Q and A article

Best Practices for Radiation Dose Management that Meet the New Joint Commission Fluoroscopy Requirements

Five new Joint Commission (JC) elements of performance aimed at facilities that provide fluoroscopy services went into effect as of 2019.1 A primary focal point of the new requirements is radiation dose management, which can face several challenges.1 These challenges can include physicians and healthcare staff who overlook the importance of their own radiation dose, more non-radiation experts performing fluoroscopically guided procedures, and increased length and complexity of the types of procedures being performed.1,2 Overcoming these barriers is essential for JC accreditation in order to deliver high quality, safe, and effective patient care.1 

One issue that may delay progress in this area for facilities in the U.S. is the lack of national standards for documenting radiation dose. Aside from the 2010 "Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging" that was launched by the U.S. Food and Drug Administration (FDA) and their online resources, organizations providing fluoroscopy services have had to rely on state mandates.3

Implementing quality assurance procedures to guide dose management

Several professional societies recommend implementing a series of quality assurance procedures using the as low as reasonably achievable (ALARA) principle as a guide to developing best practices for managing radiation from fluoroscopy.4 Evaluating the radiation dose of current procedures and protocols in the context of benchmark data where available can identify those occurrences that lie outside the norm and should receive a deeper review.4

Ongoing training is essential to radiation dose management.4 Training includes increasing knowledge about the long-term impact of radiation on the body, providing strategies for reducing risks, and demonstrating how to calculate dose.4 Regular feedback concerning individual safety-related performance and radiation exposure to nurses, technologists, and physicians can be vital for maintaining awareness and focus on a culture of safety that supports dose management.


System imaging geometry is another key strategy for optimizing dose management. Using the inverse square principle, where exposure is inversely proportional to the square of the distance from the source, the patient should be placed both as far away from and as close to the imaging detector as is possible without reducing treatment efficacy or outcome.5 

Other steps that eliminate unnecessary exposure and support radiation safety and dose management include using collimators and understanding the impact of automatic exposure control on image quality and dose.2 Stepping outside of the procedure room or increasing distance from the patient along with removing all nonessential objects to reduce scatter radiation contribute to a culture of safety.2 

Increasing radiation health and safety education can also improve the consistency with which cath lab team members wear their dosimeter.4 Knowing this data in particular that is critical to their own health as well as the optimization of patient radiation dose and procedures.4

Meeting the new JC fluoroscopy requirements is essential to accreditation and help with regulatory compliance, as well as providing safe and effective patient care.1


  1. Provide Fluoroscopy Services? You Need to Know About These New Requirements!. Joint Commission Blog https://www.jointcommission.org/ambulatory_buzz/provide_fluoroscopy_services_              you_need_to_know_about_these_new_requirements/ Accessed 6/21/2019
  2. Radiation Protection for the Fluoroscopy Operator and Staff. American Journal of Radiology https://www.ajronline.org/doi/full/10.2214/AJR.16.16556 Accessed 6/21/2019
  3. Defining the Cath Lab Workplace Radiation Safety Hazard. Diagnostic and Interventional Cardiology https://www.dicardiology.com/content/blogs/defining-cath-lab-workplace-radiation-safety-hazard Accessed 6/21/2019
  4. Cardiology Societies Call for Better Radiation Dose Tracking. Diagnostic and Interventional Cardiology https://www.dicardiology.com/article/cardiology-societies-call-better-radiation-dose-tracking Accessed 6/21/2019
  5. Radiation Protection for the Fluoroscopy Operator and Staff. American Journal of Roentgenology https://www.ajronline.org/doi/full/10.2214/AJR.16.16556 Accessed 6/21/2019