Author + information
- Received February 15, 2012
- Revision received April 20, 2012
- Accepted May 7, 2012
- Published online August 1, 2012.
- Kenneth A. Fetterly, PhD⁎,⁎ (, )
- Verghese Mathew, MD⁎,
- Ryan Lennon, MSc†,
- Malcolm R. Bell, MD⁎,
- David R. Holmes Jr, MD⁎ and
- Charanjit S. Rihal, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Kenneth A. Fetterly, Mayo Clinic, 200 1st Street SW, Rochester, Minnesota 55905
Objectives This paper investigates the effects of sustained practice and x-ray system technical changes on the radiation dose administered to adult patients during invasive cardiovascular procedures.
Background It is desirable to reduce radiation dose associated with medical imaging to minimize the risk of adverse radiation effects to both patients and staff. Several clinical practice and technical changes to elevate radiation awareness and reduce patient radiation dose were implemented under the guidance of a cardiovascular invasive labs radiation safety committee. Practice changes included: intraprocedure radiation dose announcements; reporting of procedures for which the air-kerma exceeded 6,000 mGy, including procedure air-kerma in the clinical report; and establishing compulsory radiation safety training for fellows. Technical changes included establishing standard x-ray imaging protocols, increased use of x-ray beam spectral filters, reducing the detector target dose for fluoroscopy and acquisition imaging, and reducing the fluoroscopy frame rate to 7.5 s−1.
Methods Patient- and procedure-specific cumulative skin dose was calculated from air-kerma values and evaluated retrospectively over a period of 3 years. Data were categorized to include all procedures, percutaneous coronary interventions, coronary angiography, noncardiac vascular angiography and interventions, and interventions to treat structural heart disease. Statistical analysis was based on a comparison of the cumulative skin dose for procedures performed during the first and last quarters of the 3-year study period.
Results A total of 18,115 procedures were performed by 27 staff cardiologists and 65 fellows-in-training. Considering all procedures, the mean cumulative skin dose decreased from 969 to 568 mGy (40% reduction) over 3 years.
Conclusions 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 during invasive cardiovascular procedures.
Dr. Mathew is a consultant of Lake Region Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 15, 2012.
- Revision received April 20, 2012.
- Accepted May 7, 2012.
- American College of Cardiology Foundation