Kathleen Gross

Guidelines for Patient Radiation Dose Management

Michael S. Stecker, MD, Stephen Balter, PhD, Richard B. Towbin, MD, Donald L. Miller, MD, Eliseo Vano, PhD,Gabriel Bartal, MD, J. Fritz Angle, MD, Christine P. Chao, MD, Alan M. Cohen, MD, Robert G. Dixon, MD,Kathleen Gross, MSN, RN-BC, CRN, George G. Hartnell, MD, Beth Schueler, PhD, John D. Statler, MD,Thierry de Baere, MD, and John F. Cardella, MD, for the SIR Safety and Health Committee and the CIRSEStandards of Practice Committee

Proposal of a New Adverse Event Classification by the Society of Interventional Radiology Standards of Practice Committee

PURPOSE To develop a new adverse event (AE) classification for the interventional radiology (IR) procedures and evaluate its clinical, research, and educational value compared with the existing Society of Interventional Radiology (SIR) classification via an SIR member survey. MATERIALS AND METHODS A new AE classification was developed by members of the Standards of Practice Committee of the SIR. Subsequently, a survey was created by a group of 18 members from the SIR Standards of Practice Committee and Service Lines. Twelve clinical AE case scenarios were generated that encompassed a broad spectrum of IR procedures and potential AEs. Survey questions were designed to evaluate the following domains: educational and research values, accountability for intraprocedural challenges, consistency of AE reporting, unambiguity, and potential for incorporation into existing quality-assurance framework. For each AE scenario, the survey participants were instructed to answer questions about the proposed and existing SIR classifications. SIR members were invited via online survey links, and 68 members participated among 140 surveyed. Answers on new and existing classifications were evaluated and compared statistically. Overall comparison between the two surveys was performed by generalized linear modeling. RESULTS The proposed AE classification received superior evaluations in terms of consistency of reporting (P < .05) and potential for incorporation into existing quality-assurance framework (P < .05). Respondents gave a higher overall rating to the educational and research value of the new compared with the existing classification (P < .05). CONCLUSIONS This study proposed an AE classification system that outperformed the existing SIR classification in the studied domains.

Society of Interventional Radiology IR Pre-Procedure Patient Safety Checklist by the Safety and Health Committee

Poyan Rafiei, MD, Eric M. Walser, MD, James R. Duncan, MD, PhD, Hunaid Rana, BS, Jason Robert Ross, MD, Robert K. Kerlan, Jr, MD, Kathleen A. Gross, MSN, BS, RN-BC, CRN, Stephen Balter, PhD, Gabriel Bartal, MD, Nadine Abi-Jaoudeh, MD, CCRP, Michael S. Stecker, MD, Alan M. Cohen, MD, Robert G. Dixon, MD, Raymond H. Thornton, MD, and Boris Nikolic, MD, MBA, for the Society of Interventional Radiology Health and Safety Committee

Occupational Exposure to Bloodborne Pathogens in IR - Risks, Prevention, and Recommendations: A Joint Guideline of the Society of Interventional Radiology and Cardiovascular and Interventional Radiological Society of Europe

http://dx.doi.org/10.1016/j.jvir.2013 None of the authors have identifie From the Department of Interve Texas Medical Branch, 301 Univ Department of Radiology (R.G.D.) North Carolina; Department of Rad New York, New York; Department Medical Group, Sacramento, Ca Department of Radiology (M.S.S.), Massachusetts; Department of R Center, Philadelphia, Pennsylvania ventional Radiology (G.B.), Meir M October 8, 2013; final revision rece 14, 2013. Address correspondenc STANDARDS OF PRACTICE

Society of Interventional Radiology Position Statement: Prevention of Unintentionally Retained Foreign Bodies during Interventional Radiology Procedures

From Virginia Interventional and Vascular Associates (J.D.S.), Fredericksburg; Department of Radiology (W.E.A.S.), University of Virginia Health System, Charlottesville, Virginia; Department of Radiology (J.D.S.), Uniformed Services University of the Health Sciences; Center for Devices and Radiological Health (D.L.M.), Food and Drug Administration, Silver Spring; Department of Interventional Radiology (K.G.), Greater Baltimore Medical Center, Baltimore, Maryland; Department of Radiology (R.G.D.), University of North Carolina, Chapel Hill, North Carolina; Department of Radiology (M.D.K.), University of California, Los Angeles, Medical School, Los Angeles; Department of Radiology (R.L.G.), University of California, San Francisco, San Francisco, California; Department of Vascular and Interventional Radiology (A.M.C.), University of Texas Health Science Center, Houston; Department of Radiology (R.S.), University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Mallinckrodt Institute of Radiology (J.R.D.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.E.S.), Beth Israel Medical Center; Department of Radiology, Interventional Radiology Service (R.H.T.), Memorial Sloan-Kettering Cancer Center, New York, New York; Division of Angiography and Interventional Radiology (M.S.S.), Brigham and Women’s Hospital, Boston, Massachusetts; and Department of Diagnostic and Interventional Radiology (G.B.), Meir Medical Center, Kfar Saba, Israel. Final revision received and accepted July 18, 2011. Address correspondence to J.D.S., c/o Debbie Katsarelis, 3975 Fair Ridge Dr., Suite 400 N., Fairfax, VA 22033; E-mail: jstatrad@aol.com

