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Purpose: To update normative data on fluoroscopy dose indices in the United States for the first time since the RAD-IR study in the late 1990s.Materials and Methods: The DIR-Fluoro pilot collected data from March 2018 through December 2019, with 50 fluoroscopes from 10 sites submitting data. Primary radiation dose indices including fluoroscopy time (FT), cumulative air kerma (Ka,r), and kerma area product (PKA) were collected for interventional radiology fluoroscopically-guided interventional (FGI) procedures. Clinical facility procedure names were mapped to the ACR Common procedure lexicon. Distribution parameters including the 10th, 25th, 50th, 75th, 95th, and 99th percentiles were computed.Results: Dose indices were collected for 70,377 FGI, with 50,501 ultimately eligible for analysis. Distribution parameters are reported for 100 ACR Common IDs. FT in minutes, Ka,r in mGy, and PKA in Gy-cm2 are reported here as (N; median [interquartile range]) for select ACR Common IDs: IVC filter insertion (1726; FT: 2.9 [1.8-4.3]; Ka,r: 55.8 [27.7-117.6]; PKA: 14.19 [7.17-31.67]); IVC filter removal (464; FT: 5.7 [3.3-12.6]; Ka,r: 178.6 [72.2-430.3]; PKA: 34.73 [13.74-85.81]); nephrostomy placement (2037; FT: 4.1 [2.0-8.6]; Ka,r: 39.2 [13.4-122.7]; PKA: 6.61 [2.24-23.65]); percutaneous biliary drainage (952; FT: 12.4 [4.8-24.5]; Ka,r: 160.5 [43.2-446.8]; PKA: 21.32 [6.79-65.95]); gastrostomy placement (1643; FT: 3.2 [2.0-5.0]; Ka,r: 29.1 [13.2-67.1]; PKA: 7.29 [2.97-18.01]); TIPS placement (327; FT: 34.8 [23.2-53.3]; Ka,r: 813.0 [355.5-1490.8]; PKA: 181.47 [87.71-407.49]).Conclusions: The ACR DIR-Fluoro pilot has provided state of the practice statistics for radiation dose indices from IR FGI procedures. These data can be used to prioritize procedures for radiation optimization, as demonstrated in this work. [ABSTRACT FROM AUTHOR]

To compare radiation dose index distributions for fluoroscopically guided interventions in interventional radiology from the American College of Radiology (ACR) Fluoroscopy Dose Index Registry (DIR-Fluoro) pilot to those from the Radiation Doses in Interventional Radiology (RAD-IR) study. Individual and grouped ACR Common identification numbers (procedure types) from the DIR-Fluoro pilot were matched to procedure types in the RAD-IR study. Fifteen comparisons were made. Distribution parameters, including the 10th, 25th, 50th, 75th, and 95th percentiles, were compared for fluoroscopy time (FT), cumulative air kerma (K a,r), and kerma area product (P KA). Two derived indices were computed using median dose indices. The procedure-averaged reference air kerma rate ( K a , r ¯) was computed as K a,r / FT. The procedure-averaged x-ray field size at the reference point (A r) was computed as P KA / (K a,r × 1,000). The median FT was equally likely to be higher or lower in the DIR-Fluoro pilot as it was in the RAD-IR study, whereas the maximum FT was almost twice as likely to be higher in the DIR-Fluoro pilot than it was in the RAD-IR study. The median K a,r was lower in the DIR-Fluoro pilot for all procedures, as was median P KA. The maximum K a,r and P KA were more often higher in the DIR-Fluoro pilot than in the RAD-IR study. K a , r ¯ followed the same pattern as K a,r , whereas A r was often greater in DIR-Fluoro. The median dose indices have decreased since the RAD-IR study. The typical K a,r rates are lower, a result of the use of lower default dose rates. However, opportunities for quality improvement exist, including renewed focus on tight collimation of the imaging field of view. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: To characterize the accuracy and consistency of fluoroscope dose index reporting and report rates of occupational radiation safety hardware availability and use, trainee participation in procedures, and optional hardware availability at pilot sites for the American College of Radiology (ACR) Fluoroscopy Dose Index Registry (DIR).Materials and Methods: Nine institutions participated in the registry pilot, providing fluoroscopic technical and clinical practice data from 38 angiographic C-arm-type fluoroscopes. These data included measurements of the procedure table and mattress transmission factors and accuracy measurements of the reference-point air kerma (Ka,r) and air kerma-area product (PKA). The accuracy of the radiation dose indices were analyzed for variation over time by 1-way analysis of variance (ANOVA). Sites also self-reported information on availability and use of radiation safety hardware, hardware configuration of fluoroscopes, and trainee participation in procedures.Results: All Ka,r and PKA measurements were within the ±35% regulatory limit on accuracy. The mean absolute difference between correction factors for a given system in fluoroscopic and acquisition mode was 0.03 (95% confidence interval, 0.03-0.03). For the 28 fluoroscopic imaging planes that provided data for 3 time points, ANOVA yielded an F value of 0.134 with an F-critical value of 3.109 (P = .875).Conclusions: This publication provides the technical and clinical framework pertaining to the ACR Fluoroscopy DIR pilot and offers necessary context for future analysis of the clinical procedure radiation-dose data collected. [ABSTRACT FROM AUTHOR]