over 3Gy were analyzed. Three cases were found to represent statistically significant special cause variation. These cases were individually reviewed. Education of technologists with in-service lectures, and end of procedure checklists increased compliance with the patient radiation safety program. CONCLUSION Improving patient safety in healthcare has been a primary concern since the initial publication of the Institute of Medicine To Err is Human[4] . Because of progressively more complex and repeated cases, interventional radiology patients are subjected to significant amounts of radiation exposure. Our patient radiation safety program has proven effective for three reasons: 1. Better informed patients and a more complete consent process. 2. Identifying and counseling 53 patients receiving greater than 3000mGy who would have otherwise gone unnoticed. 3. Furthermore, identifying three cases of significantly elevated dose exposure which were subsequently reviewed. References: 1. Miller, D.L., et al., Radiation doses in interventional radiology procedures: the RAD-IR study: part I: overall measures of dose. J Vasc Interv Radiol, 2003. 14(6): p. 711-27. 2. Dauer, L.T., et al., Estimating radiation doses to the skin from interventional radiology procedures for a patient population with cancer. J Vasc Interv Radiol, 2009. 20(6): p. 782-8; quiz 789. 3. Stecker, M.S., et al., Guidelines for patient radiation dose management. J Vasc Interv Radiol, 2009. 20(7 Suppl): p. S263-73. 4. Kohn, L.T., J. Corrigan, and M.S. Donaldson, To err is human : building a safer health system. 2000, Washington, D.C.: National Academy Press. xxi, 287 p.

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Interventional Radiology Patient Radiation Safety Program