ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures. A report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training

• Published in: Journal of the American College of Cardiology 2004-12, Vol.44 (11), p.2259-2282
• Main Authors: HIRSHFELD, John W, BALTER, Stephen, LORELL, Beverly H, RODGERS, George P, WEITZ, Howard H, BRINKER, Jeffrey A, KERN, Morton J, KLEIN, Lloyd W, LINDSAY, Bruce D, TOMMASO, Carl L, TRACY, Cynthia M, WAGNER, Louis K, ELNICKI, Michael
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cardiology; Cardiology - education; Cardiology - standards; Cardiology. Vascular system; Cardiovascular Diseases - diagnostic imaging; Cineradiography; Clinical Competence; Dose-Response Relationship, Drug; Dosimetry; Electrophysiologic Techniques, Cardiac - standards; Female; Fluoroscopy - standards; Geometry; Heart Diseases - diagnostic imaging; Humans; Image Processing, Computer-Assisted; Informed Consent; Injuries; Medical sciences; Meetings; Patient safety; Physics; Pregnancy; Pregnancy Complications, Cardiovascular - diagnosis; Professional standards; Radiology, Interventional - standards; Risk; Task forces; Writing
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2004.10.014

The American College of Cardiology/American Heart Association/American College of Physicians (ACC/AHA/ACP) Task Force on Clinical Competence was formed in 1998 to develop recommendations for attaining and maintaining the cognitive and technical skills necessary for the competent performance of a specific cardiovascular service, procedure, or technology. X-Ray Generation and Control 1.Bremmstrahlung and X-ray properties X-ray generators, filters, collimators, brightness, and exposure rate controls X-Ray Dosimetry 2.Radiation dosimetry, units, and measurement Image Formation 3.Effects of dose, kVp, geometry, and focal spot size on image contrast, spatial resolution, and noise Image Acquisition 4.Image intensifier and flat panel receptors Pulsed fluoroscopy (pulse duration, intensity, frame rate) Serial imaging Image Processing and Management 5.Basic aspects of the digital image (matrix size, bit depth) Digital image processing (subtraction, recursion) DICOM and PACS Imaging Laboratory--Demonstrations in the Cardiovascular Laboratory 6.Radiation-measuring instruments Effects of changing physical parameters on image quality Basic quality assurance testing Table 7a X-Ray Production and Imaging Advanced radiation physics and safety curriculum for individuals training to perform fluoroscopically guided angiographic, interventional, and electrophysiologic cardiovascular procedures (approximately 12 hours of instruction or study). Pregnancy and heritable concerns Patient Dose-Management Fundamentals 8.Clinical dose monitoring (dose @ IRP, DAP, IEC cumulative dose) Consents, history, physical examinations, follow-up procedures Effects of different operating modes on patient dose and image quality Geometry factors and patient factors Intraprocedural radiation benefit-risk evaluation Review of radiation injury cases Staff Radiation Safety 9.Distance-time-shielding Situational awareness Badges Beam orientation effects Pregnant staff Safety Laboratory--Demonstrations in the Cath Lab 10.Effects of patient size and imaging geometry on patient dose Scatter radiation fields--intensity and orientation Properties and use of radiation protection accessories Professional Standards and Regulatory Requirements (1/2 lecture) 11a.Professional standards of practice (e.g., ACC, AHA, HRS, SCAI) FDA State JCAHO Miscellaneous and Review (1/2 lecture) 11b.Other topics of current or local interest Final Examination 12.Written certification examination Table 7b Radiation Biology, Safety, a