RT Journal Article SR Electronic T1 Fluoroscopic Sentinel Events in Neuroendovascular Procedures: How to Screen, Prevent, and Address Occurrence JF American Journal of Neuroradiology JO Am. J. Neuroradiol. FD American Society of Neuroradiology SP 1513 OP 1515 DO 10.3174/ajnr.A3185 VO 34 IS 8 A1 A.Z. Vance A1 B.D. Weinberg A1 G.M. Arbique A1 J.B. Guild A1 J.A. Anderson A1 D.P. Chason YR 2013 UL http://www.ajnr.org/content/34/8/1513.abstract AB SUMMARY: Radiation-induced skin injury during fluoroscopic procedures has been recently addressed by The Joint Commission, which defined prolonged fluoroscopy resulting in a cumulative peak skin dose of ≥15 Gy to a single field as a sentinel event (FSE). Neuroendovascular procedures can be associated with a high radiation skin dose and present risks such as potential FSEs. Managing these risks is the responsibility of the interventional neuroradiologist. In this review, we discuss hospital policies needed for screening and preventing FSEs, methods for minimizing radiation-induced skin injury, and actions necessary to address potential FSEs once they have occurred. FSEfluoroscopic sentinel eventFTfluoroscopy timeKa,rreference air kermaPKAkerma-area productRCAroot cause analysisTJCThe Joint Commission