title: The role of quantitative feedback in coronary angiography radiation reduction.
abstract: OBJECTIVE
  To evaluate the benefits of radiation education with and without feedback reporting in altering clinician radiation use behaviour in performing coronary angiography (CA).
  
  
  METHODS
  A retrospective review of radiation use (fluoroscopy time) in coronary angiograms performed between July 1996 and December 2005 by 10 cardiologists to assess the impact of various interventions aimed at minimizing radiation risk. The impact of interventions such as education and audit/feedback was correlated against radiation use using cumulative sum and cumulative expected minus observed charts.
  
  
  METHODS
  Private Hospital in Brisbane, Australia.
  
  
  METHODS
  Ten cardiologists.
  
  
  METHODS
  Education and audit/feedback.
  
  
  RESULTS
  Baseline radiation use subject to standard guidelines was stable. Group performance charts show a modest transient improvement in radiation use associated with an education intervention alone. However, regular detailed personalized feedback comparing an individual's radiation use to group and external benchmarks was successful in achieving sustained reduction in overall radiation use. For individual participants, significant improvement was noted in 7 of 10 cardiologists.
  
  
  CONCLUSIONS
  Although an improved theoretical understanding of effective radiation hygiene strategies might contribute to reduced radiation use, this study suggests that regular detailed quantitative feedback supporting education is an effective tool in altering radiation use in CA. Understanding triggers that stimulate change in clinician behaviour is critical to the design of systems to optimize clinical performance. Confidentially reported benchmarking systems may be a useful tool to alter clinician behaviour.
authors.affiliation: St Andrew's Medical Institute, 457 Wickham Terrace, Spring Hill, Queensland 4000, Australia.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Smith
authors.forename: Kelley A
authors.initials: KA
authors.lastname: Foster
authors.forename: Russell D
authors.initials: RD
authors.lastname: Brighouse
authors.forename: James
authors.initials: J
authors.lastname: Cameron
authors.forename: John T
authors.initials: JT
authors.lastname: Rivers
mesh_terms: D019985:Benchmarking; D002309:Cardiology / Q000193:education; D017023:Coronary Angiography; D005471:Fluoroscopy; D006801:Humans; D008485:Medical Audit; D011829:Radiation Dosage; D011834:Radiation Monitoring; D012189:Retrospective Studies; D013997:Time Factors