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 Röntgenstr 2015; 187: 899 – 905

Zusammenfassung

Ziel: Die Strahlenexposition in der invasiven Kardiologie ist erheblich. Wir untersuchten die Akzeptanz von Strahlenschutzvorrichtungen und den Einfluss von Erfahrung, Teamleitung und technischer Ausstattung auf die Strahlenschutzbemühungen im klinischen Alltag.

Material und Methoden: 115 Kardiologen (27 Zentren) beantworteten einen Fragebogen und erhoben multiple Dosisparameter im Verlauf von 10 Koronarangiografien (KA) vor und 3,1 Monate nach einem 90-min. Kurs in strahlenreduzierenden Techniken.

Ergebnisse: Die Kursteilnehmer erzielten signifikante mediane Absenkungen des Dosisflächenprodukts (DFP: von 26,6 auf 13,0 Gy × cm²), der Bilder- (– 29 %) und Serienanzahl (– 18 %), des radiografischen DFP/Bild (– 32 %), des fluoroskopischen DFP/Sek. (– 39 %) und der Durchleuchtungszeit (– 16 %). Die Mehrebenen-Analyse ergab niedrigere DFPs mit sinkendem Körpergewichtsindex (– 1,4 Gy × cm² per kg/m²) und Alter (– 1,2 Gy × cm²/10 J.), für weibliches Geschlecht (– 5,9 Gy × cm²), Kursteilnahme der Kardiologen (– 16,1 Gy × cm²) und zusätzlich (– 9,4 Gy × cm²) des Teamleiters, für interventionelle Erfahrung (– 0,7 Gy × cm²/1000 KA) sowie ältere konventionelle Katheteranlagen (– 6,6 Gy × cm²). Strahlenschutzmittel wurden in folgender Häufigkeit verwendet: Mantel (100 %), Scheibe (95 %), Untertischlamellen längs/quer (94 %/69 %), Schilddrüsenschutz (89 %), Brille (28 %), Patienten-Oberschenkelabdeckung (19 %), Fußschalterabdeckung (7 %), Handschuhe (3 %) und Helm (1 %).

Schlussfolgerung: Strahlenschutzmaßnahmen werden in der täglichen Routine unzureichend umgesetzt. Kardiologen unterschiedlichsten Erfahrungsstandes profitierten von unserem Strahlenschutzkurs, vor allem im Falle der Kursteilnahme des Teamleiters.

Kernaussagen:

• Strahlenschutzmaßnahmen sind in der invasiven Kardiologie unteroptimal umgesetzt.

• Der vorgestellte Strahlenschutz-Minikurs erwies sich als hocheffizient.

• Kardiologen unterschiedlichsten Erfahrungsstandes profitierten von ihm: erheblich mehr im Falle einer Teilnahme des Teamleiters.

• Interventionelle Erfahrung spielte eine untergeordnete Rolle für die erzielte Dosisreduktion.

• Daher sollten Auszubildende wie auch erfahrene Kollegen durch Kursangebote zu eigenverantwortlichem Strahlenschutz ermutigt werden.

Key words

radiation safety - heart - coronary angiography - efficacy studies - education - QA/QC

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