New IAEA Safety Guide For X Ray Guided Intervention Technique

The IAEA has released its first guidelines on quality assurance and optimization for fluoroscopically guided interventional procedures – minimally invasive medical techniques used to diagnose and treat a diverse range of conditions.

This new resource advances the field of interventional medicine and helps to improve patient outcomes. 

Fluoroscopically guided interventional procedures (FGIPs) use fluoroscopy – an X ray imaging technique that generates real-time moving images – to guide clinical interventions. These procedures are cost-effective alternatives to some surgical or medical interventions for certain conditions since these procedures can help to reduce complications, mortality rates and hospital stays.

In cardiology for example, FGIPs assist in conducting angiographies to address blockages; placing electrical devices such as pacemakers; and performing structural repairs of heart defects and damage. FGIPs have notably contributed to a reduction in open heart surgeries. In neurology, they help in tackling brain aneurysms, strokes, arteriovenous malformations (abnormal connections between arteries and veins) and anomalies of the spinal cord’s vasculature, to name but a few. In interventional oncology, FGIPs enable physicians to directly target tumors.

Using these procedures in an effective and appropriate manner across medical specialties, however, requires rigorous quality standards. To address this, especially in light of the increased demand for FGIPs due to a growing global population, the IAEA has developed a dedicated document which supports the highest standards of safety and efficacy.

The publication enables care providers to better understand the critical components of FGIP facilities and systems, from reviews of the procedure’s clinical applications to examinations of the latest technical developments. On quality assurance programmes in particular, it outlines best practices and protocols; highlights the specific responsibilities of various professionals; and underlines the necessary engagement of key stakeholders throughout each stage of the equipment lifecycle. The guidance also covers several relevant performance tests, focusing on the most common pitfalls while identifying corrective actions. 

“This document is a critical international resource for medical physics professionals engaged in fluoroscopically guided interventional procedures and performing quality assurance on interventional fluoroscopes,” emphasized Kevin Wunderle, a diagnostic medical physicist and professor in the Ohio State University’s Department of Radiology and one of the experts who developed the publication. “It provides comprehensive, internationally endorsed guidance on quality assurance and optimization strategies that enhance patient safety, ensure the effective use of advanced imaging technology, and promote adherence to global standards of clinical practice.” 

In turning to optimization – the delicate balance between the highest quality of clinical images and lowest dose of necessary radiation – the publication proposes a framework to navigate advances in technology, machinery, post-processing tools and software algorithms. “Through practical clinical examples applying this framework within daily practice, it explores special considerations for patients who may need specific imaging protocols,” noted May Abdel-Wahab, Director of the IAEA Division of Human Health. “This resource is a testament to the vital work of the Agency’s human health programme in providing countries worldwide with timely and directly relevant guidance.” 

Just one month following its release, Quality Assurance and Optimization for Fluoroscopically Guided Interventional Procedures became the most accessed IAEA publication of March 2025. It has been endorsed by the American Association of Physicists in Medicine, Asia-Oceania Federation of Organizations for Medical Physics, Asociación Latinoamericana de Física Médica, European Federation of Organisations for Medical Physics, Federation of African Medical Physics Organizations, International Society of Radiographers and Radiological Technologists and Southeast Asia Federation of Organizations for Medical Physics.