AAPM Medical Physics Practice Guideline 12.a: Fluoroscopy dose management

Abstract

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. While must is the term to be used in the guidelines, if an entity that adopts the guideline has shall as the preferred term, the AAPM considers that must and shall have the same meaning. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances. Fluoroscopy equipment is used to observe or guide moving objects such as internal organs, contrast agents, catheters, and guidewires within the body to diagnose and treat disease. Procedure times range from several seconds to multiple hours, and fluoroscopes range from small, mobile C-arms used to image extremities, to complex single- or bi-plane angiography systems. These more complex fluoroscopes are used to guide performance of fluoroscopically guided interventional (FGI) procedures, and help to provide lifesaving diagnostic and therapeutic services for patients. However, unlike simpler procedures commonly accomplished using general or mobile C-arm fluoroscopes, long and complex FGI procedures can exceed radiation thresholds for tissue reactions. Proper identification, follow-up, and management of patients receiving high doses from FGI procedures are essential parts of patient care due to the slowly developing nature of radiation-induced tissue reactions. Recent standards and requirements from accrediting bodies such as The Joint Commission (TJC) and state regulatory agencies have brought focus to this issue, requiring hospitals to record patient and to and procedures for those and providing patient as These standards are in to which requires and of tissue and have and for patient the on and the of the of the of and multiple the of the American of on AAPM practice guideline to the of the diagnostic medical as by AAPM of in patient management for FGI to patient and for tissue reactions. for of standards and state regulatory requirements for radiation and are a of the by these The in standards by tissue is that may the such as and radiation are as are due to radiation on of and are by a and an in the of the These are the primary for patients FGI procedures, and will be the focus of this not not doses a which the Commission on as the to in a of the tissue in patients FGI procedures may the of the and The for is an of and are an of for tissue can be as the same has been for of radiation to is within a of of can may be to on the radiation and the tissue may be due to and may not be by the are due to in the range in from and to which can of in the radiation necessary to a specific and the of the tissue are of as than specific as in from it be that is a for developing tissue than that have the of radiation-induced from FGI procedures requires an of the radiation radiation to this or commonly as or and is not for the of tissue The and of each on equipment and equipment and each in and Fluoroscopy is the it is the in of tissue Fluoroscopy is to patient not and that on can as which can are not in the and image are for the specific of using the of from a can improve of patient However, is for radiation it can be for purposes a for and practice is to be on Commission interventional fluoroscopes and fluoroscopes in the United is the for a and of in a specific to the the for the is the of the from the the can use a if The specific used by a of equipment is in the is used as a for the and are if a more of is These and and due to and patient the may not the in a for to these is considered a for is in of in is the of and the in the same to the of the are on interventional fluoroscopes and commonly on mobile C-arms and diagnostic is of from the the to the radiation as doses to a and doses to a this is considered a of and radiation-induced tissue represents the in the it is to as a of for on equipment can the of thresholds of and are in are the are on FGI the to the tissue reactions. of the FGI is that can on in the radiation the for the of tissue it of the and using on patient and a that from has to the a is to be of to and their of to of such as and and patient of these in it is that fluoroscopes from or of the same provide of by are to FGI fluoroscopes and are not on mobile C-arms or general is commonly in of a patient management the will to the on the equipment in a or The of these will the used to thresholds for may be equipment in to be equipment that not or can provide this use the that tissue and the in and made by use the to and it is the recommendation of this that be the primary used in for and patient and of the and of patient to the patient While are not in the of these and procedures, their is in of the the can be specific and may be for or Each must a policy for a from patients to FGI procedures patients are the of tissue this policy be FGI equipment the may can be or must be may to this procedures in FGI or a of procedures as high The can in to which procedures procedures as high radiation if more than of procedures in a radiation for a of procedures a to procedures tissue are However, it may policy and process by requiring to and a of procedures in and requiring radiation of radiation from the guidelines for patient can be in can be in and such be reviewed by appropriate and to of a of the use of in the tissue from to the for these to and the for the patient if is to for medical or patients will FGI procedures be to if are for tissue The of patient is to the those have procedures or a of radiation to the same or that which are in body is a the of tissue the of radiation to an image and can in the to the radiation the to the each of an FGI FGI procedures be that a to the patient than the which radiation tissue is considered by the to a and the is in the to be the to have an of radiation the of tissue and the The as the in this can provide radiation to the to help that the is The must the of radiation to which are than the of tissue The of a radiation is than such as and However, the is not and may the be by a and be throughout the if be due to radiation or made the is if the is of to a or of developing in the will have been for to the appropriate complex procedures may be in a multiple by to the to the and the of tissue reactions. 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