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Fluoroscopy Protocols

Priscilla F. Butler, MS, FACR, FAAPM, American College of Radiology, Reston, VA
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Introduction

Fluoroscopy is a technique that provides real-time X-ray imaging that is especially useful for guiding a variety of diagnostic and interventional procedures. In some cases fluoroscopic images may be stored as part of the patient examination. Fluoroscopy is frequently used to assist in a wide variety of medical diagnostic and therapeutic procedures, both within and outside of radiology departments. In order to ensure that the lowest level of radiation exposure is used that provides only the necessary image quality for the diagnosis or procedure, physicians and ancillary professionals should be familiar with current recommendations on protocols and radiation management from professional organizations. Below is a list of publically available guidance.

General

ACR–AAPM Technical Standard for Management of the Use of Radiation in Fluoroscopic Procedures. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/MgmtFluoroProc.pdf. Accessed September 19, 2014.

ACR–SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Adolescents and Women with Ionizing Radiation. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Pregnant-Pts.pdf. Accessed September 19, 2014.

ACR–AAPM–SPR Practice Parameter for Diagnostic Reference Levels and Achievable Doses in Medical X-Ray Imaging. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Diag-Ref-Levels.pdf. Accessed September 19, 2014.

Abdomen – Gastrointestinal

ACR Practice Parameter for the Performance of a Barium Small Bowel Examinations in Adults. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/BaSmBowel.pdf. Accessed September 19, 2014.

ACR–SPR Practice Parameter for the Performance of Pediatric Contrast Examinations of the Small Bowel. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/PedSmallBowel.pdf. Accessed September 19, 2014.

ACR Practice Parameter for the Performance of Fluoroscopic Contrast Enema Examination in Adults. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/FluoroConEnema.pdf. Accessed September 19, 2014.

ACR-SAR Practice Parameter for the Performance of an Enteroclysis Examination in Adults. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Enteroclysis.pdf. Accessed September 19, 2014.

ACR Practice Parameter for the Performance of Esophagrams and Upper Gastrointestinal Examinations in Adults. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/UpperGIAdults.pdf. Accessed September 19, 2014.

ACR–SPR Practice Parameter for the Performance of Contrast Esophagrams and Upper Gastrointestinal Examinations in Infants and Children. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/UpperGI-Infants.pdf. Accessed September 19, 2014.

ACR-SPR Practice Parameter for the Performance of the Modified Barium Swallow. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Modified-Ba-Swallow.pdf. Accessed September 19, 2014.

ACR–SPR Practice Parameter for the Performance of Pediatric Fluoroscopic Contrast Enema Examinations. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/FluourConEnema-Ped.pdf. Accessed September 19, 2014.

Abdomen – Genitourinary

ACR Practice Parameter for the Performance of Hysterosalpingography. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/HSG.pdf. Accessed September 19, 2014.

ACR–SPR Practice Parameter for the Performance of Voiding Cystourethrography in Children. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/VoidingCysto.pdf. Accessed September 19, 2014.

Cardiovascular

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Available at: http://cardiocompass.cardiosource.org/cc2/openCont1?smID=1312. Accessed September 19, 2014.

2012 ECD on Cardiac Catheterization Laboratory Standards. Available at: http://cardiocompass.cardiosource.org/cc2/openCont2?objID=77. Accessed September 19, 2014.

Developing an Action Plan for Patient Radiation Safety in Adult Cardiovascular Medicine. Available at: http://content.onlinejacc.org/article.aspx?articleid=1203157. Accessed September 19, 2014.

Interventional

ACR-ASNR-SIR-SNIS Practice Parameter for the Performance of Diagnostic Cervicocerebral Catheter Angiography in Adults. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/CervicoCerebralCathAngio.pdf. Accessed September 19, 2014.

ACR–SIR Practice Parameter for Endovascular Management of the Thrombosed or Dysfunctional Dialysis Access. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Dysfunc-DialysisMgmt.pdf. Accessed September 19, 2014.

ACR–SIR–SPR Practice Parameter for the Performance of Arteriography. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Arteriog.pdf. Accessed September 19, 2014.

ACR–SIR–SPR Practice Parameter for the Performance of Inferior Vena Cava (IVC) Filter Placement for the Prevention of Pulmonary Embolism. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/IVC-FliterPlacement.pdf. Accessed September 19, 2014.

ACR–SIR–SPR Practice Parameter for the Performance of Percutaneous Nephrostomy. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Percutaneous-Nephros.pdf. Accessed September 19, 2014.

ACR–SIR–SPR Practice Parameter for Specifications and Performance of Image-Guided Percutaneous Drainage/Aspiration of Abscesses and Fluid Collections (PDAFC). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/PDFAC.pdf. Accessed September 19, 2014.

ACR–SIR–SPR Practice Parameter for the Performance of Image-Guided Percutaneous Needle Biopsy (PNB). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/PNB.pdf. Accessed September 19, 2014.

ACR–SIR Practice Parameter for the Performance of Angiography, Angioplasty, and Stenting for the Diagnosis and Treatment of Renal Artery Stenosis in Adults. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/RenalArteryStenosis.pdf. Accessed September 19, 2014.

ACR–SIR–SPR Practice Parameter for the Creation of a Transjugular Intrahepatic Portosystemic Shunt (TIPS). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/TIPS.pdf. Accessed September 19, 2014.

ACR–SIR Practice Parameter for the Performance of Diagnostic Infusion Venography. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Venography.pdf. Accessed September 19, 2014.

ACR–ASNR–ASSR–SIR–SNIS Practice Parameter for the Performance of Vertebral Augmentation. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/VerebralAug.pdf. Accessed September 19, 2014.

Neuroradiology

ACR-ASNR-SIR-SNIS Practice Parameter for the Performance of Diagnostic Cervicocerebral Catheter Angiography in Adults. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/CervicoCerebralCathAngio.pdf. Accessed September 19, 2014.

ACR–ASNR–SPR Practice Parameter for the Performance of Myelography and Cisternography. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Myelog-Cisternog.pdf. Accessed September 19, 2014.

ACR–ASNR–ASSR–SIR–SNIS Practice Parameter for the Performance of Vertebral Augmentation. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/VerebralAug.pdf. Accessed September 19, 2014.

Radiation Management for Interventions Using Fluoroscopic or Computed Tomographic Guidance during Pregnancy: A Joint Guideline of the Society of Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe with Endorsement by the Canadian Interventional Radiology Association. Available at: http://www.sirweb.org/clinical/cpg/PIIS1051044311012590[8].pdf. Accessed September 19, 2014.

Quality Improvement Guidelines for Recording Patient Radiation Dose in the Medical Record for Fluoroscopically Guided Procedures. Available at: http://www.sirweb.org/clinical/cpg/PIIS1051044311012565[4].pdf

Occupational Radiation Protection in Interventional Radiology: A Joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. Available at: http://www.sirweb.org/clinical/cpg/safety6.pdf

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medically necessary imaging studies and to eliminate unnecessary procedures

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