Prevention of incidents in diagnostic and interventional procedures
Introduction
When considering risks in diagnostic and interventional procedures in radiology and cardiology, it should always be remembered that the patient is gaining a major potential benefit from both diagnostic and interventional procedures. Unintended incidents do, however, occur. In order to prevent incidents in diagnostic and interventional procedures, it is necessary to learn from those that have occurred in the past. In interventional procedures, possible incidents would mainly include: inadvertent exposure of foetus, skin injuries in patients and eye lens injuries in staff involved in interventional procedures.
Important Principles
A patient undergoing diagnostic and therapeutic procedure will be exposed to many potential risks (probability of harm) besides exposure to ionizing radiation. Each risk deserves due consideration. The radiation risk is low in many instances and the consequences of that risk in most of the cases are not severe, but in some they are.
Inadvertent foetal exposure can arise when a pregnant patient denies or is unaware that she is pregnant when questioned or if the pregnant patient is not asked about her pregnancy status and an examination is performed. Following such an event an investigation should be carried out as per local rules and the patient should be counselled.
Radiation induced skin injuries happen very rarely with an estimated frequency of about one in 10,000 interventional procedures. This figure can vary by a large margin as many injuries go unreported. The skin injuries can vary from mild erythema to deep skin ulceration. Review of the circumstances of many of the skin injuries reveals a lack of knowledge by the physicians performing these procedures of the biological effects associated with radiation. Such injuries can be reduced by(i) establishing standard procedures and protocols for each examination or intervention, that includes a consideration of fluoroscopy exposure time, (ii) determining the radiation dose rates for specific fluoroscopy systems for all operating modes, (iii) assessing each protocol for the potential for radiation injury to the patient and (iv) by modifying protocols, when appropriate, to minimize cumulative absorbed dose to any specific skin area. The use of equipment to aid the reduction of patient dose is recommended as is the recording of the patient’s dose in the patient's records
Important references
The Radiation Protection of Patients (RPoP) website contains information to help health professionals prevent incidents in diagnostic, interventional radiology and cardiology, both in patients and in staff members. This website also contains training material on this topic, both in diagnostic and interventional radiology and interventional cardiology. Pregnancy and radiation protection is covered in the separate section of RPoP website.
In addition to IAEA, many national and international professional organisations in the area of medial application of X ray are making efforts to promote safe practice and prevent occurrence of incidents (FDA, CIRSE/SIR, HPA…).
The key standards in this area are the International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources, also known as the International BSS. These standards mark the culmination of efforts that have continued over the past several decades towards the harmonization of radiation protection and safety standards internationally. Safety report to guide users in applying safety standards in radiology and other specialized areas are available for free download.