title: Online training on the safe use of fluoroscopy can result in a significant decrease in patient dose.
abstract: OBJECTIVE
  Concerns over medical radiation exposure have received national press in recent years, and training in the appropriate use of radiation has become an essential component of every radiology residency program. Appropriate training is particularly important in fluoroscopy because it is commonly used by inexperienced radiology residents and has the potential to impart relatively high patient radiation doses. In an effort to minimize the radiation doses received by patients, our institution has recently initiated an online training program in the safe use of fluoroscopy. This course is required and must be completed by new radiology residents before their first fluoroscopy rotation. The goal of this study was to determine if the use of an online course in the safe use of fluoroscopy could result in decreased patient dose without affecting diagnostic quality.
  
  
  METHODS
  Four years of retrospective procedural data for residents performing gastrointestinal and genitourinary fluoroscopic procedures without specialized training were reviewed. Incoming residents took an American Medical Association-accredited online training program in the safe use of fluoroscopy the week before their first fluoroscopy rotation. Patient dose and diagnostic quality data, inferred from the frequency of attending physician intervention necessary to complete the procedure, were collected for all exams performed by the new group of residents after completion of the training course. This was then compared to data from prior classes and stratified by procedure type.
  
  
  RESULTS
  Statistically significant reductions in both average fluoroscopy time (FT) or dose-area-product (DAP) were found for many of the fluoroscopic procedures performed by residents who participated in the online fluoroscopy training program. Specifically, statistically significant reductions in FT for barium enema, cystogram, defecogram, and esophagram procedures (P < .001) were found. Esophagram and upper gastrointestinal studies were completed with a significantly lower DAP (P < .001). The average reduction in DAP across all procedures performed by first-year residents was 38%, whereas the average reduction in FT was 25%. Based on a review of data from all procedures performed, there was no statistically significant loss in diagnostic quality.
  
  
  CONCLUSIONS
  An online training program can be effectively used to provide radiation safety instruction immediately before the start of a resident's fluoroscopy rotation, decreasing patient dose without affecting diagnostic quality.
authors.affiliation: Department of Radiology, University of Tennessee Graduate School of Medicine, Knoxville, TN.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Frederick-Dyer
authors.forename: Austin R
authors.initials: AR
authors.lastname: Faulkner
authors.forename: Ted T
authors.initials: TT
authors.lastname: Chang
authors.forename: R Eric
authors.initials: RE
authors.lastname: Heidel
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Pasciak
mesh_terms: D001822:Body Burden; D003194:Computer-Assisted Instruction / Q000706:statistics & numerical data*; D004521:Educational Measurement; D005471:Fluoroscopy / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D011361:Professional Competence / Q000706:statistics & numerical data*; D011829:Radiation Dosage; D011835:Radiation Protection / Q000706:statistics & numerical data*; D011853:Radiobiology / Q000193:education* / Q000706:statistics & numerical data; D013714:Tennessee / Q000453:epidemiology
keywords: Dose reduction; fluoroscopy; online training