Measuring and monitoring radiation dose during fluoroscopically guided procedures.

The principal problem in measuring patient radiation dose during fluoroscopically guided procedures is that dose is not administered uniformly throughout the patient's body. Four dose metrics have been developed to quantify patient radiation dose for fluoroscopically guided procedures: fluoroscopy time, peak skin dose, reference dose, and kerma-area-product. Each metric must be understood to be used appropriately. Fluoroscopy time correlates poorly with other dose metrics. It should not be used as the sole method to estimate, monitor, or record patient radiation dose unless no alternative is available. Kerma-area-product is a good metric for estimating stochastic risk. Reference dose is a conservative method to estimate peak skin dose and deterministic risk and is recommended for this purpose. Every fluoroscope sold in the USA since mid 2006 is able to measure, display, and record reference dose. Radiation dose should be monitored during fluoroscopically guided procedures, either by the operator or by a designated individual in the procedure room, such as a technologist or nurse. Patient radiation dose should be recorded appropriately in the medical record. Patients who have received a sufficiently large radiation dose should have follow-up at 10-14 days and at 1 month after the procedure for possible deterministic effects.