Has the introduction of an advanced practitioner led service had an impact on radiation dose for fluoroscopy guided lumbar punctures? A service review

Abstract

Introduction: Historically, procedures requiring fluoroscopic guidance such as myelography; barium and video swallows; and fluoroscopy guided lumbar punctures (LP) have been performed by radiologists with the assistance of radiographers. As the National Health Service (NHS) evolves, more responsibilities are being disseminated to specifically trained radiographers to relieve workload due to a national shortage of radiologists. One step taken by the trust was to train an Advanced Practitioner (AP) in fluoroscopy to perform fluoroscopy guided LPs. Clinical audit and service evaluations are required to ensure there is no impact on patient care as a result of changes in practice. Regardless of occupation, healthcare workers undertaking procedures must ensure the same standards of care for patients. Minimising radiation dose is a duty of all radiological professionals.

Methods: This retrospective review evaluated and compared examinations performed by a group of radiologists and an AP in terms of dose area product (DAP) and fluoroscopy screening time. A total of 300 X-ray guided LPs doses were reviewed and comparison between the radiation exposure data sets was performed to determine whether there was a significant difference between the two operator groups.

Results: The study revealed that AP-performed LPs had a statistically significant lower DAP and fluoroscopy time (a mean of 4.21Gycm2 and 0.74min) compared to the radiologist-performed LPs (a mean of 5.72Gycm2 and 0.94min).

Conclusion: The review demonstrates that patient dose is not detrimentally affected by the introduction of an advanced practitioner. It establishes that dose and screening time was significantly lower. It also highlights the effectiveness of APs in an evolving radiology department.

Implications for practice: These outcomes propose advanced practitioners in this area of expertise can expand their role from neuroradiographer with no detriment to patient dose. Despite the results, it is recognised that continuous appraisal is required to ensure that competencies are maintained, and high levels of care are sustained.

Keywords: Advanced; Dose; Lumbar; Practitioner; Puncture.