Abstract 13377: Predictors of High Operator Radiation Exposure During Cardiac Catheterization: Insights From the Radicure (Radiation Reduction During Cardiac Catheterization Using Real-time Monitoring) Study

Abstract

Background: The RadiCure study examined the impact of real-time radiation monitoring on patient and operator exposure during cardiac catheterization. We sought to identify the factors associated with increased radiation exposure of the first operator. Methods: We studied the baseline clinical characteristics and procedural outcomes of 505 patients that were enrolled in the RadiCure study from January 2012 to May 2014. Multivariable analysis of high (above median or >1.0 mrem) exposure of the first operator was performed. Variables with a significant (p<0.10) association on univariable analysis were included in the multivariable model. Results: Mean age was 65±8 years and most patients were men (99%) with a high prevalence of diabetes mellitus (54%), and prior coronary artery bypass graft surgery (30%). Median procedure time was 27 (14-51) minutes; radial access was used in 18% of cases and chronic total occlusion (CTO) interventions constituted 7% of the procedures. Median fluoroscopy time was 6.2 (2.5-12.5) minutes; median patient Air Kerma (AK) radiation exposure was 0.908 (0.602-1.636) Gray; and median first operator exposure was 1.0 (0.5-2.2) mrem. On multivariable analysis, radial access (Odds ratio [OR] 6.62, 95% Confidence Interval [CI] 3.13-14.76), followed by CTO intervention (OR 5.53, 95% CI 1.73-20.71) and patient AK radiation exposure > 0.9 Gray (OR 4.56, 95% CI 2.32-9.19) were found to be the strongest independent predictors of high first operator exposure. Real-time radiation exposure monitoring and use of a radioabsorbent drape were shown to have a significant protective effect (OR 0.33, 95% CI 0.19-0.57; and OR 0.38, 95% CI 0.18-0.77; respectively) (Figure 1). Conclusions: In the RadiCure study, high patient AK exposure, radial access and CTO intervention were associated with high first operator exposure. Real-time radiation monitoring and use of a radioabsorbent drape were independently associated with lower operator radiation exposure.