Managing patient dose in interventional cardiology.
This paper introduces a methodology for managing the radiation delivered to individual patients, incidental to their fluoroscopically guided interventional procedures. Because rare, but devastating skin injuries have occurred, radiation should be monitored and managed as well as drugs or radiographic contrast media. Dose metrics such as the total dose delivered to a reference point (reference point dose) should be used for this purpose. Fluoroscopy time is a poor independent predictor of skin dose in an individual patient. The concept of a "significant dose" is introduced. This is a predetermined action level of the selected dose metric. The numerical value is set based on classes of patient and procedural factors. Exceeding this value triggers processes for clinical justification of radiation usage and patient follow-up. Slightly exceeding the significant dose threshold during a procedure should be highly unlikely to cause skin injury.
Balter
Stephen
S
Columbia University, New York, New York, USA. sb2455@columbia.edu
Moses
Jeffrey
J
D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D003198:Computer Simulation; D004307:Dose-Response Relationship, Radiation; D005471:Fluoroscopy / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D008954:Models, Biological; D009518:New York; D017410:Practice Guidelines as Topic; D016730:Program Development; D011829:Radiation Dosage; D011834:Radiation Monitoring / Q000379:methods*; D011855:Radiodermatitis / Q000209:etiology / Q000517:prevention & control*; D015641:Radiography, Interventional / Q000009:adverse effects*; D018570:Risk Assessment; D012867:Skin / Q000528:radiation effects*; D009626:Terminology as Topic; D013997:Time Factors; D016896:Treatment Outcome