Donald L. Miller

Objective. To develop and evaluate a physics-informed machine-learning framework for rapid organ-dose estimation in fluoroscopically guided interventional procedures without requiring patient-specific imaging. Approach. We used 385 adult radiation dose structured reports (RDSRs) from three procedure types—bilateral carotid angiography, percutaneous biliary drainage, and liver chemoembolization—comprising more than 50 000 irradiation events. A body-size-matched computational phantom was selected using patient sex, height, and weight. RDSR-derived beam parameters and engineered descriptors of beam-organ geometry and attenuation were used to train organ-specific XGBoost models for localized organs and a multi-output multilayer perceptron model for four distributed tissues. Monte Carlo (MC)-derived dose coefficients from NCIRF3 were used as target values. Main results. In the held-out test set of 12 683 irradiation events, 49.4% and 84.8% of XGBoost-based localized-organ estimates were within ±5% and ±20% of the MC-derived values, respectively. The corresponding proportions were 88.2% and 98.0% for the distributed-tissue estimates and 87.6% and 98.3% for detriment-weighted dose. The median relative prediction error across organs and tissues was 0.37% (interquartile range, −3.68% to 4.99%). A reliability score was developed to support uncertainty-aware interpretation. The framework required approximately 0.3 s per irradiation event, corresponding to an approximately 290-fold acceleration relative to conventional MC simulation under the benchmark conditions. Significance. The proposed image-free framework enables rapid organ-dose estimation when patient imaging is unavailable and may support large retrospective epidemiological studies and uncertainty-aware dose monitoring. Because development and validation were limited to three procedure types and relied on reconstructed phantom-beam geometry, external validation is required before application to other procedures or high-precision individual clinical decisions.

Purpose: Since the initial edition of this Guideline was published in 2010, it has become increasingly clear that occupational protection involves more than just radiation protection. Additionally, radiation exposure to operators and staff occurs from sources other than fluoroscopy. This Guideline has been updated to incorporate these topics and to reflect new information on occupational protection in interventional radiology. Methods: The CIRSE Standards of Practice Committee, in conjunction with SIR, established a writing panel of twelve clinicians, medical physics experts, and others with internationally recognised expertise in occupational protection in interventional radiology. The writing panel identified regulations, guidelines, and radiation protection documents from international and national sources, including governments, radiation protection organizations, and professional associations. Additionally, the writing panel performed a pragmatic search on PubMed for relevant studies published in English between 2011 and 2025. The final recommendations were developed by consensus. Results: The revised Guideline provides advice and guidance to physicians, radiographers, nurses, medical physics experts, and all other staff involved in interventional radiology. It also includes an online-only Annex with additional, in-depth coverage of several of the included topics.

National Council on Radiation Protection and Measurements Commentary No. 33 ‘Recommendations for Stratification of Equipment Use and Radiation Safety Training for Fluoroscopy’ defines an evidence-based, radiation risk classification for fluoroscopically guided procedures (FGPs), provides radiation-related recommendations for the types of fluoroscopes suitable for each class of procedure, and indicates the extent and content of training that ought to be provided to different categories of facility staff who might enter a room where fluoroscopy is or may be performed. For FGP, radiation risk is defined by the type and likelihood of radiation hazards that could be incurred by a patient undergoing a FGP. The Commentary also defines six training groups of facility staff based on their role in the fluoroscopy room. The training groups are based on a combination of job descriptions and the procedures in which these individuals might be involved. The Commentary recommends the extent and content of training that should be provided to each of these training groups. It also provides recommendations on training formats, training frequency, and methods for demonstrating that the learner has acquired the necessary knowledge.

The U.S. Food and Drug Administration (FDA) has been concerned with minimizing the unnecessary radiation exposure of people for half a century. Manufacturers of medical X-ray imaging devices are important partners in this effort. Medical X-ray imaging devices are regulated by FDA under both its electronic product regulations andits medical device regulations. FDA also publishes guidance documents that represent FDA’s current thinking on a topic and provide a suggested or recommended approach to meet the requirements of a regulation or statute. FDA encourages manufacturers to develop medical devices that conform to voluntary consensus standards. Use of these standards is a central element of FDA’s system to ensure that all medical devices marketed in the U.S. meet safety and effectiveness requirements. FDA staff participate actively in the development and maintenance of these standards, often advancing or introducing new safety and dose management requirements. Use of voluntary consensus standards reduces the amount of time necessary to evaluate a premarket submission and reduces the burden on manufacturers. FDA interacts with industry and other stakeholders through meetings with industry groups, public meetings, public communications, and through the development of voluntary consensus standards. In these interactions, FDA staff introduce new concepts for improving the safety of these devices and provide support for similar initiatives from professional organizations. FDA works with all stakeholders to achieve its mission of protecting and promoting the public health.

In contrast to the six-fold rise in medical radiation exposure that occurred from 1980 to 2006 in the United States, per capita radiation exposure to the population decreased by 20% between 2006 an... Background Comprehensive assessments of the frequency and associated doses from radiologic and nuclear medicine procedures are rarely conducted. The use of these procedures and the population-based...