Fluoroscopic Radiation Management

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By Stephen Balter, PhD  

‘Radiation’ is a six-hundred-pound invisible gorilla that can disrupt departmental and hospital operations. The administrators’ role in optimally managing radiation must go beyond simply assuring compliance with regulations. In the context of the radiography-fluoroscopy environment, my presentation at the 2018 Fall Virtual Conference will briefly review general principles including staff radiation safety, patient radiation management, and staff safety communications; aspects of operational safety in interventional radiology; and it will end with a preliminary analysis of the Joint Commission’s new 2019 fluoroscopy requirements.

Interventional radiology and its cousins in departments such as cardiology and surgery can necessarily use large amounts of radiation. One consequence is that patients may be at risk for tissue reactions. Another consequence is that most physician and staff irradiation occur in this arena. Fluoroscopic radiation use is much more variable than modalities such as CT. Contributing factors include operator preferences, patient characteristics, procedural requirements, and the amount of a-priori information available to the operator. In my presentation, I will provide practical materials, such as check lists and QA processes that can be used to manage radiation in this environment.

The Joint Commission has issued standards revisions for organizations providing fluoroscopy services. These revisions are scheduled to go into effect in January 2019. I will share a preview of these requirements in my presentation. These requirements are applicable beyond radiology and into the entire hospital (or other facility) and are likely to provide interesting administrative challenges for their compliance. Topics include enhanced Physics QA (with some line-items beyond current regulatory standards); training requirements for all individuals in the facility (physicians and others) holding fluoroscopic privileges; documentation of all fluoroscopic radiation use in a retrievable format; and processes for managing potential tissue reactions (such as skin injuries). Because final implementation and JC inspection details are not yet available, I will present the best available information that can be used to meet the forthcoming standards.

Radiation has both real and perceived hazards. It is usually one of the smaller real risks found in the radiology environment. Patients are expected to benefit from their procedures; some radiation risk is a cost of the procedure. Staff irradiation occurs in some procedures (eg, portables and fluoroscopy). In these cases, the staff are put at risk while delivering appropriate patient care. In addition, perceived rumors and fears can result in inappropriate avoidance of radiation by patients, and insufficient attention to more important risks by both patients and staff.

Please join me for my session, Fluoroscopic Radiation Management, on November 1 at 2:00 PM EST at AHRA’s 2018 Fall Virtual Conference, to learn more about this important topic.


Stephen Balter, PhD is Professor of Clinical Radiology at Columbia University in New York, NY. He can be reached at sb2455@cumc.columbia.edu.

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