RSNA: Quality improvement program cuts unnecessary fluoro dose, at no more costs

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CHICAGO--The implementation of a new quality improvement program to ensure safe use of radiation during fluoroscopy procedures was “easily implemented” and prevented radiation-induced injuries, while recognizing patients at risk for radiation exposure injuries, with no additional costs, based on an observational study presented as a scientific poster this week at the annual Radiological Society of North America (RSNA) conference.

Researchers from the University of Texas (UT) Health Science Center in San Antonio and Baylor University Medical Center in Dallas implemented a program in the interventional radiology department to ensure safe use of radiation during interventional procedures. The program sought to monitor and prevent procedures associated with unnecessary peak skin dose (PSD), which is a measure of the likelihood of radiation-induced skin effects for a variety of interventional radiology procedures.

Marco A. Cura, MD, from the department of interventional radiology and vascular radiology at the UT Health Science Center and colleagues conducted this study to ensure that all patients’ radiation exposure is below 2 Grays (Gy) for each fluoroscopy procedure.

The investigators used online and offline methods to measure PSD or maximum local skin dose (MSD). For online methods, they assessed point detectors (ion chamber, diode and Mosfet detectors) and the dose-to-interventional reference point via the ion chamber or calculation. For offline methods, they obtained the dose distribution with interpolation of point dose data and used the area detectors (radiotherapy portal films, radiochromic films and TLD grid).

Cura and colleagues prospectively collected demographic and radiation dose data for subjects undergoing procedures in fluoroscopic suites equipped with built-in dosimetry capability.

Subsequently, the new quality improvement program was implemented. The program consisted of monitoring real-time fluoroscopy time, notification to physician when fluoroscopy time reaches 50 minutes, education of dose reduction techniques and establishing proper clinical follow-up of patients exposed to more than 2 Gy dose. The program also included one-to-one in-service with technologist, nurses and physicians concerning dose reduction, and “active involvement” of physicians in the prevention, recognition and management of radiation side-effects, the study authors wrote.

Over a 26-day period, the researchers recorded the fluoroscopy time for all interventional radiology procedures prior to the implementation of the quality improvement program. During this time, they identified four fluoroscopy procedures with times longer than 60 minutes. The mean calculated PSD for those procedures was 806.25 centi-Gray units (cGy).

After the program was initiated, they recorded data for all interventional radiology procedures over a period of 110 days. While five procedures had a fluoroscopy time longer than 60 minutes, the mean calculated PSD was almost halved at 441.2 cGy.

The authors also noted that the quality improvement program did not increase cost to the provider or the patient, while also reducing any additional healthcare costs related to excessive use of radiation.