title: Multicenter long-term validation of a minicourse in radiation-reducing techniques in the catheterization laboratory.
abstract: Patient radiation exposure in invasive cardiology is considerable. We aimed to investigate, in a multicenter field study, the long-term efficacy of an educational 90-minute workshop in cardiac invasive techniques with reduced irradiation. Before and at a median period of 2.5 months and 2.0 years after the minicourse (periods I, II, and III, respectively) at 5 German cardiac centers, 18 interventionalists documented various radiation parameters for 10 coronary angiographies. The median patient dose area product (DAP) for periods I, II, and III amounted to 26.6, 12.2, and 9.6 Gy × cm(2), respectively. The short-term and long-term effects were related to shorter median fluoroscopy times (180, 138, and 114 seconds), fewer radiographic frames (745, 553, and 417) because of fewer (11, 11, and 10) and shorter (64, 52, and 44 frames/run) runs, consistent collimation, and restriction to an adequate image quality; both radiographic DAP/frame (27.7, 17.3, and 18.4 mGy × cm(2)) and fluoroscopic DAP/second (26.6, 12.9, and 14.9 mGy × cm(2)) decreased significantly. Multivariate analysis over time indicated increasing efficacy of the minicourse itself (-55% and -64%) and minor influence of interventionist experience (-4% and -3% per 1,000 coronary angiographies, performed lifelong until the minicourse and until period III). In conclusion, autonomous self-surveillance of various dose parameters and feedback on individual radiation safety efforts supported the efficacy of a 90-minute course program toward long-lasting and ongoing patient dose reduction.
authors.affiliation: Department 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, University of Greifswald, Greifswald, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Weitmann
authors.affiliation: Institute for Community Medicine, University of Greifswald, Greifswald, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hoffmann
authors.affiliation: Department of Internal Medicine, University Medicine, Greifswald, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Dörr
authors.affiliation: Department of Internal Medicine, University Medicine, Greifswald, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Hummel
authors.affiliation: Department of Internal Medicine, University Medicine, Greifswald, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Riad
authors.affiliation: Department of Internal Medicine, University Medicine, Greifswald, Germany.
authors.forename: Mathias C
authors.initials: MC
authors.lastname: Busch
authors.affiliation: Department of Internal Medicine, University Medicine, Greifswald, Germany.
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Felix
authors.affiliation: Department of Internal Medicine, University Medicine, Greifswald, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Empen
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002309:Cardiology / Q000193:education*; D017023:Coronary Angiography / Q000009:adverse effects*; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000517:prevention & control*; D011835:Radiation Protection / Q000379:methods*; D011874:Radiometry