7-11 July 2019
EV55 - PEP W2: Fluoroscopic System Evaluation and Radiation Safety Consideration (Borrás)Orlando VI 12:15 - 14:15 |
| Fluoroscopic studies, especially interventional ones, may result in high radiation doses to the patient and to the staff. Radiation protection can be achieved by proper equipment design, availability and selection of imaging protocols specific to the imaging task and the patient body habitus, and optimized operational procedures. While FDA standards address only the manufacturer’s equipment design, some State Radiation Control Regulations and accreditation programs such as those of The Joint Commission (TJC) and the American College of Radiology (ACR), have emphasized the need to manage the radiation risks involved. This radiation safety course will focus on the state of the art fluoro systems used in diagnostic and interventional procedures, primarily angiography units. Equipment evaluation checks and criteria will be taken from the 2016 “ACR–AAPM Technical Standard for diagnostic medical physics performance monitoring of fluoroscopic equipment”. This document lists the tests to be performed during acceptance testing, for the annual evaluation (required by many State Regulations), and to set up and implement a quality control program. The methodologies involved in the assessment of image quality and radiation dose will be described, highlighting the differences between analog and digital components such as image intensifiers vs flat panel detectors. Dosimetry parameters will be defined, and instrumentation and techniques involved in their measurement will be reviewed. Typical diagnostic reference levels for adults and children will be presented. Examples of staff and patient exposures for selected interventional procedures will be shown. Emphasis will be placed on the estimation of organ doses. DICOM standards such as the Radiation Dose Structured Report (RDSR) and Patient-RSDR will be introduced. Compliance with Federal Regulations and recent TJC fluoroscopy standards, including training requirements, will be discussed. The latter may be challenging in scope, since fluoroscopy is not only performed in radiology departments, but also in cardiology, neurology, surgery, urology, orthopedics, obstetrics and gynecology, gastroenterology, physiatry and pain management clinics, where the physicians performing the procedures may not have received any formal training in radiation protection. |
