Operators slice radiation dose by 48% after workshop

Interventional cardiologists who participated in a 90-minute course that emphasized radiation safety principals reduced patient radiation dose by 48 percent in diagnostic catheterizations. Results from the multicenter study were published online March 19 in the Journal of the American College of Cardiology: Cardiovascular Interventions.

Eberhard Kuon, MD, of the Klinik Fraenkische Schweiz in Ebermannstadt, Germany, and colleagues evaluated the use of ELICIT (Encourage Less-Irradiation Cardiac Intervention Techniques), which had positive results in a single-center pilot study, in a broader setting. Between 2003 and 2009, they enrolled 177 cardiologists from 32 centers in Germany as voluntary participants in the minicourse.

Twenty-three of the 177 cardiologists subsequently chose to not participate but were included in the analysis to study temporal trends.

ELICIT is a free, interactive workshop that focuses on dose-reduction principals. It includes discussion and videos on radiographic runs and frames, consistent collimation, low-level acquisition modes during radiography and fluoroscopy, angulations and other practices. Before the minicourse, operators had access to anonymous but individualized baseline patient exposure results that revealed suboptimal but modifiable practices.

“The minicourse does not primarily intend to instruct, rather it intends to discuss established radiation safety guidelines and to train under practical conditions for consistent collimation (e.g., fluoroscopic intubation into the coronary orifices by collimated ‘buttonhole’ technique), shortened radiographic runs, merely adequate image quality, lower pulse rates, and less-irradiating angulations,” Kuon et al explained. “Each step toward improved radiation safety practice was illustrated by fluoroscopic or radiographic runs.”

Participants’ median patient dose area product for coronary angiography decreased by 48 percent, from 26.5 Gy x cm² at baseline to 13.7 Gy x cm². Participants reduced fluoroscopy times by 21 percent, had shorter and fewer radiographic runs and better collimation. Dose-related parameters for the 23 interventional cardiologists who did not attend the minicourse did not change in the median 3.7 months after the workshop.

“Consistent collimation and merely adequate duration of runs proved to be effective radiation-reducing techniques and are within the reach of every interventionalist,” they wrote.

The researchers also emphasized the benefit of benchmarking performance against peers. “We have learned that it is highly convincing and motivating for an interventional cardiologist to experience competitive comparison of his individual technical performance in daily routine with radiation-reducing interventional benchmarks and various strategies as implemented by thoroughly experienced colleagues at widely-accepted cardiac centers using comparable or identical catheterization systems.”