Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
Acad Radiol. 2013 Apr;20(4):457-62. doi: 10.1016/j.acra.2013.01.002.
To address the risk of radiation injury during interventional procedures, the Joint Commission has defined prolonged fluoroscopy resulting in a cumulative skin dose of 15 Gy or more to a single field as a reviewable sentinel event. The goal of this work is to present a system for identifying potential fluoroscopic sentinel events (FSE) and describing common case characteristics.
Criteria based on fluoroscopic time (FT) > 150 minutes and reference air kerma (RAK) > 6 Gy were used to identify potential sentinel events. Case information including procedure type, number of procedures, and radiation dose parameters was recorded. Peak skin dose (PSD) was calculated by a medical physicist. Values were compared between procedure types and the relationship between FT, RAK, and PSD was evaluated.
Between 2008 and 2011, 183 events exceeding the investigation criteria were identified in three interventional categories: cardiology (54%), neuroradiology (31%), and vascular (16%). The average number of procedures/patient was 1.7 ± 0.1, with the majority (59.6%) having undergone only one procedure. Most cases could be identified using the RAK criterion alone (96.7%). Based on the PSD/RAK ratio, a threshold RAK of 7.5 Gy would effectively identify all cases that would exceed 15 Gy in PSD.
Radiation delivered during interventional cases can place patients at risk of cutaneous radiation injury and potential sentinel events. Using appropriate thresholds to determine which cases require detailed investigation allows efficient utilization of department resources for identifying sentinel events.
为了降低介入操作过程中的辐射损伤风险，联合委员会将 15 Gy 或以上的单次照射野累积皮肤剂量作为可审查的警戒事件，定义为透视时间延长。本研究旨在提出一种识别潜在透视警戒事件（FSE）并描述常见病例特征的系统。
基于透视时间（FT）＞150 分钟和参考空气比释动能（RAK）＞6 Gy 的标准，确定潜在的警戒事件。记录了包括手术类型、手术次数和辐射剂量参数在内的病例信息。由放射物理师计算皮肤峰值剂量（PSD）。比较不同手术类型之间的值，并评估 FT、RAK 和 PSD 之间的关系。
在 2008 年至 2011 年期间，在心血管（54%）、神经放射学（31%）和血管学（16%）三个介入类别中，确定了 183 例超过研究标准的事件。每位患者的平均手术次数为 1.7±0.1，其中大多数（59.6%）只接受了一次手术。单独使用 RAK 标准就可以识别出大多数病例（96.7%）。根据 PSD/RAK 比值，RAK 的阈值为 7.5 Gy 可有效地识别所有 PSD 超过 15 Gy 的病例。
介入治疗中辐射的传递可能会使患者面临皮肤辐射损伤和潜在警戒事件的风险。使用适当的阈值来确定需要详细调查的病例，可以有效地利用科室资源来识别警戒事件。
