Institutional Variability in Patient Radiation Doses ≥5 Gy During Percutaneous Coronary Intervention

Madder, Ryan D.; Dixon, Simon; Seth, Milan; Lee, Daniel; Earl, Thomas; Hill, Thomas C.; Shah, Ibrahim; Gurm, Hitinder S.

doi:10.1016/j.jcin.2019.11.032

Cited by 12 publications

(7 citation statements)

References 14 publications

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“…Of the 48 hospitals that participated in the registry, 33 had on-site cardiac surgery at the onset of the study period, and of these, 28 hospitals routinely collected AK values. Similar to our previously published study, 4 the present analysis was limited to these 28 hospitals having on-site cardiac surgery and that routinely collected AK values. Only those PCI procedures having a procedural AK available in the registry were included in this analysis.…”

Section: Methodsmentioning

confidence: 94%

“…The BMC2 registry is a quality improvement collaborative of all nonfederal hospitals that perform PCI in the state of Michigan whose purpose is to facilitate cross-institutional quality improvement, as described in detail elsewhere. 4,6 Procedural data on all patients undergoing PCI at participating hospitals are collected using the National Cardiovascular Data Registry CathPCI data collection system, with additional data elements collected using the BMC2 website. Baseline data include clinical, demographic, procedural, and angiographic characteristics, as well as pharmacotherapy used before, during, and after the procedure, and in-hospital outcomes.…”

Section: Methodsmentioning

confidence: 99%

“…In December 2019, a survey about radiation safety practices was distributed to catheterization laboratories, and the results of the survey were subsequently shared across the collaborative in February 2020. In April 2020, the results of our initial analysis on procedural radiation doses in PCI were published, 4 and the results were shared with the collaborative. In January 2021, PCI procedural radiation dose was added as a performance metric for all institutions in the collaborative.…”

Section: Methodsmentioning

confidence: 99%

“…Using data from >36 000 PCIs, our group previously reported substantial variability in the institutional frequency of a procedural air kerma (AK) ≥5 Gy, 4 a radiation dose threshold above which patients should be counseled about the risk of a radiation-induced skin injury. 5 In this prior analysis, the frequency of an AK ≥5 Gy ranged from <1% of PCIs at several hospitals to >10% of PCIs at others.…”

mentioning

confidence: 99%

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Statewide Initiative to Reduce Patient Radiation Doses During Percutaneous Coronary Intervention

Madder,

Seth,

Frazier

et al. 2024

Circ: Cardiovascular Interventions

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BACKGROUND: Improved radiation safety practices are needed across hospitals performing percutaneous coronary intervention (PCI). This study was performed to assess the temporal trend in PCI radiation doses concurrent with the conduct of a statewide radiation safety initiative. METHODS: A statewide initiative to reduce PCI radiation doses was conducted in Michigan between 2017 and 2021 and included focused radiation safety education, reporting of institutional radiation doses, and implementation of radiation performance metrics for hospitals. Using data from a large statewide registry, PCI discharges between July 1, 2016, and July 1, 2022, having a procedural air kerma (AK) recorded were analyzed for temporal trends. A multivariable regression analysis was performed to determine whether declines in procedural AK over time were attributable to changes in known predictors of radiation doses. Results: Among 131 619 PCI procedures performed during the study period, a reduction in procedural AK was observed over time, from a median dose of 1.46 (0.86–2.37) Gy in the first year of the study to 0.97 (0.56–1.64) Gy in the last year of the study ( P <0.001). The proportion of cases with an AK ≥5 Gy declined from 4.24% to 0.86% over the same time period ( P <0.0001). After adjusting for variables known to impact radiation doses, a 1-year increase in the date of PCI was associated with a 7.61% (95% CI, 7.38%–7.84%) reduction in procedural AK ( P <0.0001). Conclusions: Concurrent with the conduct of a statewide initiative to reduce procedural radiation doses, a progressive and significant decline in procedural radiation doses was observed among patients undergoing PCI in the state of Michigan.

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Section: Methodsmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Statewide Initiative to Reduce Patient Radiation Doses During Percutaneous Coronary Intervention

Madder,

Seth,

Frazier

et al. 2024

Circ: Cardiovascular Interventions

Self Cite

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“…To determine if the hospital at which the PCI was performed or the physician performing the PCI were independent predictors of ICI optimization, the performing hospital and physician were included as random effects in the hierarchical model, with patients nested within each hospital or under the treating physician. The details of the Bayesian model, which was based on previous published methodology, 14,15 are provided in the Supplemental Material.…”

Section: Discussionmentioning

confidence: 99%

Rates of Intracoronary Imaging Optimization in Contemporary Percutaneous Coronary Intervention: A Report From the BMC2 Registry

Madder

Seth

Sukul

et al. 2022

Circ: Cardiovascular Interventions

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Background: Intracoronary imaging (ICI) during percutaneous coronary intervention (PCI) improves outcomes, yet hospital- and physician-level variabilities in ICI and its impact on ICI use in contemporary PCI remain unknown. This study was performed to evaluate hospital- and physician-level use of ICI to optimize PCI. Methods: Using data from a large statewide registry, patients undergoing PCI between July 2019 and March 2021 were studied. The primary measure of interest was ICI (intravascular ultrasound or optical coherence tomography) optimization during PCI. A fitted hierarchical Bayesian model identified variables independently associated with ICI optimization. The performing hospital and physician were included as random effects in the model. Results: Among 48 872 PCIs, ICI optimization was performed in 8094 (16.6%). Median [interquartile range] hospital- and physician-level frequencies of ICI were 8.8% [3.1%, 16.0%] and 6.1% [1.1%, 25.0%], respectively. Bayesian modeling identified left main PCI (adjusted odds ratio [aOR], 4.41; 95% credible interval [3.82, 5.10]), proximal left anterior descending artery PCI (aOR, 2.28 [2.00, 2.59]), PCI for in-stent restenosis (aOR, 1.55 [1.40, 1.72]), and surgical consult prior to PCI (aOR, 1.21 [1.07, 1.37]) as independent predictors of ICI optimization. The hospital-level median odds ratio, an estimate of the contribution of inter-hospital variability in odds of ICI use, was 3.48 (2.64, 5.04). Physician-level median odds ratio was 3.81 (3.33, 4.45). Conclusions: Substantial hospital- and physician-level variation in ICI was observed. Except for performance of left main PCI, the hospital and physician performing the PCI were more strongly associated with ICI optimization than any patient or procedural factors.

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When, Why, and How to Perform Robotic-Assisted CTO PCI

Hirai

Grantham

2022

Percutaneous Coronary Intervention for Chronic Total Occlusion

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Institutional Variability in Patient Radiation Doses ≥5 Gy During Percutaneous Coronary Intervention

Cited by 12 publications

References 14 publications

Statewide Initiative to Reduce Patient Radiation Doses During Percutaneous Coronary Intervention

Statewide Initiative to Reduce Patient Radiation Doses During Percutaneous Coronary Intervention

Rates of Intracoronary Imaging Optimization in Contemporary Percutaneous Coronary Intervention: A Report From the BMC2 Registry

When, Why, and How to Perform Robotic-Assisted CTO PCI

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