8/2/2012. Outline. Dr M. Mahesh MS, PhD, FAAPM, FACR, FACMP, FSCCT. Fluoroscopy Training and Compliance Experience of a Large Academic Institution
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1 Fluoroscopy Training and Compliance Experience of a Large Academic Institution Mahadevappa Mahesh, MS, PhD, FAAPM, FACR, FACMP, FSCCT. Associate Professor of Radiology and Cardiology School of Medicine Chief Physicist Hospital Baltimore, MD 54 th Annual Meeting of AAPM, Aug 1 st, 2012, Charlotte, NC Outline Regulations regarding fluoroscopy training Identifying who requires training Training models Challenges with compliance Delineation of Privileges Radiation induced skin injury: Malpractice issues Cardiac Catheterization Procedure Initial: 173 min fluoroscopy and number of cine runs 5 months later: 74 min fluoroscopy & 2400 cine images (~1.5 min of cine 30 fps) Severe skin injury, underwent extensive skin grafting Malpractice lawsuit for negligence and not informing about possibility of skin injury Jury awarded $1,000,000 in compensation Berlin L, AJR: 177,
2 Skin Injury Caused Due to Malfunction of X-ray Equipment During RFA Rosenthal LS, Mahesh M, et.al. PACE 20: , 1997 Maryland Regulations regarding Fluoroscopic Users F.5 (n) Qualifications for Users who energize Fluoroscopic systems By December 31, 2005 the registrant shall ensure that only licensed practitioner of healing arts or a radiological technologist be allowed to energize fluoroscopic x-ray systems All persons energizing these systems shall have completed at least four hours of training as specified in F.5 (n)(2) prior to clinical use of a fluoroscopic system, or provide documentation to demonstrate completion of four hours of training as specified in F.5 (n)(2) F.5 (n) (2): Topics to be included in the training Biological effects of x-ray Principles of radiation protection Factors affecting fluoroscopic outputs Dose reduction techniques Principles and operation of fluoroscopic systems and outputs of each operational mode 2
3 F.5 (n) (3): Continuing Medical Education Registrant shall maintain records to demonstrate a minimum of one hour of inservice training for all users who energize fluoroscopic system every 24 months in fluoroscopic radiation safety and patient dose management F.5 (n) (4): Documentation Record Keeping Registrant shall maintain records pertaining to the requirements of sections F.5 (n)(1), F.5 (n)(2) and F.5 (n)(3) for review for three years Exempt to Regulatory Requirements Registrant may exempt from requirements of F.5(n)(1) through F.5(n)(4): Board certified radiologists Fluoroscopy systems ; Licensed practitioners of radiation simulators Physicians operating c-arms (mini) for imaging extremities only 3
4 Identifying areas utilizing fluoroscopy 4
5 Instructions for ON-LINE fluoroscopy radiation safety training The link for safety classes is: Select Access training Select Online courses Select Minimizing Risks from Fluoroscopy LOG IN 5
6 6
7 Delineation of Privileges (DOPs) Radiation Badge Compliance Fluoroscopic Minutes & Radiation Badge Readings of Radiology Fellows and Staff July May 2001 Raw data: fluoro time (min) & badge readings (mrems) Fluoro Badge Fluoro Badge Fluoro Badge Fluoro Badge Fluoro Badge Fluoro Badge Min Readings min readings min readings min readings min readings min readings User 1 User 1 User 2 User 2 User 3 User 3 User 4 User 4 User 5 User 5 User 6 User 6 Fluoroscopist 1 Fluoroscopist 2 Fluoroscopist 3 Fluoroscopist 4 Fluoroscopist 5 Fluoroscopist 6 July Aug Sept Oct Nov Dec Jan Feb Mar April May 7
8 Fluoroscopic Minutes & Radiation Badge Readings of Fellows July - Dec 2002 Badge Reading (mrem) Fluoro minutes Fellow-1 Fellow-2 Fellow-3 Fellow-4 Fellow-5 Fellow-6 Fellow-7 Fellow-8 July Aug Sept Oct Nov Dec Challenges: Radiation Badge Returns Data Jan-10 Feb 10 March 10 April 10 May 10 June 10 Jul-10 Series Areas of Interest 1st Final 1st Final 1st Final 1st Final 1st Final 1st Final 1st Final Cardiologists* 9 CVDL Physicians** S Neuro Radiologists N General Radiologists O General Pediatric 14 Radiologists W Radiology Residents Radiology Fellows Pediatric Cardiologist EP Lab Neuro Radiologists Total Jul-10 Aug 10 Sept 10 Oct 10 Nov 10 Dec10 Series Areas of Interest 1st Final 1st Final 1st Final 1st Final 1st Final 1st Final 7 Cardiologists* CVDL Physicians** Neuro Radiologists General Radiologists General Pediatric Radiologists Radiology Residents Radiology Fellows Pediatric Cardiologist EP Lab Neuro Radiologists Total Challenges: Radiation Badge Returns Data Jan-11 Feb 11 March 11 April 11 May 11 June 11 Series Areas of Interest 1st Final 1st Final 1st Final 1st Final 1st Final 1st Final 7 Cardiologists* N N 5 9 CVDL Physicians** O O 1 12 Neuro Radiologists General Radiologists R R 0 14 General Pediatric Radiologists E E 0 16 Radiology Residents P P 1 17 Radiology Fellows O O 1 25 Pediatric Cardiologist R R 0 75 EP Lab T T 2 77 Neuro Radiologists Total Jul-11 Aug 11 Sept 11 Oct 11 Nov 11 Dec 11 Series Areas of Interest 1st Final 1st Final 1st Final 1st Final 1st Final 1st Final 7 Cardiologists* CVDL Physicians** Neuro Radiologists General Radiologists General Pediatric Radiologists Radiology Residents Radiology Fellows Pediatric Cardiologist EP Lab Neuro Radiologists MSK Radiologists Total
9 Penalty for unreturned badges $50 will be charged for each dosimeter not returned within 30 days after the monitoring period Radiation safety office will bill the department for the unreturned badges Enforcement started from January 2011 Joint Commission Sentinel Event Policy Compliance Mahesh M, JACR 5(4): 601-3,
10 8/2/2012 Conclusions Many challenges exists in a large diverse academic institution Variety of training methods should be available Strong support from leadership is critical Early documentation of radiation induced skin injury Bulletin of The Hospital,
GAMINGRE 8/1/ of 7
FYE 09/30/92 JULY 92 0.00 254,550.00 0.00 0 0 0 0 0 0 0 0 0 254,550.00 0.00 0.00 0.00 0.00 254,550.00 AUG 10,616,710.31 5,299.95 845,656.83 84,565.68 61,084.86 23,480.82 339,734.73 135,893.89 67,946.95
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