December 07, 2022

DIR Fluoroscopy Data Shows Decline in Patient Radiation Doses in IR Procedures

A recent study published in the Journal of Vascular and Interventional Radiology compared radiation dose index distributions for fluoroscopically-guided interventions (FGI) in interventional radiology (IR) from the Radiation Doses in Interventional Radiology (RAD-IR) study conducted in the 1990s to those gathered in the 2018 pilot of ACR® Dose Index Registry (DIR) Fluoroscopy (Fluoro) module.

The goal of the research was to better understand changes in radiation dose from these procedures over the past two decades. The RAD-IR study published 20 years ago was, until now, the most complete multisite dataset of dose indices for FGI in IR in the United States.

According to A. Kyle Jones, PhD, primary author of the paper, “As no large multisite datasets from the U.S. have been available since RAD-IR, DIR Fluoro provides a major service to the medical imaging community by now offering practices the ability to compare their site to peer sites. Of course, we expect that this will eventually normalize the wide range of practice that has evolved since RAD-IR. In the absence of normative datasets, how in the world is a site supposed to know if they are using reasonable radiation doses or not?”

Analyzing dose index data from the DIR Fluoro pilot, the authors found that the median dose indices have decreased significantly since the RAD-IR study. Dose indices were collected for more than 20 times as many clinical procedures compared to the RAD-IR study. And median cumulative air kerma (Ka,r) had decreased by more than 50% since RAD-IR for most of the procedure types compared.

“It is interesting that we observed large reductions in median dose indices since RAD-IR, even in the absence of a living normative dataset like DIR-Fluoro,” says Jones. “We do not know the ‘spread’ in practice, but we can certainly study this with DIR-Fluoro to determine what impact the existence of the registry has on practice. Will we see further reductions in median dose indices, a reduction in practice variability or both? It will be exciting to see.”

This study also lays the foundation for the development of diagnostic reference level values for FGI, which should follow in the next few years.

Participating in the DIR Fluoroscopy Module

This study is an example of the importance of the ACR DIR in helping to raise the bar for quality imaging and patient safety. The DIR Fluoro module, which is now open for broad participation, enables facilities to submit fluoroscopy dose indices data and compare their performance reports against national standards.

The increasing scope and number of fluoroscopically guided procedures performed annually over the past decade makes participation in the fluoroscopy module a critical step for practices to enhance the safety and quality of patient care. Learn more about the features and capabilities of the DIR Fluoro module.

Getting Started

The DIR Startup Guide describes a step-by-step process for DIR participation — from assembling your team to reviewing your reports. If your facility already participates in the ACR National Radiology Data Registry (NRDR®), it’s easy to add the DIR to your facility registration. Only one registration is required to participate in any of the DIR modules.