As a member of the imaging team, you have to do your best to keep patients safe during fluoroscopy procedures .
Fluoroscopy-related skin injuries have been on the rise since 1992. They are painful and can be devastating for patients.
Want to assure your patient’s highlest level of safety before, during, and after their procedures? Then keep reading to help you get started.
Common Reasons for Preventable Injury Due to Fluoroscopy
Patients are unique in their response to radiation. The majority of skin injuries from fluoroscopy procedures are preventable. There are commonalities that cause preventable skin injuries:
- Misinformed patients
- Incorrect dose management
- Lack of awareness of total dose
- Imaging team’s lack of knowledge about the risks of prolonged fluoroscopy procedures
- Failure to identify skin injuries
An important and often overlooked cause of radiation induced injury is lack of knowledge about the cumulative dose after multiple procedures. The dose delivered during each procedure may not have been enough to cause harm alone. but the cumulative effect leads to damage or injury.
Now that we have learned the most common reasons for fluoroscopy procedure radiation-induced skin injury. Now, let’s explore exactly how the radiologic imaging team can prevent them.
How to Make Sure Your Patients are Safe During Fluoroscopy Procedures
Create a plan. This plan would ideally include measures for before, during, and after the procedure. To assure patient safety during fluoroscopy, radiologists and their radiologic interventional technologists need to have a plan.
Fluoroscopy Safety Measures Before the Procedure
Training is perhaps the most obvious– yet most vital– pre-procedure safety measure. The radiologists should fulfill academic and residential training. The interventional radiologic technologists should be trained and in some cases certified as interventional technologists. Nurses should also have training. Training doesn’t stop with the information you learn in the beginning of your career in fluoroscopy. It includes any mandated continuing education requirements.
A Radiologist should inform the patient about the risks of any procedure beforehand. It may also be helpful to outline the safety measures the interventional radiology team intend to use.
Patients at higher risk include diabetics and obese individuals. Also, patients who have undergone previous radiation at the same skin location are at increased risk for injury. They should be pre-screened.
Pre-screening should also include patients who take medications that increase photosensitivity. For example, but not limited to:
- Some antibiotics
- NSAIDs
- Diuretics
- Retinoids
The radiologist and the interventional radiology technologists must take special care with pediatric and pregnant patients.
Practice informed consent with pregnant patients. Let them know about the risk of birth defects and even miscarriage. Keep in mind that pediatric patients are more radiosensitive than adults (i.e., the cancer risk per unit dose of ionizing radiation is higher). Pediatric patients have a long life ahead of them and more time for cancers to form. They are not small adults. They are children. Image Gently®.
Safety Measures During the Procedure
Notification levels of threshold radiation used should be set by the interventional radiologic imaging team. That’s a way to ensure minimum doses are used throughout the procedure.
This is especially important for patients who were pre-screened for risk of skin injury, pregnancy, and age. For pregnant women or pediatric patients, the radiologist should make tools available like shields and imaging protocols to help him or her select the right dose.
Regular inspections must be performed to ensure procedure notifications are working, . The dose-measuring program should be re-calibrated when necessary and calibration factors should be considered in notification levels during the procedure.
Lastly, the radiologist should practice a high level of awareness about dosing. At all times, he should know the current dose rate. He should also know the total dose utilized so far.
Want more information about managing radiation dose during fluoroscopy procedures? Check out the 10 steps to manage radiation dosing.
Safety Measures After the Procedure
The radiologist should first record and review dose data after each fluoroscopy procedure. This may include:
- Fluoroscopy time
- Kerma area product
- Reference air kerma
This information should be reviewed regularly. This is especially important before their next fluoroscopy procedure.
Patient data should then be transformed into an FDS. The radiologist should compare the FDS to advisory data sets. For example, the RAD-IR study of total dose and skin dose.
The facility should also have a reference for SRDL (ideally 5Gy). If notification levels surpassed the threshold reference air kerma during a procedure? The radiologist must follow-up with that patient. The patient should also scheduled for a follow-up within 4 weeks.
The peak skin dose for the procedure in which they surpassed SRDL should be recorded. Include patient table height in this estimation as well as gantry angles for all images taken.
Once above measures are completed, the radiologist might refer the patient to an oncologist. The radiogenic oncologist will address possible skin injuries due to the procedure.
Continuing Education for Radiologists and Interventional Technologists
Radiologists, radiological technologists, interventional technologists and nurses have to complete continuing education courses. It’s important, especially if you take part in fluoroscopy procedures.
That’s where Scrubs Continuing Education comes in. Browse our radiology CE courses today and discover the ARRT® Category A course that’s right for you.
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