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Session: Fluoroscopy Dose Management [Return to Session]

Fluoroscopy Dose Management

R Fisher1*, M Mahesh2*, A Jones3*, R Fisher4*, (1) MetroHealth, Cleveland, OH, (2) Johns Hopkins Univ, Baltimore, MD, (3) UT MD Anderson Cancer Center, Houston, TX, (4) MetroHealth, Cleveland, OH


1:00 PM MPPG #12: Fluoroscopy Dose Management - R Fisher, Presenting Author
1:25 PM First CPT Code for Diagnostic Medical Physics: What to Know and How to Use This Code - M Mahesh, Presenting Author
2:05 PM ACR Dose Index Registry for Fluoroscopy (DIR-Fluoro) - A Jones, Presenting Author
2:45 PM Audience Q & A - R Fisher, Presenting Author

SU-CD-TRACK 2-0 (Sunday, 7/25/2021) 1:00 PM - 3:00 PM [Eastern Time (GMT-4)]

Ryan Fisher - MPPG #12: Fluoroscopy Dose Management
Medical physics practice guideline # 12, “Fluoroscopy Dose Management” aims to outline the role of the diagnostic qualified medical physicist in practical patient dose management for fluoroscopically-guided interventional (FGI) procedures. This role includes helping facilities set up policies related to dose management, including pre-procedure patient consent, intra-procedure dose index level notification, and post-procedure follow up for potential tissue reactions. Additionally, the document includes suggestions for methods of complying with various state regulatory requirements and Joint Commission standards related to fluoroscopy, including tracking radiation doses, setting dose index thresholds, and analyzing dose index data, and includes discussion of the challenges posed by these requirements. This presentation will cover the content of the new practice guideline, as well as potential changes to the Joint Commission fluoroscopy radiation overdose sentinel event.

Learning Objectives:
1.Understand recommendations for physicists’ responsibilities related to fluoroscopically-guided interventions outlined in the forthcoming medical physics practice guideline.
2.Understand changes related to the Joint Commission’s prolonged fluoroscopy sentinel event standard.

Mahadevappa Mahesh - First CPT Code for Diagnostic Medical Physics: What to Know and How to Use This Code
The very first CPT code (76145 – Medical physics dose evaluation for radiation exposure that exceeds institutional review threshold for diagnostic medical physics) was approved and became active from January 1st, 2021. The presentation includes explanation of the code and its origin along with discussion on when it could be used. The presentation will include sample cases with step-by-step guide on how to evaluate and complete the report. There will be discussion on how to go about setting the code in the clinic.

Learning Objectives:
1.To learn what is CPT code 76145
2.To examine when the code could be used and what should be in the report.
3.To become familiar with the threshold values that warrants the use of this code

A. Kyle Jones- ACR Dose Index Registry for Fluoroscopy (DIR-Fluoro)
The American College of Radiology (ACR) Fluoroscopy Dose Index Registry (DIR) is the latest addition to the National Radiology Data Registry (NRDR). During the pilot phase of the registry, fluoroscopy dose index data was collected from nine pilot sites over a period of 22 months from March 1, 2018 through December 31, 2019. Ultimately, dose index data from almost 40,000 unique clinical procedures was collected, reviewed, and analyzed. These procedures were mapped to one of 127 ACR Common IDs which allowed for comparison of dose indices for similar procedures among pilot sites. Broader roll-up categories were also developed, which allowed for comparison of procedures across multiple ACR Common IDs and provided sites with less granular clinical facility procedure names a pathway to analyze their submitted data and produce reasonable comparisons to the pilot group as a whole.

Learning Objectives:
1.Outline the process for sites to participate in the ACR Fluoroscopy DIR.
2.Review the dose index data collected during the pilot phase of the ACR Fluoroscopy DIR.
3.Discuss strategies for using DIR data and comparisons for quality improvement.

Funding Support, Disclosures, and Conflict of Interest: Content reviewer for online fluoroscopy training



Fluoroscopy, Angiography, Dose


IM- X-Ray: Fluoroscopy, digital angiography, and DSA

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