Efficacy of a Minicourse in Radiation-Reducing Techniques in Invasive Cardiology: A Multicenter Field Study

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• 作者：Eberhard Kuon ; MD^&lowast ; ; ^{eberhard.kuon@klinik-fraenkische-schweiz.de" class="auth_mail} ; Kerstin Weitmann ; MSc^&dagger ; ; Wolfgang Hoffmann ; MD^&dagger ; ; Marcus Dö ; rr ; MD^&Dagger ; ; Thorsten Reffelmann ; MD^&Dagger ; ; Astrid Hummel ; MD^&Dagger ; ; Alexander Riad ; MD^&Dagger ; ; Mathias C. Busch ; MD^&Dagger ; ; Klaus Empen ; MD^&Dagger ; ; Stephan B. Felix ; MD^&Dagger ;
• 关键词：coronary angiography ; dose reduction ; education ; invasive cardiology ; radiation exposure
• 刊名：JACC: Cardiovascular Interventions
• 出版年：April, 2014
• 年：2014
• 卷：7
• 期：4
• 页码：382-390
• 全文大小：875 K

文摘

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Objectives

Our goal was to validate an educational 90-min minicourse in lower-irradiating cardiac invasive techniques.

Background

Despite comprehensive radiation safety programs, patient radiation exposure in invasive cardiology remains considerable.

Methods

Before and at a median period of 3.7 months after the minicourse at 32 German cardiac centers, 177 interventionalists consistently documented radiation parameters for 10 coronary angiographies: dose area product (DAP), radiographic and fluoroscopic fractions, fluoroscopy time, and聽number of radiographic frames and runs.

Results

A total of 154 cardiologists attended the minicourse and achieved significant (p < 0.001) decrease in patients' median overall DAP (-48.4%), from baseline 26.5 to 13.7 Gy聽脳 cm². They reduced fluoroscopy times (-20.8%), radiographic runs (-9.1%), frames/run (-18.6%) and frames (-29.6%), and聽both radiographic DAP/frame (-27.4%) and fluoroscopic DAP/s (-39.3%), which indicate improved collimation, reduced-irradiation angulations, or adequate image quality. Dose-related parameters for the remaining 23 invited cardiologists unable to attend the workshop did not change significantly in univariate comparison. Multilevel analysis (p < 0.001) confirmed the efficacy of the minicourse itself (-14.7 Gy聽脳 cm²) and revealed higher DAP for increasing body mass index (+1.5聽Gy聽脳 cm² per kg/m²), male sex (+5.8 Gy聽脳 cm²), age (+1.5 Gy聽脳 cm²/decade), and鈥攐wing to different settings during image acquisition鈥攆or advanced flat-panel detector systems (+9.0 Gy聽脳 cm²) versus older, traditional image intensifier systems.

Conclusions

Despite significant required training in radiation safety for all interventional cardiologists, the presented additional 90-min minicourse significantly reduced patient dose.