Image Wisely is a joint initiative of the American College of Radiology, Radiological Society of North America, American Society of Radiological Technologists and American Association of Physicists in Medicine.
Steven Y. Huang, MD; A. Kyle Jones, PhD, University of Texas, MD Anderson Cancer Center, Houston, TX
The use of fluoroscopy has increased tremendously in the past few decades. Fluoroscopy is now routinely used in departments outside radiology, such as cardiology, endoscopy and surgery. While the corresponding improvement in patient care with fluoroscopy is undeniable, the use of this equipment, which can cause large amounts of radiation exposure to the patient and operator is concerning. In some states, personnel operating fluoroscopy require no specialized training. The combination of inadequate training and equipment capable of producing high radiation output can create serious consequences for the patient  and operator [2,3].
Minimizing radiation dose while maintaining adequate image quality is a complex problem. Dose reduction requires attention to several basic principles: (a) fluoroscopy time, (b) number of radiographic images obtained, and (c) control of technical factors that affect dose .
A checklist is a simple mechanism to effectively reduce radiation dose and improve patient and operator safety during fluoroscopy [5,6]. Physicians should already be familiar with the utility of checklists. During surgical or medical internship, physicians craft variably intricate checklists to help remember simple tasks, such as checking metoprolol dose or a CT scan result. These checklists work because they are readily adopted, simple and efficient.
For more complex problems, some may argue that the utility of checklists is limited. This may be true if the checklists are poorly constructed. Checklists can be good or bad. Bad checklists are vague, imprecise, long, hard to use and impractical. They treat the end users as ill-informed, spelling out every step. Good checklists, on the contrary, are precise, efficient and easy to use. They remind users of the most critical and important steps .
This section provides a list of tasks promoting radiation-safety items during fluoroscopy. The checklist is divided into pre-procedure, intra-procedure and post-procedure items. Of note, the pre- and post-procedure items are written in a READ-DO format (i.e., read each step, then do it). The pre-procedure portion of this checklist potentially can be integrated into most practice’s Universal Protocol. Because the logistics of executing a READ-DO checklist during a procedure are impractical (similar to a pilot reading from a checklist while landing a plane), the intra-procedure items are intended to be presented as a DO-CONFIRM checklist (do the steps from memory, then pause and check).