Radiation monitoring effort reduced high-dose procedures over 8 years

A coordinated program to reduce fluoroscopy radiation resulted in a three- to eight-fold reduction in high-dose procedures performed over an eight-year period, according to a single-center study published Jan. 15 in Radiology.

As part of the study, Bob Liu, PhD, of Massachusetts General Hospital in Boston, and colleagues sought to analyze the effect of a dose monitoring program that provided dose-related data and information on how to care for patients with potential radiation injury to radiologists.

Liu et al. included more than 41,500 procedures performed from January 2010 to December 2017. The group found the percentage of high air kerma at the reference point (Ka,r) procedures of 2-5 Gy decreased from 5.9 percent in 2010 to 2 percent in 2017. For procedures with Ka,r greater than 5 Gy, that dropped from 1 percent in 2010 to 0.13 percent in 2017.

“These efforts enabled control of patient doses from interventional procedures and had a major effect on patient dose management, which was reflected by the trend of the number of high-dose procedures decreasing over time,” the authors wrote. “Perhaps the reduction of radiation exposure to patients in turn reduced scattered radiation to the operators and probably improved radiation safety among the staff.”

Also included in the dose monitoring program were strategies that emphasized the use of ultrasound guidance when possible, use of the lower fluoroscopic dose rate during live fluoroscopy, low frame rates and multiple short fluoroscopic exposures rather than continuous exposure, according to the authors.

One unique aspect of the program, according to Liu and colleagues, is their monthly radiation safety committee meeting to review procedures with Ka,r greater than 2 Gy. The group also requires radiologists to send patient follow-up letters for all procedures greater than 5 Gy. This assures the interventionalists closely watches the doses they administer and all maintains all procedures are adequately performed.

Certain limitations existed in this study, including an inability to quantify improvements to fluoroscopic equipment which may have helped limit radiation exposure during the study. However, the authors maintained a dose-limiting program such as theirs could be helpful for future generations of radiologists.

“It (a dose-limiting program) can be incorporated into training programs for residents and fellows as a standard of safe and responsible practice for their careers,” Liu et al. concluded. “Finally, there are federal and state medical care standards with which such programs can provide consistent and transparent guidelines of image-guided therapies.”