Radiation Dose Monitoring for Fluoroscopically Guided Interventional Procedures: Effect on Patient Radiation Exposure.

Purpose To analyze the clinical effect of continuous dose monitoring and patient follow-up for fluoroscopically guided vascular interventional procedures over 8 years. Materials and Methods In this retrospective study, an in-house semiautomated system was developed for fluoroscopic dose monitoring. The quarterly number of procedures from January 2010 to December 2017 was analyzed with count time series to estimate quarterly change rate. Technologists recorded four dose surrogates in custom fields of institutional dictation software through a Web interface. Radiation doses were transferred automatically to the radiology report and a centralized dose database when the radiologist initiated procedure dictation. A medical physicist reported weekly on procedures with air kerma at the reference point (Ka,r) of 2 Gy or higher to a division-designated radiologist and hospital radiation safety committee who required the attending radiologist to set up follow-up appointments for patients who underwent procedures with a Ka,r greater than or equal to 5 Gy. Results There were a total of 41 585 procedures; 1553 (3.7%) procedures had a Ka,r of 2-5 Gy. Among 240 procedures with Ka,r greater than 5 Gy, 22 had Ka,r greater than 9 Gy. The percentage of high Ka,r procedures decreased over time, going from 5.9% in 2010 to 2.0% in 2017 for procedures with Ka,r of 2-5 Gy and from 1.0% in 2010 to 0.13% in 2017 for procedures with Ka,r greater than or equal to 5 Gy. Relative reduction per quarter was approximately 2.7% (95% confidence interval: 1.5%, 3.8%) for Ka,r of 2-5 Gy and 4.5% (95% confidence interval: 1.5%, 7.6%) for Ka,r greater than or equal to 5 Gy. Conclusion Eight-year temporal trends show three- to eightfold reduction in the number of high-dose procedures. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Balter in this issue.

An overview of clinical associate roles in the neurointerventional specialty.

Neurointerventionalists have long partnered with certain types of clinical associates to provide longitudinal care. This overview summarizes differences in education, background, roles, and scopes of practice of the various clinical associates (physician assistants, nurse practitioners, clinical nurse specialists, radiology practitioner assistants, radiologist assistants, and nursing care coordinators). Key differences and similarities are highlighted to alleviate confusion about the roles clinical associates can assume on a neurointerventional service. This overview is intended to guide practices as they consider broadening their clinical support teams.

Team training: a safer future for neurointerventional practice.

As medical errors and patient harm mount in today's healthcare arena, healthcare administrators have turned to high efficiency, high reliability, and high risk industries for strategies and guidance. By adopting elements of Crew Resource Management (CRM), healthcare teams have been shown to work more effectively together, allowing for earlier recognition of medical errors and catching them before they cause serious patient harm.

Establishing operational stability--developing human infrastructure.

Over the past year, Toyota has come under harsh scrutiny as a result of several recalls. These well publicized mishaps have not only done damage to Toyota's otherwise sterling reputation for quality but have also called into question the assertions from a phalanx of followers that Toyota's production system (generically referred to as TPS or Lean) is the best method by which to structure one's systems of operation. In this article, we discuss how Toyota, faced with the pressure to grow its business, did not appropriately cadence this growth with the continued development and maintenance of the process capabilities (vis a vis the development of human infrastructure) needed to adequately support that growth. We draw parallels between the pressure Toyota faced to grow its business and the pressure neurointerventional practices face to grow theirs, and offer a methodology to support that growth without sacrificing quality.