Re: Greetings

["CAPT J. A. Thomas" <jathomas@radlinux1.usuf1.usuhs.mil>]

Laura,

I am just getting back to my office from a trip.  I see I have missed your "deadline".    How did your talk with the Medical Staff go?  The issue of credentialing physicians to use Fluorosocpy has been a pet interest of mine for a long time.  In the Navy we don't have an "official" training/credentialling program.  It is my hope to establish the criteria for such a program and see it implemented.  Again, I am sure there will be many objections to such a program; however, it should be implemented.  Failure to do so will ultimately generate "Institutional Incompetence" in Fluoroscopy and 

The training program should include both theory and hands on.  My ideas "off the top of my head" are:

Formal Training Program:

Brief overview of x-ray interactions with matter (don't go into the actual types of scatter, but rather focus on how the primary beam and scatter affects image quality, patient dose and radiation safety of the procedure)

Discussion of shielding and its effectiveness and methods of careing for (Pb aprons, Pb gloves, protable shieds -- or Cardiac Cath, etc.)

Discussion of types of fluoro examinations, doses to the patient, doses to the operator and doses to the technologists/nursing personnel.

Discussion of parameters (e.g. variation in technique factors) that can reduce exposures to all parties listed above.  How do such changes affect image quality and Diagnostic Quality.

Discussion of "what you can see at a given dose"  (e.g. image resolution of imaging system, how it changes with II size and how patient dose and image quality changes with changing II size and dose.)


LAB

Have a "hands on demonstration" of the Unit.  Take survey meters into the Laboratory session and demonstrate changes in radiation exposure rates throughout the room.  Use appropriate phantoms/scattering materials.

Demonstrate protection afforded by Pb aprons

Show a glove with "no fingers"  (e.g. one that has lost its Pb)

Demonstrate remote compression devices

Demonstrate pulse fluoro modes


Then have them operate the unit.



Finally,  Go into the room with them the first time they use the unit with a patient.  Be avaliable to answer questions the physician may have, as well as the clinical support staff that works with the credentialled physician.


Let me know how your meeting went.  I am sorry that I did not get this back before your meeting.

vR,

JERRY THOMAS








At 15:56 04/14/97 -0500, you wrote:
>Greetings,
>This is my first communicaiton with this list.  My question is directed to 
>Hospital HP's and Med. Phys. who are also responsible for radiation safety:
>What do you do about credentialling (privileges) of physicians for use of 
>fluoroscopy?  What is your training program?  I am finally gettin an 
>opportunity to speak at a med. staff mtg. on Wed 4/17 - they have only 
>given me 5 minutes - and I am struggling with how to best use the time.  I 
>want to avoid stirring up defensiveness, but need to make the time 
>meaningful.  I am trying to get the use of fluoro approved as a privilege 
>with radation safety education requirements.  Any help or comments are 
>appreciated, either to list or private e-mail.  Thank you all in advance.
>lo.
>-------------------------------------
>Name: Laura O'Neill
>E-mail: loneill@Haysmed.com
>Date: 4/14/97
>Time: 2:53:51 PM
>
>


CAPT Jerry A. Thomas,  MSC, USN
Chief Radiological Physics
Department of Radiology/Nuclear Medicine
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD  20814-4799

mailto:thomas@bob.usuf2.usuhs.mil
Phone:   (301) 295-3246
Fax:        (301) 295-3893

Homepage:  http://radlinux1.usuf1.usuhs.mil/rad/