Establishing a Follow-Up Process for Angiographic Patients Receiving An Estimated Entrance Skin Dose in Excess of 5 Gy
K Kanal*, R Dickinson, D Zamora, W Cohen, K Valji, B Stewart, University of Washington, Seattle, WAMO-F-213CD-5 Monday 4:30:00 PM - 6:00:00 PM Room: 213CD
Purpose: To establish a follow-up process for angiography patients estimated to receive an entrance skin dose (ESD) in excess of 5 Gy.
Methods: A look-up table showing the estimated ESD corresponding to incremental displayed air kerma (AK) values was posted within each angio suite. Patients receiving a cumulative AK value corresponding to an ESD exceeding 5 Gy are identified by the technologist. The technologist notifies the diagnostic physics section (DPS) which calculates a more accurate estimation of the ESD by taking into account system and exam-specific estimated table height and attenuation, backscatter, and mean energy absorption coefficient. The DPS then generates and sends a standard notification alert to the attending physician including case information, estimated ESD, and potential tissue effects. Hospital staff follows-up with the patient via phone to discuss possible skin effects and the location of where those effects may be observed. The patient is asked to call the clinic if any skin redness or epilation in the area of exposure is observed.
Results: In the past 4 months, 15 cases greater than 5 Gy ESD were identified across the different services using the angio suite. Of the 15 cases, the neuro radiology interventional group had the maximum number of cases at 10 (median: 5.2 Gy, max: 7.3 Gy) while the vascular surgery group had 2 cases (median: 7.1 Gy, max: 7.6 Gy) and the vascular interventional group had 3 cases (median: 5.7 Gy, max: 6.8 Gy). All cases received follow-up. No deterministic effects were observed in these cases as of yet.
Conclusions: Establishing a follow-up procedure for angiography patients receiving an ESD > 5 Gy is essential to anticipate possible skin injury. This is good patient safety practice which falls in line with our institution's patient first initiative.