Abstract 8717: A Significant Reduction in Air Kerma with A Simple Radiation Quality Initiative
Background: Minimizing exposure to ionizing radiation in the cardiac catheterization laboratory reduces the risk of both deterministic and stochastic injury to patients as well as lab personnel. We hypothesize that a Radiation Quality Improvement (RQI) program of education and feedback could modify operator behavior to decrease radiation use.
Methods: We performed a single center prospective registry from March 2010 to March 2011 incorporating all consecutive coronary diagnostic and interventional procedures. Both air kerma (AK) and fluoroscopic time (FT) values were documented. RQI consisted of mandatory physician training of all staff and operators with 2 follow up educational sessions. Intervention included a mandatory warning system for excessive FT (>25min) during procedures as well as regular e-mail tips on c-arm settings associated with lower radiation use. Feedback tools were developed to provide quarterly individual operator FT and AK. We compared the use of radiation in the 4 month period before and the 6 month period after RQI.
Results: A total of 1,838 patients were enrolled across 9 PCI operators. Pre-RQI (N=704) and Post-RQI (N=1,134) procedures were similar in terms of indication, clinical characteristics, level of urgency and operator representation. FT per case was similar pre and post RQI: 9.98±0.70 min vs. 10.48±0.53 min; p=0.26. There was a significant decrease in the average AK per case (1652±116 mGy vs. 1515±78 mGy, p=0.047). There was heterogeneity in the response to our intervention amongst the operators (p=0.001 for the interaction) but no heterogeneity in response based on diagnostic versus interventional cases.
Conclusions: Radiation quality improvement is feasible and an intervention consisting of physician/staff education and rapid individualized feedback significantly reduces the use of radiation in the cardiac catheterization laboratory. This simple intervention has potential to improve patient and lab personnel safety.
- © 2011 by American Heart Association, Inc.