Mnemonic checklist cuts fluoro radiation exposure

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Looking to ultimately reduce patient radiation, a team of researchers from University of Michigan Health System developed a mnemonic checklist that reduced mean fluoroscopy time in second year residents.

Jessica R. Leschied, MD, and colleagues, inspired by medical checklist development in other specialty areas and cognizant of the fact that exposure to medical ionizing radiation has more than doubled in the U.S., designed a preprocedural checklist for fluoroscopy studies to optimize safe tower operation with the goal of reducing dose.

“The purpose of this study was to operationalize the checklist, assess qualitative and quantitative changes in radiation dose awareness among first-year resident fluoroscopists, and track intraprocedural fluoroscopy times as a surrogate measure of radiation exposure for patients and operators,” Leschied and team wrote in an article published Oct. 24 in Academic Radiology.

The research team designed a cohort study with retrospective collection of fluoroscopy time data from July 2011 to June 2013 and included two consecutive first-year residents. The first resident cohort (year 1) was the baseline group and the second resident cohort (year 2) was the intervention group.

Fluoroscopy time was chosen as the marker for radiation dose and fluoroscopy times were retrospectively collected for first-year residents performing GI and GU fluoroscopy between July 2011 and June 2012 before the introduction of the checklist (year 1). This served as the baseline.

The intervention was the visual preprocedural checklist designed as mnemonic device using the acronym PRODUCT ( Pulsed fluoro, Remove grid, Off pedal, De-magnify, Use badge, Collimate, Tower down).

The checklist was to be used by the second cohort of residents before and during fluoroscopy procedures as a teaching tool for fluoroscopy physics principles and to visibly promote the department’s radiation safety culture.

This intervention group of year 2 residents used the checklist before performing each fluoroscopy procedure and participated in the weekly faculty-led teaching sessions during their 4-week GI radiology rotation.

After the completion of the 2-year study, several technologists with experience in GI/GU fluoroscopy ranging from 7 to 35 years were informally interviewed regarding their observations on ease of use and resident confidence with the checklist.

The study included 1,710 examinations (778 in year 1 and 941 in year 2). After the checklist was implemented, mean fluoroscopy times for all examinations decreased by 41.1 seconds in year 2 residents.

Radiation safety knowledge was similar in both groups but self-reported confidence in safe fluoroscopy tower operation increased slightly in year 2.

Leschied and colleagues summarized the use of the checklist meant a reduction in radiation doses delivered to patients and a modest increase in awareness of safe fluoroscopy tower operation.

“We will continue to use the checklist for fluoroscopy studies in our radiology department and use it as an aid to teach residents basic fluoroscopy physics principles,” the authors wrote.