Jaydev Dave, Presenter: Nothing to Disclose

Eric Laurence Gingold PhD, Abstract Co-Author: Consultant, Agfa-Gevaert Group

A patient radiation dose monitoring program for FGI procedures was initiated. Six potentially high dose procedures were identified for this population and interventional service. The program extended to non-radiology specialties. Such evidence based knowledge facilitates physician education and management of patient radiation safety.

NCRP Report #168 recommends monitoring patient radiation dose for fluoroscopically-guided interventional (FGI) procedures. Suggested action levels for patient follow-up are cumulative air kerma (CAK) to the interventional reference point above 5 Gy and dose-area product (DAP) or kerma-area product (KAP) above 500 Gy*cm2. These are called substantial radiation dose levels (SRDL). Procedures for which 5% of cases reach 3 Gy CAK or 300 Gy*cm2 DAP are deemed “potentially high radiation dose procedures” and should be monitored closely for possible radiation-induced bioeffects. The purpose of this report is to demonstrate the practicality of implementing a program in accordance with these recommendations.

3843 cases from 71 unique FGI procedure codes were analyzed. Among FGI procedures with 30 or more cases performed in interventional radiology (“frequent” IR procedures), 6 procedures were deemed to be potentially high radiation dose procedures. SRDLs were reached in 98 of the 707 cases (14%) within this category triggering post-procedure follow-up. For the 6 potentially high dose procedures, mean CAK and DAP ranged from 0.5–1.3 Gy and 73-525 Gy*cm2, respectively. In only 2 out of 2480 cases among the non-potentially high dose frequently-performed procedures was a SRDL reached. SRDLs were reached in 38 out of 213 cases (18%) among infrequently-performed procedures. Overall, SRDLs were reached in 4.1% of all IR cases, compared with 50 out of 443 (11.3%) of vascular surgery procedures that used fluoroscopic guidance. The correlation coefficient between CAK and DAP was 0.83.

System reported CAK and DAP were recorded in a radiology information system for all FGI procedures in interventional radiology and vascular surgery over a 9-month period. These dose metrics were subsequently exported to a database for analysis.

Dave, J, Gingold, E, Auditing and Tracking Patient Radiation Exposure from Fluoroscopically Guided Interventional Procedures.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12028823.html