title: Efficacy of a minicourse in radiation-reducing techniques in invasive cardiology: a multicenter field study.
abstract: OBJECTIVE
  Our goal was to validate an educational 90-min minicourse in lower-irradiating cardiac invasive techniques.
  
  
  BACKGROUND
  Despite comprehensive radiation safety programs, patient radiation exposure in invasive cardiology remains considerable.
  
  
  METHODS
  Before and at a median period of 3.7 months after the minicourse at 32 German cardiac centers, 177 interventionalists consistently documented radiation parameters for 10 coronary angiographies: dose area product (DAP), radiographic and fluoroscopic fractions, fluoroscopy time, and number of radiographic frames and runs.
  
  
  RESULTS
  A total of 154 cardiologists attended the minicourse and achieved significant (p < 0.001) decrease in patients' median overall DAP (-48.4%), from baseline 26.5 to 13.7 Gy × cm(2). They reduced fluoroscopy times (-20.8%), radiographic runs (-9.1%), frames/run (-18.6%) and frames (-29.6%), and both radiographic DAP/frame (-27.4%) and fluoroscopic DAP/s (-39.3%), which indicate improved collimation, reduced-irradiation angulations, or adequate image quality. Dose-related parameters for the remaining 23 invited cardiologists unable to attend the workshop did not change significantly in univariate comparison. Multilevel analysis (p < 0.001) confirmed the efficacy of the minicourse itself (-14.7 Gy × cm(2)) and revealed higher DAP for increasing body mass index (+1.5 Gy × cm(2) per kg/m(2)), male sex (+5.8 Gy × cm(2)), age (+1.5 Gy × cm(2)/decade), and-owing to different settings during image acquisition-for advanced flat-panel detector systems (+9.0 Gy × cm(2)) versus older, traditional image intensifier systems.
  
  
  CONCLUSIONS
  Despite significant required training in radiation safety for all interventional cardiologists, the presented additional 90-min minicourse significantly reduced patient dose.
authors.affiliation: Division of Cardiology, Klinik Fraenkische Schweiz, Ebermannstadt, Germany. Electronic address: eberhard.kuon@klinik-fraenkische-schweiz.de.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Kuon
authors.affiliation: Institute for Community Medicine, Ernst Moritz Arndt University, Greifswald, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Weitmann
authors.affiliation: Institute for Community Medicine, Ernst Moritz Arndt University, Greifswald, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hoffmann
authors.affiliation: Division of Internal Medicine, Ernst Moritz Arndt University, Greifswald, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Dörr
authors.affiliation: Division of Internal Medicine, Ernst Moritz Arndt University, Greifswald, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Reffelmann
authors.affiliation: Division of Internal Medicine, Ernst Moritz Arndt University, Greifswald, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Hummel
authors.affiliation: Division of Internal Medicine, Ernst Moritz Arndt University, Greifswald, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Riad
authors.affiliation: Division of Internal Medicine, Ernst Moritz Arndt University, Greifswald, Germany.
authors.forename: Mathias C
authors.initials: MC
authors.lastname: Busch
authors.affiliation: Division of Internal Medicine, Ernst Moritz Arndt University, Greifswald, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Empen
authors.affiliation: Division of Internal Medicine, Ernst Moritz Arndt University, Greifswald, Germany.
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Felix
mesh_terms: D000368:Aged; D002309:Cardiology / Q000193:education*; D017023:Coronary Angiography / Q000009:adverse effects; D003479:Curriculum; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011835:Radiation Protection; D015642:Radiology, Interventional / Q000193:education*
keywords: coronary angiography; dose reduction; education; invasive cardiology; radiation exposure