title: Improving our PRODUCT: a quality and safety improvement project demonstrating the value of a preprocedural checklist for fluoroscopy.
abstract: OBJECTIVE
  To implement a preprocedural checklist in gastrointestinal (GI)/genitourinary (GU) fluoroscopy suites to assist radiology residents in performing studies with optimal fluoroscopic technique with a goal to lower radiation dose delivered to patients and operators.
  
  
  METHODS
  We introduced a preprocedural checklist in the form of a mnemonic to first-year resident fluoroscopy operators. The checklist was augmented by teaching sessions at the fluoroscopy tower. Fluoroscopy time (FT) was collected for GI/GU fluoroscopy studies performed by first-year residents who did not use the checklist (year 1) and compared with FT from first-year residents who used the checklist for one full academic year (year 2). Residents in both groups were surveyed to assess their knowledge of radiation safety at the end of their respective radiology 1 (R1) academic years.
  
  
  RESULTS
  A total of 778 examinations were analyzed from year 1, and 941 total examinations from year 2. After implementation of the checklist, mean FT for all studies decreased by 41.1 seconds (P < .0001) in year 2 residents. Multivariate linear regression confirmed that year of examination was the strongest independent predictor of FT when other covariates such as resident age, gender, and experience and patient age and gender were included. Radiation safety knowledge was similar in both groups but self-reported confidence in safe fluoroscopy tower operation increased slightly in year 2 (P = .144).
  
  
  CONCLUSIONS
  A visual preprocedural radiation safety checklist in GI/GU fluoroscopy was associated with a reduction in mean FT and may contribute to a culture of radiation safety awareness.
authors.affiliation: Division of Abdominal Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI. Electronic address: jleschi@med.umich.edu.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Leschied
authors.affiliation: Division of Abdominal Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Glazer
authors.affiliation: Division of Abdominal Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Bailey
authors.affiliation: Division of Abdominal Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Maturen
mesh_terms: D000328:Adult; D057189:Checklist / Q000379:methods*; D005260:Female; D052776:Female Urogenital Diseases / Q000175:diagnosis; D005471:Fluoroscopy / Q000592:standards; D005767:Gastrointestinal Diseases / Q000175:diagnosis; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D052801:Male Urogenital Diseases / Q000175:diagnosis; D008875:Middle Aged; D061214:Patient Safety / Q000706:statistics & numerical data*; D011829:Radiation Dosage; D011835:Radiation Protection; D011871:Radiology / Q000193:education* / Q000592:standards*; D013997:Time Factors
keywords: Resident education; checklists; fluoroscopy; quality improvement; radiation safety