skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Patient radiation dose audits for fluoroscopically guided interventional procedures

Abstract

Purpose: Quality management for any use of medical x-ray imaging should include monitoring of radiation dose. Fluoroscopically guided interventional (FGI) procedures are inherently clinically variable and have the potential for inducing deterministic injuries in patients. The use of a conventional diagnostic reference level is not appropriate for FGI procedures. A similar but more detailed quality process for management of radiation dose in FGI procedures is described. Methods: A method that takes into account both the inherent variability of FGI procedures and the risk of deterministic injuries from these procedures is suggested. The substantial radiation dose level (SRDL) is an absolute action level (with regard to patient follow-up) below which skin injury is highly unlikely and above which skin injury is possible. The quality process for FGI procedures collects data from all instances of a given procedure from a number of facilities into an advisory data set (ADS). An individual facility collects a facility data set (FDS) comprised of all instances of the same procedure at that facility. The individual FDS is then compared to the multifacility ADS with regard to the overall shape of the dose distributions and the percent of instances in both the ADS and the FDS thatmore » exceed the SRDL. Results: Samples of an ADS and FDS for percutaneous coronary intervention, using the dose metric of reference air kerma (K{sub a,r}) (i.e., the cumulative air kerma at the reference point), are used to illustrate the proposed quality process for FGI procedures. Investigation is warranted whenever the FDS is noticeably different from the ADS for the specific FGI procedure and particularly in two circumstances: (1) When the facility's local median K{sub a,r} exceeds the 75th percentile of the ADS and (2) when the percent of instances where K{sub a,r} exceeds the facility-selected SRDL is greater for the FDS than for the ADS. Conclusions: Analysis of the two data sets (ADS and FDS) and of the percent of instances that exceed the SRDL provides a means for the facility to better manage radiation dose (and therefore both deterministic and stochastic radiation risk) to the patient during FGI procedures.« less

Authors:
; ; ; ;  [1];  [2]
  1. Department of Radiology and Department of Medicine, Columbia University, New York, New York 10032 (United States)
  2. United States
Publication Date:
OSTI Identifier:
22096947
Resource Type:
Journal Article
Journal Name:
Medical Physics
Additional Journal Information:
Journal Volume: 38; Journal Issue: 3; Other Information: (c) 2011 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0094-2405
Country of Publication:
United States
Language:
English
Subject:
61 RADIATION PROTECTION AND DOSIMETRY; 60 APPLIED LIFE SCIENCES; AIR; CORONARIES; DOSIMETRY; HEALTH HAZARDS; KERMA; METRICS; PATIENTS; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIATION INJURIES; RADIATION MONITORING; SKIN; STOCHASTIC PROCESSES; X RADIATION

Citation Formats

Balter, Stephen, Rosenstein, Marvin, Miller, Donald L., Schueler, Beth, Spelic, David, Clarksburg, Maryland 20871, Department of Radiology, F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, Maryland 20814, Department of Radiology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, and Division of Mammography Quality and Radiation Programs, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, Maryland 20903. Patient radiation dose audits for fluoroscopically guided interventional procedures. United States: N. p., 2011. Web. doi:10.1118/1.3557868.
Balter, Stephen, Rosenstein, Marvin, Miller, Donald L., Schueler, Beth, Spelic, David, Clarksburg, Maryland 20871, Department of Radiology, F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, Maryland 20814, Department of Radiology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, & Division of Mammography Quality and Radiation Programs, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, Maryland 20903. Patient radiation dose audits for fluoroscopically guided interventional procedures. United States. https://doi.org/10.1118/1.3557868
Balter, Stephen, Rosenstein, Marvin, Miller, Donald L., Schueler, Beth, Spelic, David, Clarksburg, Maryland 20871, Department of Radiology, F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, Maryland 20814, Department of Radiology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, and Division of Mammography Quality and Radiation Programs, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, Maryland 20903. 2011. "Patient radiation dose audits for fluoroscopically guided interventional procedures". United States. https://doi.org/10.1118/1.3557868.
@article{osti_22096947,
title = {Patient radiation dose audits for fluoroscopically guided interventional procedures},
author = {Balter, Stephen and Rosenstein, Marvin and Miller, Donald L. and Schueler, Beth and Spelic, David and Clarksburg, Maryland 20871 and Department of Radiology, F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, Maryland 20814 and Department of Radiology, Mayo Clinic and Foundation, Rochester, Minnesota 55905 and Division of Mammography Quality and Radiation Programs, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, Maryland 20903},
abstractNote = {Purpose: Quality management for any use of medical x-ray imaging should include monitoring of radiation dose. Fluoroscopically guided interventional (FGI) procedures are inherently clinically variable and have the potential for inducing deterministic injuries in patients. The use of a conventional diagnostic reference level is not appropriate for FGI procedures. A similar but more detailed quality process for management of radiation dose in FGI procedures is described. Methods: A method that takes into account both the inherent variability of FGI procedures and the risk of deterministic injuries from these procedures is suggested. The substantial radiation dose level (SRDL) is an absolute action level (with regard to patient follow-up) below which skin injury is highly unlikely and above which skin injury is possible. The quality process for FGI procedures collects data from all instances of a given procedure from a number of facilities into an advisory data set (ADS). An individual facility collects a facility data set (FDS) comprised of all instances of the same procedure at that facility. The individual FDS is then compared to the multifacility ADS with regard to the overall shape of the dose distributions and the percent of instances in both the ADS and the FDS that exceed the SRDL. Results: Samples of an ADS and FDS for percutaneous coronary intervention, using the dose metric of reference air kerma (K{sub a,r}) (i.e., the cumulative air kerma at the reference point), are used to illustrate the proposed quality process for FGI procedures. Investigation is warranted whenever the FDS is noticeably different from the ADS for the specific FGI procedure and particularly in two circumstances: (1) When the facility's local median K{sub a,r} exceeds the 75th percentile of the ADS and (2) when the percent of instances where K{sub a,r} exceeds the facility-selected SRDL is greater for the FDS than for the ADS. Conclusions: Analysis of the two data sets (ADS and FDS) and of the percent of instances that exceed the SRDL provides a means for the facility to better manage radiation dose (and therefore both deterministic and stochastic radiation risk) to the patient during FGI procedures.},
doi = {10.1118/1.3557868},
url = {https://www.osti.gov/biblio/22096947}, journal = {Medical Physics},
issn = {0094-2405},
number = 3,
volume = 38,
place = {United States},
year = {Tue Mar 15 00:00:00 EDT 2011},
month = {Tue Mar 15 00:00:00 EDT 2011}
}