title: Effect of a real-time radiation monitoring device on operator radiation exposure during cardiac catheterization: the radiation reduction during cardiac catheterization using real-time monitoring study.
abstract: BACKGROUND
  The Radiation Reduction During Cardiac Catheterization Using Real-Time Monitoring study sought to examine the effect of a radiation detection device that provides real-time operator dose reporting through auditory feedback (Bleeper Sv; Vertec Scientific Ltd; Berkshire, UK) on patient dose and operator exposure during cardiac catheterization.
  
  
  RESULTS
  Between January 2012 and May 2014, 505 patients undergoing coronary angiography, percutaneous coronary intervention, or both were randomized to use (n=253) or no use (n=252) of the Bleeper Sv radiation monitor. Operator radiation exposure was measured in both groups using a second, silent radiation exposure monitoring device. Mean patient age was 65±8 years, most patients (99%) were men, and 30% had prior coronary artery bypass graft surgery. Baseline clinical characteristics were similar in the 2 study groups. Radial access was used in 18% and chronic total occlusion percutaneous coronary intervention constituted 7% of the total procedures. Median procedure time was 17 (12-27) minutes for diagnostic angiography, 42 (28-70) minutes for percutaneous coronary intervention, and 27 (14-51) minutes in the overall study population, with similar distribution between the study groups. First (9 [4-17] versus 14 [7-25] μSv; P<0.001) and second (5 [2-10] versus 7 [4-14] μSv; P<0.001) operator radiation exposure was significantly lower in the Bleeper Sv group. Use of the device did not result in a significant reduction in patient radiation dose. The effect of the Bleeper Sv device on operator radiation exposure was consistent among various study subgroups.
  
  
  CONCLUSIONS
  Use of a real-time radiation monitoring device that provides auditory feedback can significantly reduce operator radiation exposure during cardiac catheterization.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT01510353.
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Georgios
authors.initials: G
authors.lastname: Christopoulos
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Aristotelis C
authors.initials: AC
authors.lastname: Papayannis
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alomar
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Anna
authors.initials: A
authors.lastname: Kotsia
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Tesfaldet T
authors.initials: TT
authors.lastname: Michael
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Michele
authors.initials: M
authors.lastname: Roesle
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Deborah
authors.initials: D
authors.lastname: Shorrock
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Lorenza
authors.initials: L
authors.lastname: Makke
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Ronald
authors.initials: R
authors.lastname: Layne
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Rebecca
authors.initials: R
authors.lastname: Grabarkewitz
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Donald
authors.initials: D
authors.lastname: Haagen
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Spyros
authors.initials: S
authors.lastname: Maragkoudakis
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Atif
authors.initials: A
authors.lastname: Mohammad
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Karan
authors.initials: K
authors.lastname: Sarode
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Daisha J
authors.initials: DJ
authors.lastname: Cipher
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Charles E
authors.initials: CE
authors.lastname: Chambers
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.).
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: From the Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (G.C., A.C.P., M.A., A.K., T.T.M., B.V.R., M.R., D.S., L.M., R.L., R.G., D.H., A.M., K.S., S.B., E.S.B.); University of Heraklion, Heraklion, Greece (S.M.); Department of Biostatistics, College of Health Innovation, University of Texas at Arlington, Arlington, TX (D.J.C.); and Department of Cardiology, Penn State Hershey Medical Center, Hershey, PA (C.E.C.). esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D001307:Auditory Perception; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D056902:Clinical Alarms; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D004867:Equipment Design; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000209:etiology / Q000517:prevention & control; D016273:Occupational Exposure / Q000517:prevention & control*; D016272:Occupational Health; D011446:Prospective Studies; D011481:Protective Clothing; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011834:Radiation Monitoring / Q000295:instrumentation*; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D013781:Texas; D013997:Time Factors
keywords: cardiac catheterization; quality improvement; radiation