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M Mahesh
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ABSTRACT: Training of physicians performing fluoroscopy is key to patient and staff safety. In the absence of uniform regulations regarding credentialing of physicians performing fluoroscopy, various states have adopted/implemented regulations. State of Maryland requires a 4-hour initial training in fluoroscopy operations and safety and a one-hour refresher course on the same subject once every 2 years. This applies to all physicians performing fluoroscopy with exception to board certified radiologists. The implementation of a program to comply with such regulatory requirements in a large academic center (Johns Hopkins) and the challenges to ensure compliance of all physicians performing fluoroscopy is the focus of this presentation. Along with that, the process on how to prepare and comply for the Joint Commission's sentinel event policy pertaining to prolonged fluoroscopy will be discussed. In addition, the presentation will also discuss process set in place to comply with regulatory requirements of monitoring personal radiation monitors, other training issues and radiation dose reduction strategies in fluoroscopy.Learning Objectives:1. To understand the credentialing and other requirements for physicians performing fluoroscopy.2. To become familiar with the process set to comply with regulations at a large academic medical center.3. To be able to utilize the information to implement similar process at other institutions.
Medical Physics 06/2012; 39(6):3942. · 2.83 Impact Factor
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ABSTRACT: The authors develop a unique CT simulation tool based on the 4D extended cardiac-torso (XCAT) phantom, a whole-body computer model of the human anatomy and physiology based on NURBS surfaces. Unlike current phantoms in CT based on simple mathematical primitives, the 4D XCAT provides an accurate representation of the complex human anatomy and has the advantage, due to its design, that its organ shapes can be changed to realistically model anatomical variations and patient motion. A disadvantage to the NURBS basis of the XCAT, however, is that the mathematical complexity of the surfaces makes the calculation of line integrals through the phantom difficult. They have to be calculated using iterative procedures; therefore, the calculation of CT projections is much slower than for simpler mathematical phantoms. To overcome this limitation, the authors used efficient ray tracing techniques from computer graphics, to develop a fast analytic projection algorithm to accurately calculate CT projections directly from the surface definition of the XCAT phantom given parameters defining the CT scanner and geometry. Using this tool, realistic high-resolution 3D and 4D projection images can be simulated and reconstructed from the XCAT within a reasonable amount of time. In comparison with other simulators with geometrically defined organs, the XCAT-based algorithm was found to be only three times slower in generating a projection data set of the same anatomical structures using a single 3.2 GHz processor. To overcome this decrease in speed would, therefore, only require running the projection algorithm in parallel over three processors. With the ever decreasing cost of computers and the rise of faster processors and multi-processor systems and clusters, this slowdown is basically inconsequential, especially given the vast improvement the XCAT offers in terms of realism and the ability to generate 3D and 4D data from anatomically diverse patients. As such, the authors conclude that the efficient XCAT-based CT simulator developed in this work will have applications in a broad range of CT imaging research.
Medical Physics 09/2008; 35(8):3800-8. · 2.83 Impact Factor
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ABSTRACT: OBJECTIVE: With single-slice helical CT, an increased pitch can decrease the radiation dose to the patient if all other parameters are constant. The purpose of this study was to determine whether the same relationship holds for a particular multislice helical CT system (Somatom Plus 4 VZ multislice helical CT scanner, version A11A) in our department. CONCLUSION: The measured radiation dose to the phantom was identical for all pitch selections on the multislice helical CT system we tested. This unexpected result was because of an automatic proportionate increase in the tube current when the pitch selection was increased. Radiologists and physicists should exercise caution when extrapolating dose reduction strategies from single-slice to multislice helical CT systems, and they must acquire a detailed understanding of the multislice helical CT scanner of their chosen manufacturer.
American Journal of Roentgenology 01/2002; 177(6):1273-5. · 2.78 Impact Factor
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L S Rosenthal, M Mahesh,
T J Beck,
J P Saul,
J M Miller,
N Kay,
L S Klein,
S Huang,
P Gillette,
E Prystowsky,
M Carlson,
R D Berger,
J H Lawrence,
P Yong,
H Calkins
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ABSTRACT: The objective of this study was to identify factors that predict fluoroscopy duration and radiation exposure during catheter ablation procedures. The patient population included 859 patients who participated in the Atakr Ablation System clinical trial at 1 of 9 centers (398 male and 461 female patients, aged 36 +/- 21 years). Each patient underwent catheter ablation of an accessory pathway, the atrioventricular junction, or atrioventricular nodal reentrant tachycardia using standard techniques. The duration of fluoroscopy was 53 +/- 50 minutes. Factors identified as independent predictors of fluoroscopy duration included patient age and sex, the success or failure of the ablation procedure, and the institution at which the ablation was performed. Catheter ablation in adults required longer fluoroscopy exposure than it did in children. Men required longer durations of fluoroscopy exposure than did women. The mean estimated "entrance" radiation dose was 1.3 +/- 1.3 Sv. The dose needed to cause radiation skin injury was exceeded during 22% of procedures. The overall mean effective absorbed dose from catheter ablation procedures was 0.025 Sv for female patients and 0.017 Sv for male patients. This degree of radiation exposure would result in an estimated 1,400 excess fatal malignancies in female patients and 2,600 excess fatal malignancies in male patients per 1 million patients.
The American Journal of Cardiology 09/1998; 82(4):451-8. · 3.37 Impact Factor
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ABSTRACT: Radiation exposure during fluoroscopic imaging poses potential risks to patients and physicians, especially during protracted cardiovascular or radiological interventional procedures. We describe a woman with refractory paroxysmal supraventricular tachycardia who underwent radiofrequency catheter ablation of the slow pathway involved in atrioventricular nodal reentrant tachycardia. The patient subsequently returned 4 weeks later with acute radiation dermatitis that was retrospectively attributed to a malfunction in the fluoroscopy unit that lacked a maximum current output cut-off switch. Using dose reconstruction studies and her estimated biological response, we determined that she received between 15 and 20 Gy (1 Gy = 100 rads) to the skin on her back during the procedure. The exposure will result in an increase in her lifelong risk of skin and lung cancer. This article underscores the potential for radiation-induced injury during lengthy therapeutic procedures using x-ray equipment.
Pacing and Clinical Electrophysiology 08/1997; 20(7):1834-9. · 1.35 Impact Factor
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M Mahesh
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ABSTRACT: Fluoroscopic procedures (particularly prolonged interventional procedures) may involve high patient radiation doses. The radiation dose depends on the type of examination, the patient size, the equipment, the technique, and many other factors. The performance of the fluoroscopy system with respect to radiation dose is best characterized by the receptor entrance exposure and skin entrance exposure rates, which should be assessed at regular intervals. Management of patient exposure involves not only measurement of these rates but also clinical monitoring of patient doses. Direct monitoring of patient skin doses during procedures is highly desirable, but current methods still have serious limitations. Skin doses may be reduced by using intermittent exposures, grid removal, last image hold, dose spreading, beam filtration, pulsed fluoroscopy, and other dose reduction techniques. Proper training of fluoroscopic operators, understanding the factors that influence radiation dose, and use of various dose reduction techniques may allow effective management of patient dose.
Radiographics 21(4):1033-45. · 2.85 Impact Factor
