Radiation Safety Program in the Cardiac Catheterisation Laboratory
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Imaging Equipment with Operator Knowledge in Use
On-screen dose assessment (Ka,r, PKA) Dose saving: “fluoroscopy store” function, adjustable pulse and frame rate, virtual collimation, last image hold.
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Pre-procedure dose planning
Assess patient and procedural issues including patient size and lesion(s) complexity. Examine patient’s back before starting re-attempt CTO PCI procedures.
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Informed Patient with appropriate Consent
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| II. Procedure |
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| A. Limit fluoroscopy – step on pedal only when looking at screen |
| B. Limit cine – use “fluoroscopy store” function when high quality imaging is not required, for example to document balloon and stent inflation |
| C. Limit magnification, frame rate (7.5 frames per second is preferred), and steep angles |
| D. Use collimation and filters to fullest extent possible |
| E. Vary tube angle when possible to change skin area exposed |
| F. Position table and image receptor appropriately: the patient should be placed as far possible from the X-ray tube and the image intensifier as close as possible to the patient |
| G. Keep patient and operator body parts out of field of view |
| H. Maximise shielding and distance from x-ray source for all personnel |
| I. Manage and monitor dose in real time from the beginning of the case |
| III. Post Procedure |
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| A. Document radiation dose in records (fluoroscopy time, Ka,r, PKA) |
B. Patient and referring physician notification for high doses
Ka,r >5 Gy, chart document; inform patient; arrange follow up When Ka,r >10 Gy, qualified physicist should calculate skin dose Peak Skin Dose > 15, contact risk management (sentinel event)
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| C. Adverse skin effects should be referred to appropriate consultant |
