Reduction of radiation delivered to patients undergoing invasive coronary procedures. Effect of a programme for dose reduction based on radiation-protection training.
BACKGROUND
Exposure of patients to radiation from invasive cardiac procedures is high and may be deleterious.


OBJECTIVE
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.cm(2)), 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 (23cm), 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.cm(2) [33-84] vs 26 [16-43] and 21 [14-32], respectively; p<0.0001) and PCI (125 Gy.cm(2) [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.


CONCLUSIONS
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.
Georges
Jean-Louis
JL
Service de cardiologie, centre hospitalier de Versailles, hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France. jgeorges@ch-versailles.fr
Livarek
Bernard
B
Gibault-Genty
Géraldine
G
Aziza
Jean-Paul
JP
Hautecoeur
Jean-Louis
JL
Soleille
Henry
H
Messaoudi
Hela
H
Annabi
Nizar
N
Kebsi
Mohammed Al
MA
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D002309:Cardiology / Q000193:education*; D017023:Coronary Angiography / Q000009:adverse effects*; D003479:Curriculum; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011835:Radiation Protection; D015641:Radiography, Interventional / Q000009:adverse effects*; D015642:Radiology, Interventional / Q000193:education*; D012042:Registries; D018570:Risk Assessment; D013997:Time Factors