2020 Health Physics Society Midyear Meeting & ExhibitionMPM-A
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| Chair(s): Ray Dielman, Bryan Lemieux |
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MPM-A.1 14:00 Radiation Protection in Interventional Fluoroscopy: A Continuing Story. Miller Donald L.*, U.S. Food and Drug Administration donald.miller@fda.hhs.gov
Patient injuries from radiation exposure during interventional fluoroscopy were first recognized as an important concern more than 25 years ago. Since then, many individuals and organizations have participated in the evolution of radiation protection in interventional fluoroscopy. In 1992, at a symposium sponsored by the American College of Radiology and the Food and Drug Administration, four central areas of concern were identified: equipment, quality management, operator training, and occupational radiation protection. In the intervening years attention has been focused on each of these. Advances in equipment have permitted lower fluoroscopy dose rates and reduced the need for radiographic imaging during procedures. The introduction of quality management methods provided greater awareness of patient doses and a new opportunity for continuous improvement. Operator training in radiation management and radiation protection has become even more important as the complexity of fluoroscopes, implantable devices, and procedures has increased. New knowledge of the effects of radiation exposure on the lens of the eye and increased awareness of the ergonomic hazards of personal protective equipment have led to changes in recommendations for allowable occupational exposure and methods of protection. On a continuing basis we see the introduction of new fluoroscopes with new technologies, new devices for use in interventional procedures, and new interventional procedures. Radiation protection procedures and practices need to evolve continuously to deal with these new challenges. The goal remains the same: Maximizing benefit for patients and minimizing radiation risks for both patients and staff. |
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MPM-A.2 14:30 Fluoroscopy Training: Content. Balter Stephen*, Columbia University; Balter Stephen, Columbia University sb2455@cumc.columbia.edu
Fluoroscopic training is unique because fluoroscopic procedures differ from other medical imaging procedures: The amount of radiation delivered to the patient and its spatial distribution on the patient are both under the dynamic control of the operator. For the patient to receive a medical benefit, both the patient and staff are exposed to radiogenic and other risks. However, radiation is almost always among the lowest risks from any fluoroscopic procedure. Ideally, training requires both content and delivery be adapted to both patient risk level and the specific tasks performed by individuals working in the fluoroscopic environment. Examples range from occasional fluoroscopy with a mini C-arm to full-time extensive neuro-embolic procedures. Staff risk is higher for individuals close to the patient when the beam is on, and lower for those who are usually far from the beam. Educational content should also differ between initial and recurrent training. Initial safety training should appropriately present all the materials needed to help optimize the radiation aspects of the risk-benefit balance for both patients and staff. Recurrent training is most efficient when it reminds individuals of key items, including regulatory requirements, and reviews radiogenic happenings in the time after the previous training session. Recurrent training should also provide an explicit platform for the instructor to respond to attendee concerns. This HPS presentation will include representative materials from a one-on-one training provided to an onboarding experienced interventional cardiologist, and a refresher course presented at a recent national interventional meeting. |
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MPM-A.3 14:45 Lessons Designing and Implementing a Fluoroscopy Training Program. Caracappa Peter F*, Columbia University; Caracappa Peter, Columbia University pc2837@columbia.edu
In recent years, radiation regulators, standards committees, and accreditation bodies have turned greater attention to the safe use of fluoroscopy, particularly in the area of fluoroscopically guided interventional (FGI) procedures, due to potential for significant radiation dose and injury. The principles of the Image Gently and Image Wisely campaigns have begun to be codified into institutional requirements. A key element to the FGI safety program is appropriate training for those operating equipment and performing procedures. Several challenges can be illustrated from lessons learned in implementing such a program at a major university medical facility. An important initial challenge is distilling the overlapping (sometimes complementary, but occasionally contradictory) requirements from different bodies into an audience-appropriate educational program. In addition to sheer numbers, the distribution of individuals requiring training may span different departments, campuses, and employers, which leads to difficulties in tracking and accountability. Additional lessons from fluoroscopy safety education will be shared. |
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MPM-A.4 15:30 Physician Credentialing in Fluoroscopy -- Is there a "BEST" approach? Thomas Jerry*, Ascension Via Christi Hospital; Thomas jerry jerry.thomas@ascension.org
Physician credentialing is at times a slippery slope when the need is mandated/suggested by others not trained as physicians. How does a non-physician present the need and benefit of adding fluoroscopic machine operation to become a mandated credential for physicians? There are "novel" and "standardized" approaches to credentialing and there are others that may be considered as being approaches that are "behind the barn" or "around the block". The various approaches to selling the need for those operating fluoroscopic x-ray units to have demonstrated expertise in their training and continued use of this equipment will be addressed along with the acceptance of these concepts by differing medical specialties whose clinical work requires the use of fluoroscopic imaging. While not a new concept in the medical community the addition of a “new” credentialing requirement comes with increased administrative hurdles and professional biases that may require a radical adjustment of both processes and mind-sets. This presentation is designed to present these issues in a factual and humorous manner. |
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MPM-A.5 16:00 CURRENT STATUS OF THE JOINT COMMISSION FLUOROSCOPY STANDARDS IN AN ACUTE GENERAL HOSPITAL. DIELMAN RAY*, MHP CONSULTANT RAY.DIELMAN@BAYCARE.ORG
THE PATHWAY HAS BEEN CHALLENGING AT ALL LEVELS COMMENCING WITN THE HISTORY OF THE FLUOROSCOPY STANDARDS EFFORT AND CONTINUING TO THE PRESENT DUE TO THE LACK OR CONSENSUS S AMONG STAKEHOLDERS, GOVERNMENT AND ACCREDITATION GROUPS. THE RECENT EFFORT WAS NEGATIVELY IMPACTED BY "A FEW" STAKEHOLDERS AND WITHDRAWN RESULTING IN THE NEED FOR OPERATOR PRIVILEGING AND CREDENTIALING CRITERIA IN FLUOROSCOP.Y. WE WILL PRESENT THE REPORTED PERFORMANCE STANDARDS TO BE SURVEYED BY ACCREDITATION SURVEYORS & FOR HOSPITALS TO ANSWER: "HOW DO YOU KNOW?". |