A diagnostic medical physicist’s guide to the American College of Radiology Fluoroscopy Dose Index Registry

INTRODUCTION The American College of Radiology (ACR) computed tomography (CT) Dose Index Registry (DIR) has been extraordinarily successful, with dose indices collected for over 102 million CT examinations to date. 1,2 The CT DIR has provided an ongoing source of normative clinical data which has been the gold standard for national and international benchmarking. 3 The largest existing normative dataset for fluoroscopically guided procedures is the Radiation Doses in Interventional Radiology (RAD‐IR) study, with a data collection period covering the mid‐ to late 1990’s. 4–6 The RAD‐IR study included 2142 clinical interventional fluoroscopy procedures, performed at one of seven sites using a single fluoroscope make and model. Much has changed since the late 1990's, including the scope and number of fluoroscopically guided procedures performed; fluoroscope technology, including the introduction of flat panel image receptors and variable added filtration; informatics, including widespread implementation and availability of the Digital Imaging and Communications in Medicine (DICOM) Radiation Dose Structured Report (RDSR); and regulation, including mandatory reporting of reference air kerma (Ka,r) in the United States starting in 2006. [...]fluoroscopy is used in a very wide range of medical procedures, ranging from diagnostic procedures such as barium swallow, barium enema, and cystography to complex image‐guided interventions such as aortic aneurysm repair and hepatic embolization. Fluoroscopy DIR team roles These are not official administrative roles or user profiles in the DIR, however, identifying the right personnel to play the following roles is key to a successful implementation of the Fluoroscopy DIR. Physician champion The physician champion is the coordinator and director of the implementation process, and is essential to securing and maintaining institutional support for implementation of the ACR Fluoroscopy DIR. Sites in states with requirements for fluoroscopy radiation protocol committees or similar committees may find their physician champion on one of these committees.