Reproduced with permission from Peterson et al.236 Levine et al 2011 ACCF/AHA/SCAI PCI Guideline e649 Appendix 4C. Strategies to Reduce Radiation Exposure to Patient and Operator Precautions to minimize exposure to patient and operator Use radiation only when imaging is necessary to support clinical care Minimize use of cine Minimize use of steep angles of x-ray beam Minimize use of magnification modes Minimize frame rate of fluoroscopy and cine Keep the image receptor close to the patient Utilize collimation to the fullest extent possible Monitor radiation dose in real time to assess patient risk-benefit during procedure Precautions to specifically minimize exposure to operator Use and maintain appropriate protective garments Maximize distance of operator from x-ray source and patient Keep above-table and below-table shields in optimal position at all times Keep all body parts out of field of view at all times Precautions to specifically minimize exposure to patient Keep table height as high as comfortably possible for operator Vary imaging beam angle to minimize exposure to any single skin area Keep patient s extremities out of beam Appendix 4D. Patient Care Consideration Based on Procedural Radiation Dose Ka,r* PKA FT Action 60 min Physician charts documentation about why exposure at this level occurred, documents whether multiple skin entry angles were used, assesses risk, educates patient about potential for skin injury, and arranges for appropriate follow-up within 30 d. Phone calls may be sufficient with an office visit arranged if issues/questions arise or a potential tissue injury is suspected. 10 Gray Physician contacts radiation safety officer/medical physicist. The radiation safety officer/medical physicist should perform a detailed analysis of PSD. Document a) FOV, b) skin entrance port number, c) known geometry, with a rough geometric setup required. Educate patient about the potential for skin injury and document this in chart. 