Evaluating Discrepancies between Rdsrs and Traditional Dose Sheets for Fluoroscopic Imaging
Abstract
Purpose
Accurate radiation documentation is essential for assessing patient risk during fluoroscopically guided procedures. Radiation Dose sheets are commonly used but may omit exposure details while DICOM Radiation-Dose-Structured-Reports (RDSRs) provide more comprehensive event-level data. Quantifying differences between these reporting methods is important for understanding dose monitoring accuracy.
Methods
We retrospectively analyzed 29,957 radiation events from 605 consecutive fluoroscopy procedures performed for patients over a six-month period at a tertiary academic medical center. Data entries were analyzed to note discrepancies in radiation doses reported in the form of RDSRs and Dose Sheets.
Results
Significant discrepancies were found between RDSR and Dose Sheets across all scanners. On average, Dose Sheets only captured 29.8% of the procedure total radiation and excluded some key imaging variables if the entry had a lower radiation dose, lower DAP, larger collimated field area, or higher tube voltage, that were always reported in the RDSR (p<0.001). Another interesting finding was that the radiation events were most accurately accounted for in peripheral angiograms (69.9%) and least accurately reported in IVC filter placements (0.6%). Multi-variate analysis showed that the higher tube voltage variable was more likely to be excluded on the Dose Sheets while higher radiation dose and higher tube current-time product values (mAs) would always be reported in both Dose Sheets and RDSR. ROC model indicated strong performance (AUC=0.84), in effectively distinguishing between RDSR entries that were captured versus omitted on the Dose Sheet. Device-dependent variations across both devices were also observed which included capture proportions of 54.8% (device1) versus 8.0% (device2), indicating that underreporting is influenced by vendor settings implementation rather than physician preference or protocol selection.
Conclusion
Dose Sheets systematically underreport radiation exposure, often omitting low-dose and collimated events. Referencing RDSR-based documentation over Dose Sheets may improve exposure assessment, enhance dose accuracy, and radiation safety practices.