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Patient radiation management in interventional fluoroscopy

16 May 2019

Recorded broadcast →

Presenter: Prof. Stephen Balter
Date of broadcast: 16 May 2019, 3 pm CET 

Organized jointly with the International Organization for Medical Physics

About the webinar

Fluoroscopically guided interventional procedures (FGI) are used with increasing frequency in place of open surgery for a growing number of procedures. FGI usually reduces both hospital-time and procedural-related morbidity. One cost of FGI is the exposure of both patients and staff to radiogenic risks from these procedures. In addition, operators are an active element of much of the logic needed to control FIG systems. Appropriate application of fundamental concept and optimized use of system-specific controls by the physician performing the procedure are essential elements of radiation management.

This webinar will start with a brief review selected biological factors underlying potential FGI injuries and provide examples of current and forthcoming technologies used for real-time radiation use tracking. Actionable results from a recently concluded United States Veterans Administration Healthcare Failure Mode Effects analysis entitled “Preventing Harm from Fluoroscopically‐Guided Interventional Procedures” will be discussed. 

At present, there are more than a dozen suppliers of commercial dose management systems and several non-commercial software packages available for hospital use. No current offerings are capable of satisfying all of the needs of every user. The presentation will describe a manufacturer-neutral composite dose management system based on these offerings and additional important elements that are not usually parts of these packages. Associated implementation barriers for any radiation management system include: Fluoroscopic systems without dose communication capabilities, physical transport layer topologies & limitations, as well as inappropriate and inconsistent procedural descriptors. 

Operational aspects of patient dose management system successfully used at Columbia University’s Interventional Cardiology Laboratory for more than a decade will be outlined. Elements of this program should be useful in developing local policies and procedures suitable for any FGI laboratory. 

The average per-procedure radiation use in FGI has decreased by a factor of two in the past decade both at Columbia and in several other facilities. These declines are generally attributable to a combination of improved medical devices, technological improvements in the imaging system, and operator influences. Appropriate and frequent feedback from a radiation management process is an important factor in its own right.. 

Learning objectives

  1. To understand key elements of FGI radiation management
  2. To describe currently available and forthcoming FGI resources
  3. To utilize Columbia’s Cath Lab FGI program and comparative results to develop a local patient management program.

About the presenter

Stephen Balter is a Professor of Clinical Radiology (physics) and Medicine at Columbia University. He is an international authority on all aspects of medical fluoroscopy. Dr. Balter is a member of Council of the National Council on Radiation Protection and Measurements, and served as the chair of NCRP Report-168 – Radiation Dose Management for Fluoroscopically-Guided Interventional Medical Procedures.

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