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Fluoroscopy Dose Calculations - Adding Value to Safety

R Fisher1*, A Jones2*, E Marshall3*, (1) MetroHealth, Cleveland, OH, (2) UT MD Anderson Cancer Center, Houston, TX, (3) University of Chicago, Boynton Beach, FL


TU-A-Diagnostic Room-0 (Tuesday, 4/20/2021) 10:00 AM - 12:00 PM [Eastern Time (GMT-4)]

Current Procedural Terminology (CPT) codes are maintained by the American Medical Association and describe a wide range of services in medicine. As of 2021, CPT code #76145 has been issued for diagnostic physicists to provide “Medical physics dose evaluation for radiation exposure that exceeds institutional review threshold, including report.” This presentation will describe the origins of the code and how it can be implemented in a clinical setting. The specific requirements for billing will be discussed, as well as examples of dose evaluation reports.

Of the data available for peak skin dose (PSD) estimation, a few key pieces of information are absolutely necessary to produce a reasonable estimate. Some of this data is procedure specific, while some is machine-specific and should be collected during commissioning or annual testing. Achieving a high degree of accuracy is often not possible, and it is preferable to report results as a range with a most likely value rather than a single number to reflect this uncertainty. Biological effects from exposure to high PSD vary substantially from patient to patient and are presently stratified into broad PSD bands. Therefore, it is most important to identify into which band a patient falls.

Dose tracking software can automate the estimation of PSD. However, this process requires substantial effort from the qualified medical physicist ranging from the incorporation of critical technical factors into the skin dose estimate to final data interpretation. The primary objective of this talk will be to provide a step-wise process to calculate procedural-specific PSD utilizing PACS and Radimetrics™. The second objective of this talk will extend beyond PSD calculations, exploring how to apply Joint Commission regulations to encourage administrator progress towards enterprise-wide dose tracking.

Learning Objectives:
1. Describe the origins of CPT Code #76145 and how it can be implemented in a clinical setting.
2. Learn the essential aspects of PSD estimation.
3. Recognize how to stratify PSD estimates into biologically relevant dose bands.
4. Understand the basics of set-up and quick computing of PSD estimates using the Bayer Radimetrics™ dose software platform.
5. Explore possibilities and pathways of expanding PSD estimate access across hospital enterprises.


Fluoroscopy, Dose


IM- Radiation Dose and Risk: General (Most Aspects)

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