Abstract 277: Quality Initiative to Reduce Radiation Exposure and Detect Radiation Injury in the Congenital Cardiac Catheterization Lab

Abstract

Background: The frequency and duration of cardiac catheterization for patients with complex congenital heart disease have increased as a result of the advances in technique and devices available. Increasing catheter interventions require efforts to reduce patient radiation exposure and improve detection of radiation burns. Follow-up protocols based on fluoroscopy time alone are often inadequate as surveillance measures to identify patients that develop radiation burns. Objective: The objective of this study was (1) to reduce the radiation exposure during cardiac catheterization and (2) to improve the quality of post cardiac catheterization radiation surveillance by the development of standardized dose dependent follow-up protocols. Methods: Quality initiatives introduced to reduce radiation exposure from July 2008 - July 2010 included (1) fluoroscopy frame rate reduction from 30 to 15 fps; (2) digital acquisition frame rate reduction from 30 to 15 fps for pts > 65kg; (3) Toshiba system upgrade superior noise reduction filter with high-quality fluoro-record capabilities. Quality initiatives for follow-up surveillance based on radiation exposure included (1) all patients exposed to a dose of ≥ 3000mGy received a letter explaining radiation risks and possible signs of radiation burns, as well as a phone call 1 week post procedure inquiring about possible signs of radiation burns or other skin changes; (2) all patients exposed to a dose of ≥ 6000mGy received 2 additional phone calls at 3 and 6 weeks post procedure; and (3) all patients exposed to a dose of > 9000mGy had a follow-up appointment with a cardiologist 4-6 weeks post procedure with skin assessment for radiation injury. Results: In 2008, there were 519 patients; median radiation exposure was 544 mGy (range 10-31519); median fluoroscopy time was 23 min (range 1-335); radiation burns N=4. In 2009, there were 495 patients; median radiation exposure was 439 mGy (range 0.4-15955); median fluoroscopy time was 24 min (range 0.1-192); radiation burns N=7. In 2010, there were 519 patients; median radiation exposure was 322 mGy (range 1.6-19196); median fluoroscopy time was 24 min (range 0.5-386); radiation burns N=4. In 2011, there were 572 patients; median radiation exposure was 220 mGy (range 1-11108); median fluoroscopy time was 23 min (range 0.3-201); radiation burns N=3. The median patient radiation exposure decreased by over 50% from 2008 to 2011 (p<0.001 ). Fluoroscopy times did not change significantly during the study period (p=0.9). Conclusions: Quality improvement initiatives aimed at reduction of cardiac catheterization radiation exposure and dose dependent follow-up protocols have been effective in reducing the radiation exposure and improving detection of radiation burns in patients with congenital heart disease undergoing cardiac catheterization.