Patient Radiation Doses in IR Procedures: The American College of Radiology Dose Index Registry-Fluoroscopy Pilot

Abstract

Purpose: To update normative data on fluoroscopy dose indices in the United States for the first time since the Radiation Doses in Interventional Radiology study in the late 1990s.

Materials and methods: The Dose Index Registry-Fluoroscopy pilot study collected data from March 2018 through December 2019, with 50 fluoroscopes from 10 sites submitting data. Primary radiation dose indices including fluoroscopy time (FT), cumulative air kerma (K_a,r), and kerma area product (P_KA) were collected for interventional radiology fluoroscopically guided interventional (FGI) procedures. Clinical facility procedure names were mapped to the American College of Radiology (ACR) common procedure lexicon. Distribution parameters including the 10th, 25th, 50th, 75th, 95th, and 99th percentiles were computed.

Results: Dose indices were collected for 70,377 FGI procedures, with 50,501 ultimately eligible for analysis. Distribution parameters are reported for 100 ACR Common IDs. FT in minutes, K_a,r in mGy, and P_KA in Gy-cm² are reported in this study as (n; median) for select ACR Common IDs: inferior vena cava filter insertion (1,726; FT: 2.9; K_a,r: 55.8; P_KA: 14.19); inferior vena cava filter removal (464; FT: 5.7; K_a,r: 178.6; P_KA: 34.73); nephrostomy placement (2,037; FT: 4.1; K_a,r: 39.2; P_KA: 6.61); percutaneous biliary drainage (952; FT: 12.4; K_a,r: 160.5; P_KA: 21.32); gastrostomy placement (1,643; FT: 3.2; K_a,r: 29.1; P_KA: 7.29); and transjugular intrahepatic portosystemic shunt placement (327; FT: 34.8; K_a,r: 813.0; P_KA: 181.47).

Conclusions: The ACR DIR-Fluoro pilot has provided state-of-the-practice statistics for radiation dose indices from IR FGI procedures. These data can be used to prioritize procedures for radiation optimization, as demonstrated in this work.