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Review of Patients Undergoing Fluoroscopically-Guided Interventions and External Beam Radiation Therapy Within a Quaternary Care Medical Center

A Zhao*, K Wunderle , A Godley , Cleveland Clinic Foundation, Cleveland, OH


(Monday, 7/30/2018) 3:45 PM - 4:15 PM

Room: Exhibit Hall | Forum 6

Purpose: To investigate the frequency of patients undergoing fluoroscopically-guided intervention(s) (FGI) and external beam radiation therapy (EBRT) within any 12 month period over a 3-year date range in a quaternary care medical center.

Methods: Electronic medical records were queried using CPT codes to identify patients having EBRT in Radiation Oncology and FGIs in Radiology, Cardiology or Vascular Surgery in 2013 through 2015. That dataset was further refined to identify instances where both procedures occurred within the same, or similar anatomical region (e.g. liver chemoembolization and liver EBRT).

Results: 3,000 patients were initially identified, approximately half of which had procedures where anatomic regions may have overlapped. Of that dataset approximately 5% (~75) received high radiation doses from both procedures. For this purpose an FGI exceeding 3 Gy of reference point air kerma [Kâ‚?,áµ£] was considered high. For example, one patient received 10 Gy Kâ‚?,áµ£ from spinal angiogram and 36 Gy prescribed dose from spinal EBRT.

Conclusion: Although not routine, there was a higher frequency than initially expected where patients underwent both EBRT and FGIs in a similar anatomic region. As treatment of advanced diseases requires complex multi-modality procedures patient safety must be paramount. Medical physicists and clinicians from all applicable departments must work together to identify and properly care for patients being exposed to large radiation doses. Patient dose management systems need to accommodate radiation dose information from all sources of patient radiation dose, including radiation therapy, in order to allow better communication between different departments. Physicists need to determine a meaningful approach to aggregate patient radiation dose across disciplines. Clinicians in all departments managing patient care must be aware that substantial radiation doses may be delivered in other departments, and know how to properly consent those patients and how to appropriately treat them.


Dose, Image-guided Surgery, Fluoroscopy


IM- Radiation dose and risk: General (Most Aspects)

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