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Minimizing radiation in the cardiac cath lab reduces the risk to patients and lab personnel. We hypothesize that a Radiation Quality Improvement (RQI) program of education and feedback could modify operator behavior to decrease radiation.
We performed a single center prospective registry from March 2010 to October 2012 incorporating all coronary procedures. Air kerma (AK) and fluoro time (FT) values were documented. RQI consisted of training of all staff in radiation use, including using low fluoro settings, minimizing use of cine, and improving image intensifier positioning and source-image distance. There were serial group feedback and quarterly operator FT and AK reviews. Radiation use in the 4 months before and Year 1 as well as Year 2 after the RQI was compared.
There were a total of 6,081 patients across 9 PCI operators. Pre- (N=690) and Post-RQI (N=5,391) procedures were similar. There was no significant change in the FT across the registry period. However, there was a significant decrease in the AK per case (1660±116 mGy vs. 1427±78 mGy, p<0.001) in the Year 1 after the RQI. Moreover, further improvement in AK occurred in the Year 2 after the initial RQI program (p=0.01).
RQI is feasible; an intervention consisting of staff education and individualized feedback significantly reduces radiation. This simple intervention has potential to improve safety. The effects of continuous feedback are durable and continue to enhance safety late after the initial intervention.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: PCI: Outcomes, Adherence and Appropriateness
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1288-105
- 2013 American College of Cardiology Foundation