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Report No. 168 - Radiation Dose Management for Fluoroscopically-Guided Interventional Medical Procedures (2010)

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This Report is focused on the use of fluoroscopic systems as a tool for guiding diagnostic and therapeutic procedures because higher radiation doses (compared to conventional radiography and fluoroscopy) are received regularly from some types of FGI procedures and occasionally from many other types of FGI procedures. Other medical applications of fluoroscopy (e.g., examination of the gastrointestinal system, guiding open surgical procedures) are outside the scope of this Report. Computed-tomography-guided interventional (CTGI) procedures are not discussed in detail due to continuing changes in the technology driven by the evolution of multi-slice computed tomography (CT) detectors. However, the principles presented in this Report are generally applicable to these domains. Most of the recommendations contained in this Report should be applied in all settings where fluoroscopic guidance is used.

Within the context of radiation dose management, the goal of this Report is to supply information that helps optimize patient outcomes without compromising worker safety. However, radiation is not the only risk to which patients and workers are exposed. In many cases, radiation is a minor component of overall risk. In these situations, too great a focus on radiation safety (e.g., the use of unnecessarily thick lead aprons) may reduce the overall safety of patients or workers.

Some beneficial, clinically-justified FGI procedures, even when optimized for radiation protection, deliver substantial doses of radiation to patients. This puts the patient at risk for radiogenic stochastic effects and occasionally induces radiogenic deterministic effects. However, a complete risk analysis usually identifies many other procedural hazards and will often conclude that radiation is one of the lesser hazards from FGI procedures. While the decision to conduct an FGI procedure assumes that the use of ionizing radiation is warranted by the disease state for which the patient undergoes treatment, the benefits, risks, and alternative procedures that do not require the use of ionizing radiation should be considered.

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Scientific Committee:
Stephen Balter, Chairman

Beth A. Schueler, Vice Chair
Donald L. Miller, Vice Chair
Jeffrey A. Brinker
Charles E. Chambers
Kenneth F. Layton
M. Victoria Marx
Cynthia H. McCollough
Keith J. Strauss
Louis K. Wagner

Six Consultants
I Disagree
I Agree

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