Interventional procedures guided by X-ray imaging are replacing more invasive open surgeries in a growing number of medical situations. This decreases the potential postoperative complications for patients, but it requires that medical staff consider and manage the risk resulting from radiation exposure.
How to improve radiation protection for patients undergoing fluoroscopy guided interventional procedures was the focus of an IAEA regional workshop held 10-14 June in Belgrade, Serbia. The participants - 25 medical doctors, medical physicists and radiographers from 18 European countries and three international experts - discussed how participation in the IAEA’s Safety in Radiological Procedures (SAFRAD) database can help medical specialists optimize radiation protection to avoid adverse side effects while maintaining medical benefits.
The SAFRAD database collects anonymized data on doses, side effects and other procedure details for patients that have been exposed to radiation doses above a certain level during diagnostic and interventional procedures guided by X-ray fluoroscopy. Based on voluntary reporting, the database enables users to improve safety by learning from international experience.
Prolonged or complex cardiac, neuro-interventional or other interventional procedures can in very rare cases cause radiation-induced skin reactions. Such side effects are sometimes unavoidable due to the complexity of the procedure, but in many situations, they can be avoided by planning and proper use of equipment and techniques.
“SAFRAD is the only international database of its kind in the world, and to fulfil its potential for improving the radiation protection of patients, it needs active participation of radiological facilities,” said Jenia Vassileva, IAEA radiation protection specialist and SAFRAD technical officer. “More data from more facilities will increase the ability to draw conclusions on the relationship between the skin dose from X-ray exposure and skin reactions. This will also help prevent and manage such side effects.”
Benefits of using the SAFRAD Database
Medical facilities that participate in and contribute to SAFRAD can use database findings to create efficient local programmes for patient follow-up and early detection of potential skin reactions. The database also offers insights on how to prevent overexposure and limit side effects to only those that are unavoidable and medically justified.
“Departments performing interventional procedures should have an established procedure to monitor appropriate dose parameters displayed by the fluoroscopy equipment, and to follow up patients when a pre-defined trigger level is exceeded,” said workshop expert Françoise Malchair, a medical physicist from Belgium who was involved in developing SAFRAD. “It is very important that medical staff inform the patient in such a case to inspect the skin for signs of redness or rash after the procedure and report back to the department to get the best advice and treatment.”
Learning from experience
Workshop participants discussed experiences of and good practices for optimizing fluoroscopy-guided interventional procedures and reducing the risk of side effects, new dose reduction features of imaging equipment and ways to accurately define dose to the patient skin. They also conducted exercises based on previously reported cases and created an action plan to further strengthen SAFRAD and establish local procedures for reporting and follow-up of patients.
“The key message of this workshop is the need to enhance collaboration and cooperation between professions involved in interventional radiology to improve knowledge, awareness and communication with patients,” said meeting participant Dimitrij Kuhelj, Head of the Department of Interventional Radiology at the University Medical Centre in Ljubljana, Slovenia. “If we succeed in improving cooperation, this will lead to the optimal use of ionizing radiation in medicine and improved patient management.”
The workshop was organized in the framework of the IAEA technical cooperation project for the European region that aims to enhance Member States’ capabilities for ensuring radiation protection of patients.
