Role of Experience, Leadership and Individual Protection in the Cath Lab – A Multicenter Questionnaire and Workshop on Radiation Safety

Abstract

Purpose: Radiation exposure in invasive cardiology remains considerable. We evaluated the acceptance of radiation protective devices and the role of operator experience, team leadership, and technical equipment in radiation safety efforts in the clinical routine. Materials and Methods: Cardiologists (115 from 27 centers) answered a questionnaire and documented radiation parameters for 10 coronary angiographies (CA), before and 3.1 months after a 90-min. mini-course in radiation-reducing techniques. Results: Mini-course participants achieved significant median decreases in patient dose area products (DAP: from 26.6 to 13.0?Gy???cm2), number of radiographic frames (??29?%) and runs (??18?%), radiographic DAP/frame (??32?%), fluoroscopic DAP/s (??39?%), and fluoroscopy time (??16?%). Multilevel analysis revealed lower DAPs with decreasing body mass index (??1.4?Gy???cm2 per kg/m2), age (??1.2?Gy???cm2/decade), female sex (??5.9?Gy???cm2), participation of the team leader (??9.4?Gy???cm2), the mini-course itself (??16.1?Gy???cm2), experience (??0.7?Gy???cm2/1000 CAs throughout the interventionalist?s professional life), and use of older catheterization systems (??6.6?Gy???cm2). Lead protection included apron (100?%), glass sheet (95?%), lengthwise (94?%) and crosswise (69?%) undercouch sheet, collar (89?%), glasses (28?%), cover around the patients? thighs (19?%), foot switch shield (7?%), gloves (3?%), and cap (1?%). Conclusion: Radiation-protection devices are employed less than optimally in the clinical routine. Cardiologists with a great variety of interventional experience profited from our radiation safety workshop ? to an even greater extent if the interventional team leader also participated. Key Points: ??Radiation protection devices are employed less than optimally in invasive cardiology. ??The presented radiation-safety mini-course was highly efficient. ??Cardiologists at all levels of experience profited from the mini-course ? considerably more so if the team leader also took part. ??Interventional experience was less relevant for radiation reduction. ??Consequently both fellows and trainers should be encouraged to practice autonomy in radiation safety. Citation Format: ??Kuon E, Weitmann K, Hoffmann W et?al. Role of Experience, Leadership and Individual Protection in the Cath Lab ? A Multicenter Questionnaire and Workshop on Radiation Safety. Fortschr R?ntgenstr 2015; 187: 899???905

Long-term strategies support autonomy in radiation safety in invasive cardiology

“…The participating cardiologists achieved considerable and ongoing decreases of DAP from CA by À55% and À64% at a median period of 2.5 months after and 2.0 years after the course, respectively [17]. Multivariate analysis of the short-term results of the program revealed lower DAPs from CA (median baseline level: 26.6 Gy cm 2 ) with decreasing body mass index (À1.4 Gy cm 2 per kg/m 2 ), age (À1.2 Gy cm 2 /decade), female sex (À5.9 Gy cm 2 ), participation of the team leader (À9.4 Gy cm 2 ), the minicourse itself (À16.1 Gy cm 2 ), increasing operator experience (À0.7 Gy cm 2 / 1000 CAs performed in the course of a professional life), and use of older image intensifier catheterization systems (À6.6 Gy cm 2 ) [18]. The reason behind higher patient doses with advanced flat-panel systems, however, cannot lie in their improved technology, but in a tendency to preselected higher pulsing and dose intensities during radiography: at least in current clinical practice [16,17].…”

Radiation protection for surgeons and anesthetists: practices and knowledge before and after training

“…There is a need to strengthen RP awareness in medical staff. This mostly concerns the attitude of team leaders who serve as role models for their staff [5]. The study results show the need to modify the training strategy regarding RP: regular and more easily accessible computer training with a self-assessment questionnaire, promoting access to lead glasses and installation of collective protective equipment in OR.…”

“…As regards the European directive Euratom, professionals exposed to ionizing radiation, such as operating room (OR) doctors, must be trained in RP [4]. Not only is training beneficial for optimizing the use of x-ray machines [5], but it promotes awareness of ionizing radiation hazards among staff. Moreover, analysis of workstations (evaluation of the projected dosimetry of workers which determines occupational categorization) and the use of dosimeters (passive and electronic) in areas exposed to ionizing radiation are mandatory and require coordination between the Occupational Health Department, RP technical advisors and employers.…”

Die kardiale Resynchronisationstherapie (CRT)

“…Da die IRCP die im medizinischen Strahlenschutz wichtigsten Grundsätze der Rechtfertigung und Optimierung der Strahlenanwendung vorgibt, ist danach zu streben, bei jeder CRT-Implantation alle Maßnahmen zu treffen, die zu einer Dosisreduktion führen, ohne die Behandlung negativ zu beeinflussen. [11], [12], [13], [14].…”