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(Circulation. 2005;111:511-532.)
© 2005 American Heart Association, Inc.

ACC/AHA Clinical Competence Statement

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

WRITING COMMITTEE MEMBERS John W. Hirshfeld, Jr, MD, FACC, FAHA, FSCAI, Chair; Stephen Balter, PhD, FACR, FAAPM, FSIR; Jeffrey A. Brinker, MD, FACC, FSCAI; Morton J. Kern, MD, FACC, FAHA, FSCAI^*; Lloyd W. Klein, MD, FACC, FAHA, FSCAI; Bruce D. Lindsay, MD, FACC, FAHA; Carl L. Tommaso, MD, FACC, FAHA, FSCAI; Cynthia M. Tracy, MD, FACC, FAHA^*,; Louis K. Wagner, PhD, FACR, FAAPM

TASK FORCE MEMBERS Mark A. Creager, MD, FACC, FAHA, Chair; Michael Elnicki, MD, FACP; John W. Hirshfeld, Jr, MD, FACC, FAHA; Beverly H. Lorell, MD, FACC, FAHA; George P. Rodgers, MD, FACC; Cynthia M. Tracy, MD, FACC, FAHA; Howard H. Weitz, MD, FACC, FACP

*AHA Representative; HRS Representative; SCAI Representative.

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 

	TABLE OF CONTENTS

 

Preamble  512

  I. Introduction and Background  512

 II. The Physics and Nature of X-Radiation  514

   The Nature of X-Radiation  514

   X-Ray Generation  514

   X-Ray Spectra  514

   Mechanisms of X-Ray Absorption  514

   X-Ray Dose  514

   Measurements of Radiation  515

 III. Principles of X-Ray Image Formation  514

   X-Ray Image Generation  514

   Parameters That Affect X-Ray Image Formation  516

 IV. The Operation of an X-Ray Cinefluorographic Unit  517

   Overview  517

   X-Ray Generation  517

   X-Ray Exposure Modulation  519

   Video Image Capture  519

   Image Display and Processing  520

   Optimizing the Exposure Parameters That Determine Image Quality  521

   Fluoroscopy Dose Management Issues  521

   Acquisition Dose Management Issues  522

   Digital Image Subtraction  522

 V. Determinants of Patient X-Ray Dose  522

   Measurements of Patient Dose  522

   Dose (Air Kerma) at the IRP  522

   DAP  522

   Value of Dose Monitoring  523

   Dose at the IRP Monitoring  523

   DAP Benchmarking Data  523

   Factors That Influence Patient Absorbed Dose  523

   Equipment-Related Factors  524

   Patient-Related Factors  524

   Procedure Conduct Factors  524

   Beam Collimation  524

   Input Dose and Frame Rate  524

 VI. Patient Effects of X-Ray Exposure  525

   Deterministic Effects  525

   Cataract  526

   Stochastic Effects  526

 VII. Radiation Risks From Typical Invasive Cardiovascular Procedures  528

   Clinical Risk-Benefit Ratio  528

   General Considerations for Deterministic Risk  528

   General Considerations for Stochastic Risk  528

   Multiple Procedure Considerations  528

VIII. Physician Responsibilities to Patients  528

   Patient Education and Consent  528

   Procedural Dose Management  529

   IX.  Recommended Radiation Safety Curriculum for Physicians Who Perform Invasive Cardiac Procedures  530

	Preamble

 
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