Cath Lab Changes Cut Radiation Exposure (CME/CE)

By Crystal Phend, Senior , MedPage TodayPublished: August 21, 2012Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

The cardiac catheterization laboratory can achieve massive reductions in radiation exposure for patients and staff through changes to protocols and culture, a single-center’s experience showed.

Such changes dropped the mean radiation exposure of patients by 40% over a 3-year period, from a cumulative skin dose of 969 mGy to 568 mGy across interventional procedures, Kenneth A. Fetterly, PhD, of the Mayo Clinic in Rochester, Minn., and colleagues found.

Radiation scatter to cath lab staff, which is directly proportional to patient dose, likely fell by a similar degree, the group reported in the August issue of JACC: Cardiovascular Interventions.

“This work demonstrates that a philosophy of radiation safety, implemented through a collection of sustained practice and x-ray system changes, can result in a significant decrease in the radiation dose administered to patients,” they wrote.

“Although the patient dose associated with invasive cardiovascular procedures is below the level that is known to be associated with elevated cancer risk, it is assumed that even low levels of radiation have a proportionate risk and that dose should be minimized as much as possible,” they said.

Progressive changes carried out at the Mayo Clinic from 2008 to 2010 for radiation safety included:

Establishment of a multi-disciplinary cath lab radiation safety committee Radiation dose announcements during the procedure at 3,000 mGy intervals to elevate awareness and minimize high-dose procedures Putting the radiation dose in the final report of the procedure Compulsory fellows training on x-ray imaging and radiation safety Standardized x-ray protocols Increased spectral filtration for acquisition imaging Setting the default fluoroscopy program to low Fluoroscopy frame rate reduced to 7.5 frames per second Reduced acquisition detector target dose

The culture of the cath lab also had to change, the researchers noted.

“To reduce patient radiation dose requires that the physician’s expectations change from a desire for excellent image quality to a desire for low radiation dose and acceptance of clinically adequate image quality,” Fetterly’s group noted.

Over the 3-year period, the cumulative skin dose — calculated directly from numbers reported by the x-ray system — fell 41% for percutaneous coronary interventions, 34% for structural heart procedures, and 53% for vascular angiographic and interventional procedures.

That resulted from a reduction in both image acquisition radiation dose to the skin by 46% and in fluoroscopy skin dose by 33%.

Altogether, the proportion of the 18,115 procedures done that had a cumulative skin dose exceeding the high-dose threshold of 6,000 mGy dropped from 0.33% in the first year of the intervention to 0.13% in the third year.

“This reduction was accomplished in a clinical environment with several x-ray systems, 27 doctor operators, and 65 fellows-in-training while performing a wide variety of cardiovascular procedures,” the researchers noted.

Of the 21 doctors who practiced in the cath lab across the entire study period, all but two cut their patient radiation dose in the range 22% to 69%. The other two increased patient radiation dose by 6% and 33%, respectively.

The researchers noted massive interpatient and interprocedure variability in radiation dose that would tend to mask changes.

The study could not determine the absolute effect of any single change among the many instituted during the 3-year period, nor did it estimate the impact on lower dose for individual patients.

Fetterly reported no conflicts of interest.

joined MedPage Today in 2006 after roaming conference halls for publications including The Medical Post, Oncology Times, Doctor’s Guide, and the journal IDrugs. When not covering medical meetings, she writes from Silicon Valley, just south of the San Francisco fog.

Related News:

• AHA: HDL Boosters Still Promising (CME/CE)
• AHA: Chelation Tx in Post-MI Not Ready Yet (CME/CE)
• Novel Drug Helps Statins Cut Cholesterol (CME/CE)
• Psoriasis Drug Eases Refractory Crohn’s Disease (CME/CE)
• Mom’s Depression Slows Baby’s Development (CME/CE)
• Genes Point to Risk of Finger Disease (CME/CE)
• CJD Dementia Diagnosis Often Delayed (CME/CE)
• CJD Dementia Diagnosis Often Delayed (CME/CE)
• DNA Not Enough to Target HPV as Cancer Culprit (CME/CE)
• DNA Not Enough to Target HPV as Cancer Culprit (CME/CE)

Details :
Submited at Wednesday, August 22nd, 2012 at 12:15 am on Uncategorized by admin
Comment RSS 2.0 - leave a comment - trackback