Purpose or Case Report: The aim of this strategy is to standardize the performance of our modified barium swallow studies (MBSS) with a focus on communication between team members and the reduction of fluoroscopic radiation dose exposure to the radiosensitive head and neck region.
The radiation dose reduction strategy is composed of the following steps:
The radiology technologist will initiate the patient encounter, begin room setup, and notify the radiologist of patient arrival.
The radiologist will review prior examinations, if available, and discuss the current indication and goal of the examination with the Speech/Occupational Therapist and Radiology Technologist.
The pulsed acquisition rate is standardized at 15 frames/second, and the optimal field of view will be discussed and adjusted dynamically, if necessary.
The team will utilize standardized consistencies based on the International Dysphagia Diet Standardization Initiative (IDDSI).
Once the in-room team has a clear objective the performing radiologist will proceed with the fluoroscopic examination. The radiologist will announce to the in-room team when fluoroscopic time points are met at 1 minute, 2 minutes, and a "hard-stop" at 3 minutes of fluoroscopic exposure.
In order for an examination to continue beyond the 3 minute time point a mandatory discussion regarding clinical necessity will occur between the supervising radiologist and the in-room team members.
The average fluoroscopic time required for the acquisition of a MBSS at our institution was calculated and reviewed before (2.07 minutes) and after (1.35 minutes) the implementation of this fluoroscopic radiation dose reduction strategy. The result is a 36 percent reduction in time of fluoroscopic exposure.
The implementation of a radiation dose reduction strategy to our MBSS protocol has resulted in decreased fluoroscopic times, and therefore, a decrease in fluoroscopic radiation dose. An emphasis on verbal communication between team members ensures an understanding of the goal of the examination and awareness of proper management of radiation dose to patients and workers. This modified approach to the MBSS better aligns with the principle of “as low as reasonably achievable” (ALARA).
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