Blue ribbon panel of experts shares advice on improving fluoroscopy safety: 5 takeaways
A blue ribbon panel of experts, convened by the American College of Radiology, is sharing recommendations on how to improve safety in the delivery of fluoroscopy imaging services.
There are many challenges associated with the modality including highly variable regulatory requirements, scope of practice concerns, inconsistent training and a “lack of staff empowerment.” To address these issues, ACR brought together thought leaders from 32 different organizations to begin brainstorming.
Their goal was to establish standards for safe use of fluoroscopy across different disciplines and specialties, sharing their work Feb. 5 in the Journal of the American College of Radiology.
“Implementing standardized local procedures and actions and aiming for long-term opportunities and best practices through policy can bring about substantial and enduring reductions in patient and staff exposure to unnecessary radiation,” lead author Dustin A. Gress, senior advisor for medical physics with the ACR, and co-authors wrote. “These changes will require commitment across all levels of local leadership and should be prioritized as risk management through a culture of safety, especially in facilities in which frequent or high-dose fluoroscopy procedures are performed.”
Organizations involved in producing the report included the American College of Cardiology, American Society of Radiologic Technologists, Image Wisely, the Joint Commission, U.S Food and Drug Administration and numerous others. Fluoroscopy has become an essential tool across a wide variety of specialties, they note, including radiology, orthopedics, urology and pain management, among numerous others. However, such a diverse group of users can lead to challenges ensuring the safe and effective delivery of the exam. Fluoroscopy involves potentially harmful ionizing radiation, used to either obtain real-time images of moving anatomic structures in the body or for image guidance during procedures.
Recognizing these challenges, ACR convened a two-day Blue Ribbon Panel on Fluoroscopy Safety in Reston, Virginia, held in October 2023. It pursued the goal of arriving at consensus recommendations for helping improve and standardize radiation safety practices for the use of fluoroscopy. Panelists were mostly professional society member leaders in elected office or well-known domain experts.
The group produced a report with recommendations pertaining to professional organizations, industry vendors, and regulatory and accrediting agencies. Gress and co-authors offered five take-home points from their findings:
- Consistency in education: Standardized, role‑specific fluoroscopy training is required for all operators. The panel recommends mandatory initial and periodic refreshers aligned with the National Council on Radiation Protection and Measurement stratified model, with competency assessment for every provider using fluoroscopy.
- Bolstering institutional culture: Improving the wide variability in fluoroscopy safety culture requires intentional institutional support, including empowered safety champions, adequate staffing, routine protective‑equipment checks, and nonpunitive reporting.
- Uniformity around system controls: Inconsistent fluoroscope user interfaces can create operational challenges. The panel recommends more standardized controls, improved onboarding and hands‑on training on each device an operator uses.
- Standardize local practices: Fluoroscopy providers should use standardized imaging protocols and structured dose management processes, including use of lowest dose defaults, real time dose index thresholds, routine personnel dosimetry review, and oversight by a multidisciplinary quality improvement group.
- Continuous improvement: Sustained gains in safety depend on coordinated action among societies, regulators, and industry, with harmonized credentialing standards, continued development of safer and more consistent equipment, and alignment of education and quality requirements.
Read much more about the report’s findings in JACR.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.