Reduction of radiation delivered to patients undergoing invasive coronary procedures. Effect of a programme for dose reduction based on radiation-protection training

Summary Background Exposure of patients to radiation from invasive cardiac procedures is high and may be deleterious. Aims To assess the effectiveness of a dose-reduction programme based on radiation-protection training, according to the recommendations of the Euratom Council, the International Comm...

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Bibliographic Details
Published in:Archives of cardiovascular diseases 2009-12, Vol.102 (12), p.821-827
Main Authors: Georges, Jean-Louis, Livarek, Bernard, Gibault-Genty, Géraldine, Aziza, Jean-Paul, Hautecoeur, Jean-Louis, Soleille, Henry, Messaoudi, Hela, Annabi, Nizar, Kebsi, Mohammed Al
Format: Article
Language:English
Subjects:
Aged
Angioplastie coronaire
Angioplasty, Balloon, Coronary - adverse effects
Atherosclerosis (general aspects, experimental research)
Biological and medical sciences
Biological effects of radiation
Blood and lymphatic vessels
Cardiology - education
Cardiology. Vascular system
Cardiovascular
Cardiovascular system
Coronarographie
Coronary angiography
Coronary Angiography - adverse effects
Coronary heart disease
Curriculum
Dose area product
Dose-Response Relationship, Radiation
Female
Fluoroscopy - adverse effects
Formation à la radioprotection
Fundamental and applied biological sciences. Psychology
Guideline Adherence
Health Care Surveys
Heart
Humans
Internal Medicine
Investigative techniques, diagnostic techniques (general aspects)
Linear Models
Male
Medical sciences
Middle Aged
Percutaneous coronary intervention
Practice Guidelines as Topic
Produit dose × surface
Program Evaluation
Radiation Dosage
Radiation Injuries - etiology
Radiation Injuries - prevention & control
Radiation Protection
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Radiography, Interventional - adverse effects
Radiology, Interventional - education
Radioprotection
Registries
Risk Assessment
Time Factors
Tissues, organs and organisms biophysics
Training
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Summary:Summary Background Exposure of patients to radiation from invasive cardiac procedures is high and may be deleterious. Aims To assess the effectiveness of a dose-reduction programme based on radiation-protection training, according to the recommendations of the Euratom Council, the International Commission on Radiological Protection and the French Society of Cardiology. Methods In this single-centre survey, dose-area product (DAP, Gy.cm2 ), fluoroscopy time (minutes) and number of runs were evaluated in 3285 consecutive procedures (2077 coronary angiographies [CAs], 1208 percutaneous coronary interventions [PCIs]), performed one year before (2005) and two years after (2006 to 2007) implementation of a programme for radiation dose-reduction. The programme included a 2-day training course in radiological protection for all medical and paramedical staff and recommendations for routine use of low fluoroscopic and acquisition pulse rates (6.25 and 12.5 i/s, respectively), large field size (23 cm), maximal collimation and optimal X-ray tube/patient/detector distances. Routine left ventriculography was discouraged. The radial approach was used in > 80% of the procedures. Results Compared with 2005, a significant 50% reduction in DAP was observed in 2006 and 2007 during CA (median [interquartile range] 53 Gy.cm2 [33–84] vs 26 [16–43] and 21 [14–32], respectively; p < 0.0001) and PCI (125 Gy.cm2 [78–184] vs 49 [31–79] and 44 [27–66], respectively; p < 0.0001). Fluoroscopy time and number of runs did not vary significantly in 2006, and decreased slightly in 2007, likely due to an important reduction in rate of left ventriculographies (from 32 to 4%). Inter-operator variability in DAP was reduced. Conclusion Training in radiation protection for interventional cardiologists and use of simple and cost-free dose-reduction techniques were associated with a 50% reduction in radiation exposure to patients undergoing invasive cardiac procedures, without any loss of diagnostic information.
ISSN:1875-2136
1875-2128
DOI:10.1016/j.acvd.2009.09.007