Fluoroscopy-related skin injuries have been on the rise  since 1992. They are uncomfortable and can be devastating for patients. 

As a member of the imaging team, you have to do your best to keep patients safe during fluoroscopy procedures .

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 

The majority of skin injuries from fluoroscopy procedures are preventable. Patients are unique in their response to radiation. Still, there are some commonalities among procedures that cause preventable skin injuries:

  1. Misinformed patients
  2. Incorrect dose management
  3. Lack of awareness of total dose
  4. Imaging team’s lack of knowledge about the risks of prolonged fluoroscopy procedures
  5. Failure to identify skin injuries

Another common 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. 

Those are 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

To assure patient safety during fluoroscopy, radiologists and their radiologic interventional technologists need to have a plan. This plan would ideally include measures for before, during, and after the procedure. 

Safety Measures Before the Procedure 

Perhaps the most obvious– yet most vital– pre-procedure safety measure is training. The radiologist 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 had training.  This includes any mandated continuing education requirements.

Does the procedure use high-dose fluoroscopy? If so, the radiologist should inform the patient about the risks of the procedure beforehand. It may also be helpful to outline the safety measures the radiologist and their interventional radiology team intend to use.  

The radiologist should pre-screen patients for risk of skin injury. 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.

Pre-screening should also include patients who take medications that increase photosensitivity. For example, but not limited to:

  • Some antibiotics
  • NSAIDs
  • Diuretics
  • Retinoids

Finally, 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). 

Safety Measures During the Procedure

During the procedure, the interventional radiologic imaging team should set notification levels of threshold radiation used. That way, the team can 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 to help him select the right dose (for example, imaging protocols). 

To ensure procedure notifications are working, regular inspections must be performed. 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

After the fluoroscopy procedure, the radiologist should first record and review dose data. This may include:

  • Fluoroscopy time
  • Kerma area product
  • Reference air kerma

The radiologist should record this data for every procedure the patient undergoes. Radiologists should review this information 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.

If the procedure did exceed SRDL, the facility should inform the 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 this is complete, 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® Cat A or A+ course that’s right for you.