Abstract 19818: Improving Radiation Safety in the Cardiac Catheterization Laboratory - a Quality Improvement Initiative
Introduction: Cardiovascular imaging and interventions account for 40% of total medical radiation exposure (excluding radiation therapy). Exposure to ionizing radiation may cause skin injuries or increased risk of cancer and genetic defects.
Hypothesis: Changing fluoroscopy defaults to low dose and low frame rate, while maintaining the option to use higher settings when needed, would decrease average patient radiation dose during cardiac catheterization without compromising procedural success.
Methods: In 5/2013 we changed fluoroscopy defaults in 1 of 4 cardiac catheterization laboratories to lower dose (600 nGy/sec from 660 nGy/sec to the detector), lower frame rate (7.5 frames/sec from 15 frames/sec) and lower maximum patient exposure (5 Rad/min from 10 Rad/min). We recorded the air kerma (AK) in mGy/case for 719 coronary angiograms (448 pre, 271 post intervention) and 730 coronary interventions (451 pre, 279 post intervention) performed in this laboratory from 6/12-12/13. We used statistical process control analysis to evaluate changes in average monthly AK and to assess for statistical significance.
Results: Following fluoroscopy default changes, average AK/case decreased by 21.2% for coronary angiograms (1282.1 ± 857.7 pre vs 1010.9 ± 846.4 post) and by 17.7% for coronary interventions (2858.6 ± 1802.9 pre vs 2353.6 ± 1210 post). After 5/13 there was a significant reduction in average monthly AK with a value below the 3 sigma line in 10/13 for coronary angiograms, and 2 consecutive values below the 2 sigma line in 11/13 and 12/13 for coronary interventions. There were no temporal changes in the incidence of adverse outcomes for interventions.
Conclusions: Utilizing low fluoroscopy dose and frame rate defaults can significantly decrease exposure to ionizing radiation for patients undergoing cardiac catheterizations without affecting procedural success.
- Cardiovascular imaging
- Heart catheterization
- Interventional cardiology
- Patient safety
- Quality improvement
Author Disclosures: A.M. Robert: None. J.T. DeVries: None. J.E. Jayne: None. J.B. Weaver: None. S.M. Conley: None. W.C. Burke: None. D.F. Guadagni: None. A.V. Kaplan: None. B.D. Hettleman: None. B.J. Friedman: None. N.W. Niles: None. J.F. Robb: None. D.J. Malenka: None.
- © 2014 by American Heart Association, Inc.