Figure 7.1: accessible version
Published 4 August 2021
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Flow diagram showing how cumulative air kerma (CAK) can be used as a reference level to anticipate skin damage.
1. Pre-procedure – has patient undergone fluoroscopically guided procedure within 14 days?
Yes
Check for any sign of skin injury. If found, try to keep this area out of the primary beam – go to question 2.
No
Go to question 2.
2. During procedure – does CAK (skin dose) reading reach 2,000 mGy?
Yes
Radiographer to alert the operator. Operator to consider if a change of beam entry area / projection is possible to spare patient skin dose – go to question 3.
No
No further action.
3. At end of procedure – is final CAK (skin dose) > 3,000 mGy?
Yes
Go to question 4.
No
No further action.
4. At end of procedure – is final CAK (skin dose) between 3,000 and 5,000 mGy?
Yes
Issue ‘Low dose’ peak skin dose (PSD) pack. Clinician to sign skin dose advice form and discuss the dose with the patient. The form should be placed in the patient’s notes. Radiographer to record issuing of PSD pack.
No
Issue ‘Moderate dose’ PSD pack. Clinician to sign skin dose advice form and discuss the dose with the patient. The form should be placed in the patient’s notes. Radiographer to record issuing of PSD pack.