Systematic radiation reduction possible for fluoroscopic procedures

A systematic approach to improving radiation use during fluoroscopic procedures led to a substantial and sustained reduction in risk without a cutback in benefits, according to a study published in the November issue of the Journal of the American College of Radiology.

Despite the number of advantages that fluoroscopically-guided interventional procedures offer to patients, there are risks associated with the ionizing radiation exposure involved.

“When the radiation risks are aggregated across the millions of procedures performed each year, the risks for cancer induction, permanent skin injuries, and germline mutations are compelling,” wrote James R. Duncan, MD, PhD, of the Washington University School of Medicine in St. Louis, and colleagues.

The authors created a study aimed to optimally balance the benefits and risks of fluoroscopic procedures through a data-driven approach that includes data collection, analysis, and feedback.

Manual and automated data capture systems were used to ascertain a series of varying metrics such as fluoroscopy time, kerma area product, and reference point air kerma, from adult and pediatric interventional radiologic procedures at St. Louis Children’s Hospital and Barnes-Jewish Hospital. The teams involved were comprised of interventional radiologists, fellows, residents, nurses, technologists, and medical physicists.

The study first focused on producing a system capable of reliably capturing fluoroscopy time from all interventional procedures by using the RIS. A manual workflow that reliably captured fluoroscopy time was developed from ongoing data analysis and feedback to frontline teams.

Data capture was augmented by automatic capture of electronic records, which exploited DICOM Structured Reporting, the standardized format that more recent fluoroscopy units employ to record radiation metrics.

Data analysis discovered stark differences between the imaging protocols used for adults and children. Once the adult protocols were revised, a stable twofold reduction in average exposure per adult procedure occurred. Analysis of balancing measures revealed no impact on workflow.

Feedback to frontline teams is a fundamental element of any sustainable improvement initiative, the authors wrote.

“We expect that the general strategy of data collection, analysis, and feedback can be used to improve the performance of any team that routinely performs fluoroscopically guided interventions,” remarked Duncan and colleagues. “We believe that medical imaging, with its established infrastructure for capturing and analyzing data, can use patient exposure to ionizing radiation as a clear example of how it is not only possible but absolutely crucial that we learn to ‘do more with less.’”