Radiation Dose Management for Fluoroscopically Guided Interventional Medical Procedures

Abstract

This report released by the National Council of Radiation Protection and Measurements (NCRP) discusses how to manage radiation doses during fluoroscopically guided interventional medical procedures. It provides recommendations and supporting information with a compendium of references on radiation dose management for patients and medical personnel during interventional medical procedures. This report was prepared by the members of the NCRP Scientific Committee 2-3 on Radiation Safety Issues for Image-Guided Interventional Medical Procedures which includes well-known scientific experts on the subject. The report is a welcome addition as it contains a wealth of information on the types of interventional fluoroscopy procedures, fluoroscopy equipment, radiation dose measurements, assessment of risks, how to manage radiation dose, and so forth. Recent surveys have shown an increasing number of fluoroscopically guided interventional procedures performed in the United States and worldwide. The procedures are often less invasive and less costly with significant benefits to patients. They are performed by radiologists, cardiologists, and other medical specialists with assistance from medical support staff. However, according to another NCRP report (160), interventional procedures now account for nearly 14% of the collective dose to the US population from among the various medical x-ray procedures and therefore warrants ways to optimize and manage radiation doses. The main purpose of the report is to provide valuable information about interventional fluoroscopy procedures and how to manage the radiation dose to both patient and staff. As aptly described in the report's preface, this report will benefit radiologists, cardiologists and other medical specialists performing fluoroscopy procedures. Those who perform fluoroscopically guided interventional procedures, but do not have sufficient training in the practical aspects of radiation protection, will find this report very useful. Medical physicists, health physicists, and radiation safety officers will find this report especially helpful in assisting their physician colleagues in developing optimal methods for managing radiation dose during interventional fluoroscopy. This report is also intended to benefit policy makers who plan to establish radiation dose management requirements for those who conduct fluoroscopically guided interventional procedures with regard to optimizing imaging protocols, managing, tracking, and trending radiation doses to patients and medical staff and credentialing and privileging physicians to use the fluoroscopic equipment for such procedures. The report follows the standard NCRP report format with an executive summary providing more than 30 recommendations with references to the sections that discuss each recommendation in detail. The report is further divided into sections organized in the following way: general information (Sec. II) that includes a list of fluoroscopically guided interventional procedures, justification, benefit-risk, physics, dosimetry and radiation biology; Sec. III on fluoroscopy equipment and facilities that includes discussion on room design and structural radiation protection and protection of patients; Sec. IV is the longest section providing details on patient dose reviews, a patient dose management program with a sample dose-management process including how to monitor patient radiation dose. This section contains a number of tables of patient radiation doses for various interventional procedures, including table (4.7) that suggests values for first and subsequent notifications for the various dose metrics available during interventional procedures. Section V deals with the protection of staff while Sec. VI covers the administrative and regulatory considerations that includes discussion on education and training, purchase, configuration and quality control followed by summary and conclusions (Sec. VII). In addition, the report consists of 13 appendices that include topics such as benefit-cost and benefit-risk analyses, physics and dosimetry, radiation injuries, equipment operations, an example for informed consent for radiation risk plus an extensive bibliography. In addition to providing thorough treatment of each of the subject areas, the report offers unique methods to implement and assess radiation protection programs in general. Overall this report is very timely and will benefit the reader in understanding various aspects of radiation protection during interventional fluoroscopy procedures. This report can serve as a valuable resource guide to anyone exploring ways to optimize fluoroscopy procedures, to establish guidelines on patient dose, dose tracking and trending, and establish education and training to those performing fluoroscopically guided interventional procedures. Medical physicists will find this report very helpful and can use this as a reference guide to assist their physician colleagues to optimize interventional procedures. I highly recommend this report to medical physicists and health physicists who are active in the area of interventional fluoroscopy and also participating in maintenance of certification (MOC) related activities. Mahadevappa Mahesh is Associate Professor of Radiology and Cardiology at the Johns Hopkins University School of Medicine and is the Chief Physicist at the Johns Hopkins Hospital, Baltimore, MD. His research interests are in medical imaging, particularly in areas of multiple-row detector computed tomography (MDCT), interventional fluoroscopy and digital mammography. He teaches medical physics related topics to medical residents, and undergraduate and graduate students.