Society of Interventional Radiology: Occupational Back and Neck Pain and the Interventional Radiologist

INTRODUCTION Interventional radiology is a unique specialty that involves vascular and nonvascular procedures involving virtually every patient population. Currently, most interventional radiologists perform several procedures per day, some lasting hours, and also typically provide on-call coverage for hospitals 24 hours a day, 7 days a week. The physical demands are distinctly different from those of diagnostic radiology, as interventional radiology requires standing while wearing heavy personal protective garments, performing technically complex procedures, moving equipment, and changing positions to accomplish the task at hand. An interventionalist who has spent a career providing procedural care for patients and is affected by occupational musculoskeletal problems ought to be able to refer to a corresponding topic-specific societal document. As no such official Society of Interventional Radiology (SIR) document exists, it is hoped that this document will fill that void. Standing occupations are associated with higher levels of low back pain (LBP) compared with sitting occupations (1). In addition, the use of ionizing radiation requires personal protection, typically in the form of heavy protective garments. This, combined with standing for most of the day and performing procedures with repetitive motions in awkward positions, has been associated with occupational neck and back pain (2). Whereas the hazards of radiation and bloodborne pathogen exposure are well established (3–5), the musculoskeletal

Society of Interventional Radiology Position Statement on Injection Safety: Improper Use of Single-dose/Single-use Vials

Efficient health care delivery includes expense reduction, distribution of limited resources, and minimization of medical waste. These goals must be achieved without patient safety compromise. One challenging example is the administration of injectable medications. Some common procedures may require injection of only a small quantity of medication such as sodium tetradecyl sulfate (Sotradecol; AngioDynamics, Queensbury, New York), onabotulinumtoxinA (BOTOX Cosmetic; Allergan, Irvine, California), or radiocontrast agents for arthrography, myelography, or percutaneous pain management procedures. In a busy clinical setting, with several consecutive patients scheduled for similar procedures, it may be tempting to purchase a medication in a large ‘‘economy-size’’ container and split the doses into multiple syringes for administration to multiple patients. An essential feature of injection practice involves the safe administration of a medication packaged in a single-dose vial (SDV) or singleuse vial. The Centers for Disease Control and Prevention (CDC) note that improper use of a medication packaged in an SDV can place a patient at increased risk for acquiring a health care–related infection (1). Medication from an SDV is intended for parenteral administration for a single patient during a single procedure. SDVs are labeled as such in the manufacturer’s package insert. The CDC states that SDVs must not be used for multiple patients. Even if an SDV contains more medication than is needed for a single patient, that vial should not be used for more than one patient nor stored for future use in the same patient. In contrast with an SDV, a multidose vial (MDV) of a medication contains more than a single medication dose. MDVs are labeled as such by the manufacturer and typically contain an antimicrobial preservative agent to help prevent bacterial growth. The preservative agent has no effect on viruses and does not protect against contamination when health care personnel fail to follow safe injection practices. MDVs are discarded within 28 days unless the manufacturer specifies a different (shorter or

Ultrasonographic diagnosis and guided compression repair of femoral artery pseudoaneurysm: An update for the vascular nurse

Rapid advances in technology have led to the use of radiographic technology for therapeutic interventions. This article is an all-inclusive procedure guide for the imaging nurse as well as the bedside nurse caring for the patient before or after the procedure. Key aspects of the nurses functions are educating the patients to gain their cooperation and improve their understanding of the procedure and post-procedure expectations, physiologic monitoring, and administering sedation and analgesia. Ultrasonographic guided compression repair is a safe, cost-effective first approach to treatment for many femoral artery pseudoaneurysms and does not affect possible surgical intervention if the ultrasonographic guided compression repair attempt fails.

Ebola and Other Highly Contagious Diseases: Strategies by the Society of Interventional Radiology for Interventional Radiology

INTRODUCTION The present update from the Safety and Health Committee of the Society of Interventional Radiology reviews Ebola virus disease (EVD) and the important points relevant to interventional radiology (IR) professionals who may encounter patients with or suspected to have EVD. The aim of this article is to shed some light on the perceptions and misconceptions of preparedness and protection of patients and hospital staff. This document also reviews the Centers for Disease Control and Prevention (CDC) guidelines related to personal protective equipment (PPE) and management of patients with EBV by health care workers in the United States. Finally, we present two potential EVD scenarios to put prevention and procedure into perspective.