Online Training on the Safe Use of Fluoroscopy Can Result in a Significant Decrease in Patient Dose

Academic Radiology.  VOLUME 20, ISSUE 10, P1272-1277, OCTOBER 2013




Rationale and Objectives

Concerns over medical radiation exposure have received national press in recent years, and training in the appropriate use of radiation has become an essential component of every radiology residency program. Appropriate training is particularly important in fluoroscopy because it is commonly used by inexperienced radiology residents and has the potential to impart relatively high patient radiation doses. In an effort to minimize the radiation doses received by patients, our institution has recently initiated an online training program in the safe use of fluoroscopy. This course is required and must be completed by new radiology residents before their first fluoroscopy rotation. The goal of this study was to determine if the use of an online course in the safe use of fluoroscopy could result in decreased patient dose without affecting diagnostic quality.

Materials and Methods

Four years of retrospective procedural data for residents performing gastrointestinal and genitourinary fluoroscopic procedures without specialized training were reviewed. Incoming residents took an American Medical Association–accredited online training program in the safe use of fluoroscopy the week before their first fluoroscopy rotation. Patient dose and diagnostic quality data, inferred from the frequency of attending physician intervention necessary to complete the procedure, were collected for all exams performed by the new group of residents after completion of the training course. This was then compared to data from prior classes and stratified by procedure type.


Statistically significant reductions in both average fluoroscopy time (FT) or dose-area-product (DAP) were found for many of the fluoroscopic procedures performed by residents who participated in the online fluoroscopy training program. Specifically, statistically significant reductions in FT for barium enema, cystogram, defecogram, and esophagram procedures (P < .001) were found. Esophagram and upper gastrointestinal studies were completed with a significantly lower DAP (P < .001). The average reduction in DAP across all procedures performed by first-year residents was 38%, whereas the average reduction in FT was 25%. Based on a review of data from all procedures performed, there was no statistically significant loss in diagnostic quality.


An online training program can be effectively used to provide radiation safety instruction immediately before the start of a resident’s fluoroscopy rotation, decreasing patient dose without affecting diagnostic quality.

What you will learn after reading this article:

  • Effective Online Training Enhances Radiation Safety: Physicians will learn about the role and effectiveness of online training programs in enhancing safe practices in fluoroscopy, potentially applicable to their own training or teaching methodologies.
  • Reduction in Patient Radiation Exposure: The article presents data demonstrating how specialized training can significantly reduce patient radiation doses during fluoroscopic procedures, a key aspect for physicians aiming to improve patient safety.
  • Maintenance of Diagnostic Integrity: Insights are provided on maintaining diagnostic quality despite reduced radiation exposure, essential for physicians concerned about balancing patient safety with clinical effectiveness.
  • Detailed Data on Specific Procedures: The article offers specific, quantitative outcomes of training effects on different fluoroscopic procedures, valuable for physicians looking for data-driven insights into procedure-specific radiation safety improvements.

Who should read this study?



  • Radiologists: Radiologists are at the forefront of using fluoroscopy and other imaging techniques that involve radiation. This study is particularly relevant to them as it demonstrates how targeted online training can significantly reduce patient radiation exposure without compromising diagnostic quality. Radiologists constantly seek ways to optimize imaging techniques for better patient outcomes, and understanding the impact of such training can directly influence their practice, especially in guiding and mentoring residents in safe and effective imaging practices.
  • Interventional Radiologists: This subspecialty of radiology often relies heavily on fluoroscopic guidance for procedures. Interventional radiologists would benefit from this study as it offers insights into reducing radiation exposure during complex procedures. The balance between maintaining diagnostic quality and minimizing radiation dose is crucial in interventional radiology, where procedures can be lengthy and involve significant radiation exposure. The study’s findings could help these specialists refine their techniques and training protocols, potentially leading to safer practices for both patients and medical staff.
  • Orthopedic Surgeons: Orthopedic surgeons frequently use fluoroscopy for a variety of procedures, including spinal surgeries and joint replacements. This study’s findings on reducing radiation exposure are highly relevant for them, as they often rely on real-time imaging to guide surgical interventions. Understanding how improved training in fluoroscopy can decrease patient radiation doses could influence their approach to using fluoroscopic guidance in surgeries. This knowledge is also vital for orthopedic surgeons in training, as it underscores the importance of mastering safe imaging practices early in their careers.

In our opinion, the study “Online Training on the Safe Use of Fluoroscopy Can Result in a Significant Decrease in Patient Dose” is one of keen interest and critical evaluation. The study aptly addresses a crucial aspect of radiological practice: the balance between effective diagnostic imaging and minimizing patient exposure to radiation.

A notable strength of this study is its relevance and timeliness. In an era where concerns about radiation safety are increasingly at the forefront, the study’s focus on enhancing training methodologies through an online platform is both innovative and apt. The incorporation of digital learning aligns well with contemporary educational trends and offers a scalable and accessible approach to training, which is particularly beneficial in the fast-evolving field of radiology.

Another commendable aspect is the comprehensive approach to data analysis. By comparing procedural data over a significant period and involving a substantial number of cases, the study provides robust and convincing evidence of the effectiveness of the training program. This detailed analysis adds to the credibility of the findings and makes a compelling case for the adoption of similar training programs in other institutions.

However, the study is not without its limitations. One notable weakness is the inherent limitation of retrospective studies. While the data presented is extensive, retrospective analyses are often limited by the quality and consistency of record-keeping. Additionally, the study focuses solely on the impact of training on new radiology residents, which leaves a gap in understanding its effectiveness on more experienced practitioners. The dynamics of learning and adaptability can significantly vary between inexperienced residents and seasoned radiologists, which may influence the overall impact of such training programs in a real-world setting.

Another area that warrants further exploration is the subjective measure of diagnostic quality. The study uses the frequency of attending physician intervention as a proxy for diagnostic quality, which might not comprehensively capture all the nuances of diagnostic accuracy and effectiveness.

While the study presents valuable insights and a strong case for online training in radiation safety, it would benefit from a more diverse and longitudinal approach, possibly incorporating prospective studies and a broader range of participants. This would not only enhance the generalizability of the findings but also provide a more nuanced understanding of the long-term impact of such training programs across different levels of expertise in radiology.