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

More documents

Recommendations

Info

therapy (for outpatient procedures), an unplanned increasein the level of care, prolonged hospitalization, permanentadverse sequelae, or death. Minor complications result inno sequelae, but may require nominal therapy or a shorthospital stay for observation (generally overnight; seeAppendix A). The complication rates and thresholdsdescribed herein refer to major complications.Routine periodic review of all cases having less thanperfect outcomes is strongly encouraged. Seriouscomplications of vertebral augmentation are infrequent. Areview is therefore recommended for all instances ofdeath, infection, or symptomatic pulmonary embolus.Table 1: Vertebral Augmentation Success Rates [51-58]Success RatesWhen vertebral augmentation is performed forosteoporosis, procedure outcomes can be defined usingthe criteria by Hodler et al [50] with patients categorizedas worse, same, better, or pain/disability gone. For thepurpose of this document pain/disability gone is definedas improved. Therefore patients should be categorized aseither improved, the same, or worse. This categorizationshould be determined with the use of a validatedmeasurement tool.When vertebral augmentation is performed for neoplasticinvolvement, success is defined as achievement ofsignificant pain relief and/or improved mobility asmeasured by validated measurement tools.Published Success Rates Threshold for ReviewNeoplastic, all causes 70% to 92% 10%Permanent neurological deficit (within 30 days ofthe procedure or requiring surgery)OsteoporosisNeoplasm1%>5%Fracture of rib, sternum or vertebra 1% >2%Allergic or idiosyncratic reaction 1%Infection 0%Symptomatic pulmonary material embolus 0%Significant hemorrhage or vascular injury 0%Symptomatic hemothorax or pneumothorax 0%Death 0%The overall procedure threshold for all complications resulting from vertebral augmentation performed for osteoporosis is2%, and when performed for neoplastic indications it is 10%.8 / Vertebral Augmentation PRACTICE GUIDELINE
IX.RADIATION SAFETY IN IMAGINGRadiologists, medical physicists, radiologic technologists,and all supervising physicians have a responsibility tominimize radiation dose to individual patients, to staff,and to society as a whole, while maintaining the necessarydiagnostic image quality. This concept is known as “aslow as reasonably achievable (ALARA).”Facilities, in consultation with the medical physicist,should have in place and should adhere to policies andprocedures, in accordance with ALARA, to varyexamination protocols to take into account patient bodyhabitus, such as height and/or weight, body mass index orlateral width. The dose reduction devices that areavailable on imaging equipment should be active; if not;manual techniques should be used to moderate theexposure while maintaining the necessary diagnosticimage quality. Periodically, radiation exposures should bemeasured and patient radiation doses estimated by amedical physicist in accordance with the appropriate ACRTechnical Standard. (ACR Resolution 17, adopted in2006 – revised in 2009, Resolution 11.)X. QUALITY CONTROL ANDIMPROVEMENT, SAFETY, INFECTIONCONTROL, AND PATIENT EDUCATIONPolicies and procedures related to quality, patienteducation, infection control, and safety should bedeveloped and implemented in accordance with the ACRPolicy on Quality Control and Improvement, Safety,Infection Control, and Patient Education appearing underthe heading Position Statement on QC & Improvement,Safety, Infection Control, and Patient Education on theACR web site (http://www.acr.org/guidelines).ACKNOWLEDGEMENTSThis guideline was revised according to the processdescribed under the heading The Process for DevelopingACR Practice Guidelines and Technical Standards on theACR web site (http://www.acr.org/guidelines) by theGuidelines and Standards Committees of the Commissionon Neuroradiology and the Commission on Interventionaland Cardiovascular Radiology in collaboration with theASNR, the ASSR, the SIR, and the SNIS.Collaborative Committee – members represent theirsocieties in the initial and final revision of this guideline.ACRJoshua A. Hirsch, MD, FACR, ChairJohn E. Jordan, MDPhilip M. Meyers, MDJohn D. Statler, MDASNRDavid F. Kallmes, MDJerry G. Jarvik, MDASSRDmitry Niman, MDDan L. Nguyen, MDR. Sean Pakbaz, MDKent B. Remley, MDMichael I. Rothman, MDSIRJohn D. Barr, MDJ. Kevin McGraw, MDSNISAllan L. Brook, MDMary (Lee) Jensen, MDAlbert J. Yoo, MDGuidelines and Standards Committee – Interventional –ACR Committee responsible for sponsoring the draftthrough the processDonald L. Miller, MD, Chair, FACRAradhana M. Venkatesan, MD, Vice-ChairStephen Balter, PhD, FACRRobert G. Dixon, MDLawrence T. Dauer, PhDJoshua A. Hirsch, MD, FACRSanjoy Kundu, MDPhilip M. Meyers, MDJohn D. Statler, MDMichael S. Stecker, MDTimothy L. Swan, MDRaymond H. Thornton, MDAnne C. Roberts, MD, FACR, Chair, CommissionGuidelines and Standards Committee – Neuroradiology –ACR Committee responsible for sponsoring the draftthrough the processJacqueline A. Bello, MD, FACR, ChairJohn E. Jordan, MD, Vice-ChairMark H. Depper, MDAllan J. Fox, MD, FACRSteven W. Hetts, MDEllen G. Hoeffner, MDThierry A.G.M. Huisman, MDStephen A. Kieffer, MD, FACRSrinivasan Mukundan, MD, PhDEric M. Spickler, MD, FACRAshok Srinivasan, MDKurt E. Tech, MD, MMM, FACRMax Wintermark, MDCarolyn C. Meltzer, MD, FACR, Chair, CommissionPRACTICE GUIDELINE Vertebral Augmentation / 9
Page 2 and 3: any new methods for achieving the s
Page 4 and 5: adiologic personnel, and radiationm
Page 6 and 7: 4. The facility must provide adequa
Page 10 and 11: REFERENCES1. Galibert P, Deramond H
Page 12: 54. McDonald RJ, Trout AT, Gray LA,

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?