title: Increased fluoroscopy time for central venous catheter placement by radiology residents versus staff radiologists.
abstract: OBJECTIVE
  To evaluate differences in interventional radiology procedural fluoroscopy time (FT) for radiology residents versus staff radiologists, using central venous catheter (CVC) placement as an index service.
  
  
  METHODS
  To minimize interservice and complexity variables, stand-alone temporary internal jugular CVC procedures were targeted for analysis. Reports and images from 1,067 temporary CVC services from 2 hospitals over 2 years were reviewed as part of a quality improvement initiative. Insertion site, catheter type (eg, smaller triple lumen versus larger hemodialysis), resident identifier, staff identifier, and documented FT were compiled and analyzed.
  
  
  RESULTS
  Applying clinical (eg, concomitant venous angioplasty) and anatomic (eg, femoral access) exclusions, 537 cases with complete CVC procedure records were available for analysis. Radiology residents and staff radiologists were primary operators in 128 and 409 procedures, respectively. Distribution of resident procedures (82% right, 66% large lumen) was similar to that of staff (79% right, 63% large lumen). Mean FT of resident services was twice as long as that of staff services (1.24 minutes versus 0.63 minutes, P < .0001). Resident FT was independent of supervising staff radiologist. Increasing years of training for residents did not significantly reduce FT.
  
  
  CONCLUSIONS
  When CVCs are placed by radiology residents, FT is double that for identical procedures performed by staff radiologists. Similar discrepancies likely exist for other interventional radiologic procedures. Residency training programs should initiate measures to monitor and manage fluoroscopy during interventional procedures to minimize radiation dose to patients, trainees, and other staff.
authors.affiliation: University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. bxu5@uthsc.edu
authors.forename: Baogang J
authors.initials: BJ
authors.lastname: Xu
authors.forename: Richard
authors.initials: R
authors.lastname: Duszak
authors.forename: Robert S
authors.initials: RS
authors.lastname: McGinnis
authors.forename: John G
authors.initials: JG
authors.lastname: Stanfill
authors.forename: Jeff
authors.initials: J
authors.lastname: O'Rear
authors.forename: Angel Q
authors.initials: AQ
authors.lastname: An
mesh_terms: D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D004522:Educational Status; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D061646:Operative Time; D011361:Professional Competence / Q000706:statistics & numerical data*; D015641:Radiography, Interventional / Q000706:statistics & numerical data*; D011871:Radiology / Q000706:statistics & numerical data*; D013714:Tennessee / Q000453:epidemiology