Improving the effectiveness and efficiency of a skin dose investigation protocol in interventional radiology.

Cardiac catheterisation is an invasive procedure carried out under fluoroscopic guidance, which exposes the patient's skin to X-ray radiation. In some cases, the skin receives a radiation dose, which is sufficiently high to cause a radiation injury. To ensure the timely identification of patients at risk of such an injury, a skin dose investigation protocol was implemented within the United Lincolnshire Hospitals Trust. However, two shortcomings with the new protocol were identified: first, it was possible for a patient to receive a clinically significant skin dose without the protocol being triggered; second, the investigation protocol increased staff workload. The Radiation Protection Department undertook to resolve these issues by making use of two software packages (openSkin and OpenREM) to automate key processes in the skin dose investigation protocol. The automation was introduced over three distinct Plan-Do-Study-Act cycles. The introduction of openSkin and OpenREM eliminated the possibility of a high skin dose procedure failing to trigger an investigation. The time spent by staff on skin dose investigations was reduced by an estimated 94%.