Abstract 170: Improving Radiation Safety in the Cardiac Catheterization Lab

Abstract

Objective: Ionizing radiation, while necessary for cardiac catheterization and angioplasty, is an ever present and often unappreciated safety concern for the patient and operator. Radiation exposure has both deterministic and stochastic effects, with risk estimated by peak Skin Dose and Air kerma Area product . Exposure guidelines have been set for radiation safety (4,000 mGray and 20,000 c Gray cm 2 ). Procedure: The frequency of guideline excessive radiation exposure for cardiac cath lab patients was tracked. Operator, patient, anatomic, procedural variables associated with high radiation exposures were identified and specific interventions to minimize radiation exposure identified. Results: Over a 3 year period 17% of interventions [2011- 220/1,543 (14.3%), 2012- 268/1,420 (18.9%), 2013- 270/1,476 (18.3%)] received excessive skin or total body radiation. In 2013 the average peak skin dose/patient for operators ranged from 1,250 -3,252; the average total area dose/patient ranged from 7,360- 20,988 for operators, with only one operator exceeding 20,000 as an average. Advances in equipment and operator experience have been offset by the increasing disease complexity of attempted interventions. Frequency of excessive radiation by operator ranged from 1.4 - 46% of interventions. Patient risk factors included: obesity, multivessel disease and lesion complexity, highly angled views, number, length, and frame rate of cine and fluoroscopy runs. Specific interventions that decreased the frequency of excess radiation administered included: increasing operator feedback and awareness of radiation used, shortening cine runs, decreased frame rate for fluoroscopy and cine, staging procedures, increase use of stored images and mapping capabilities. Physicians adopting safer radiation practices decreased excess radiation cases from 15.8% [35/222] in 2012 to 8.0% [18/224] in 2013. The default settings of X-Ray equipment have been modified to encourage safe and appropriate use of radiation in the cardiac catheterization lab (however, physician overide of settings is still possible). Conclusions: Patient factors (e.g. obesity, prior CABG) and complex, multivessel interventions are potentially frequently associated with excess radiation. Changing default settings and implementing radiation safety practices can significantly decrease radiation exposure to patients and staff.