acr–asnr–assr–sir–snis practice guideline for the performance of ...

adiologic personnel, and radiationmonitoring requirements.e. Anatomy, physiology, and pathophysiologyof the spine, spinal cord, and nerve roots.f. Pharmacology of contrast agents andimplanted materials and recognition andtreatment of potential adverse reactions tothese substances.g. Technical aspects of performing thisprocedure.The written substantiation should come from thechief of interventional radiology, the chief ofneuroradiology, the chief of interventionalneuroradiology, or the chair of the department ofthe institution in which the physician will beproviding these services 1 . Substantiation couldalso come from a prior institution in which thephysician provided the services, but only at thediscretion of the current interventional,Neurointerventional, or neuroradiology chief, orthe chair who solicits the additional input.and5. Physicians must possess certain fundamentalknowledge and skills that are required for theappropriate application and safe performance ofvertebral augmentation:a. In addition to a basic understanding ofspinal anatomy, physiology, andpathophysiology, the physician must havesufficient knowledge of the clinical andimaging evaluation of patients with spinaldisorders to determine those for whomvertebral augmentation is indicated.b. The physician must fully appreciate thebenefits and risks of vertebral augmentationand the alternatives to the procedure.c. The physician is required to be competent inthe use of fluoroscopy, CT, and MRI orinterpretation of images in the modalitiesused to evaluate potential patients and guidethe vertebral augmentation procedure.d. The physician should be able to recognize,interpret, and act immediately on imagefindings.e. The physician must have the ability, skills,and knowledge to evaluate the patient’sclinical status and to identify those patientswho might be at increased risk, who mayrequire additional perioperative care, or whohave relative contraindications to theprocedure.1 At institutions in which there is joint (dual) credentialingacross departments doing like procedures, this substantiation ofexperience should be done by the chairs of both departments toensure equity of experience among practitioners when theirtraining backgrounds differ [43].f. The physician must be capable of providingthe initial clinical management ofcomplications of vertebral augmentation,including administration of basic lifesupport, treatment of pneumothorax, andrecognition of spinal cord compression.g. Training in radiation physics and safety is animportant component of these requirements.Such training is important to maximize bothpatient and physician safety. It is highlyrecommended that the physician haveadequate training in and be familiar with theprinciples of radiation exposure, the hazardsof radiation exposure to both patients andradiologic personnel, and the radiationmonitoring requirements for the imagingmethods listed above.Some methods of vertebral augmentation may requirespecialized training and experience, and such needsshould be assessed before a physician contemplates usingany method.Maintenance of CompetencePhysicians should perform a sufficient number ofvertebral augmentation procedures to maintain their skills,with acceptable success and complication rates as laid outin this guideline. Continued competence depends onparticipation in a quality improvement program thatmonitors these rates. Regular attendance at postgraduatecourses that provide continuing education on diagnosticand technical advances in vertebral augmentation isnecessary.Continuing Medical EducationThe physician’s continuing education should be inaccordance with the ACR Practice Guideline forContinuing Medical Education (CME).B. Nonphysician PractitionersPhysician assistants and nurse practitioners can bevaluable members of the interventional radiology teambut not as primary operator. These nonphysicianpractitioners can function as independent members of theteam but not as primary operator. See the ACR–SIR–SNIS Practice Guideline for Interventional ClinicalPractice.C. Qualified Medical PhysicistA Qualified Medical Physicist is an individual who iscompetent to practice independently one or more of thesubfields in medical physics. The American College ofRadiology (ACR) considers certification, continuingeducation, and experience in the appropriate subfield(s) to4 / Vertebral Augmentation PRACTICE GUIDELINE