SIR Issues Best Practice Guidelines for CT-Guided Interventional Procedures
April 18, 2018—In Journal of Vascular and Interventional Radiology (JVIR), an executive summary of the best-practice guidelines for CT-guided interventional procedures was published by A. Kyle Jones, PhD, et al on behalf of the Society of Interventional Radiology's (SIR) Health and Safety Committee (2018;29:518–519). The complete guidelines from JVIR are available online here.
Dr. Jones addressed the need for these guidelines in comments to Endovascular Today. He stated, "I think one of the most important things a practice can do is to define protocols for the performance of CT-guided procedures, from start to finish. This includes diverse topics such as sedation management, limiting CT scan extent, setting baseline techniques for different tasks, selecting a method for adapting CT technical factors to patient size, and expectations for radiation protection of staff. Data on these aspects should be collected and reviewed on a regular basis."
As summarized in JVIR, the document is intended to assist practitioners to establish and maintain a quality CT-guided procedure program while providing a review of the available technology and strategies to optimize patient and operator doses and image quality during CT-guided procedures.
The aims of the guidelines are to:
- Review relevant technical aspects of CT image acquisition, reconstruction, and dosimetry
- Review the use of CT to perform image-guided procedures
- Discuss strategies for managing radiation dose and image quality during CT-guided procedures
- Review radiation protection for the operator(s), staff, and patient during CT-guided procedures
- Review essential CT-guided procedural quality-improvement activities
As stated in the document's Executive Summary, with advances in CT scanner technology and the increasing use of CT in interventional radiology, it is important that interventional radiologists observe best practices for CT-guided procedures, including acquiring images of only the quality necessary to safely and accurately access a target and participating in radiation management and monitoring efforts.
It is the recommendation of the SIR Safety and Health Committee that interventional radiologists who perform CT-guided procedures review and be familiar with the best practices guidelines for and consider the following steps when reviewing their practice:
- Review available CT equipment and ensure that the equipment used to perform CT-guided procedures meets the minimum performance requirements recommended
- Review procedures for performing CT-guided procedures
- Review CT protocols used for acquiring and reconstructing CT images during CT-guided procedures
- Review policies and procedures covering radiation management
- Review policies and procedures covering documentation and review of radiation dose indices
- Review policies and procedures covering radiation protection for the operator and staff
- Review quality-improvement initiatives focused on CT-guided procedures
The document states, "The SIR Health and Safety Committee hopes that implementation of the recommendations of the Best Practices Guidelines for CT-Guided Interventional Procedures will result in an overall reduction in radiation doses used during CT-guided procedures as technical factors are optimized and scanning durations are reduced. This, along with adoption of best practices for radiation protection, will translate into reduced operator and staff radiation doses. Routine collection and analysis of radiation dose metrics will facilitate the development and population of clinical data registries and offer the opportunity for assembly of normative datasets for CT-guided interventional procedures."