Radiology: Exposure Dose Indices Reported for Procedures Using Fluoroscopy

Measure Specification

Increasing physician awareness of patient exposure to radiation is an important step towards reducing the potentially harmful effects of radiation as a result of imaging studies. Studies have shown that dose monitoring for fluoroscopy procedures has resulted in an overall reduction in patient radiation exposure. Proper identification and management of patients receiving high doses of radiation from fluoroscopy procedures are essential elements of patient care due to the slowly developing nature of radiation-induced tissue reactions.

All available radiation dose data should be recorded in the patient’s medical record. Adequate recording of dose metrics is defined as documentation in the patient record of at least one of the following for all interventional procedures requiring fluoroscopy (in descending order of desirability): Ka,r, PKA, and PSD. Reference air kerma is the most useful and widely available of these metrics as it is required to be displayed on all fluoroscopes sold in the United States as of June 2006, however all three metrics are sufficient in estimating radiation exposure from fluoroscopic procedures.

(AAPM, 2022) More complete patient radiation dose data should be recorded for all high-dose interventional procedures, such as embolizations, transjugular intrahepatic portosystemic shunts, and arterial angioplasty or stent placement anywhere in the abdomen and pelvis. (Amis et al., ACR, 2007) PKA, also known as kerma-area product (KAP) or dose-area product (DAP), is the integral of air kerma (the energy extracted from an x-ray beam per unit mass of air in a small irradiated air volume; for diagnostic x-rays, the dose delivered to that volume of air) across the entire x-ray beam emitted from the x-ray tube.

It is a surrogate measure of the amount of energy delivered to the patient, and thus a reasonable indicator of the risk of stochastic effects. The symbol PKA is the notation recommended by the International Commission on Radiation Units and Measurements (ICRU, 2012).

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this procedure measure is submitted each time a procedure is performed during the performance period.