Radiation safety in the cardiac catheterization lab: a time series quality improvement initiative

• Published in: Cardiovascular revascularization medicine 2017-07, Vol.18 (5), p.S22-S26
• Main Authors: Abuzeid, Wael, Abunassar, Joseph, Leis, Jerome A, Tang, Vicky, Wong, Brian, Ko, Dennis T, Wijeysundera, Harindra C
• Format: Article
• Language: English
• Subjects: Cardiac catheterization; Cardiac Catheterization - adverse effects; Cardiac Catheterization - methods; Cardiovascular; Coronary Angiography - methods; Humans; Occupational Exposure - prevention & control; Patient Safety; Percutaneous Coronary Intervention - methods; Quality Improvement; Radiation Exposure - prevention & control; Radiation Injuries - etiology; Radiation Monitoring - methods; Radiation safety; Radiography, Interventional - adverse effects; Risk Assessment
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2017.04.009

Abstract Background Interventional cardiologists have one of the highest annual radiation exposures yet systems of care that promote radiation safety in cardiac catheterization labs are lacking. This study sought to reduce the frequency of radiation exposure, for PCI procedures, above 1.5 Gy in labs utilizing a Phillips system at our local institution by 40%, over a 12-month period. Methods We performed a time series study to assess the impact of different interventions on the frequency of radiation exposure above 1.5 Gy . Process measures were percent of procedures where collimation and magnification were used and percent of completion of online educational modules. Balancing measures were the mean number of cases performed and mean fluoroscopy time. Interventions Information sessions, online modules, policies and posters were implemented followed by the introduction of a new lab with a novel software ( AlluraClarity © ) to reduce radiation dose. Results There was a significant reduction (91%, p < 0.05) in the frequency of radiation exposure above 1.5 Gy after utilizing a novel software ( AlluraClarity © ) in a new Phillips lab. Process measures of use of collimation (95.0% to 98.0%), use of magnification (20.0% to 14.0%) and completion of online modules (62%) helped track implementation. The mean number of cases performed and mean fluoroscopy time did not change significantly. Conclusion While educational strategies had limited impact on reducing radiation exposure, implementing a novel software system provided the most effective means of reducing radiation exposure.