Author + information
- Received August 8, 2013
- Revision received October 26, 2013
- Accepted November 7, 2013
- Published online April 1, 2014.
- Eberhard Kuon, MD∗∗ (, )
- Kerstin Weitmann, MSc†,
- Wolfgang Hoffmann, MD†,
- Marcus Dörr, MD‡,
- Thorsten Reffelmann, MD‡,
- Astrid Hummel, MD‡,
- Alexander Riad, MD‡,
- Mathias C. Busch, MD‡,
- Klaus Empen, MD‡ and
- Stephan B. Felix, MD‡
- ∗Division of Cardiology, Klinik Fraenkische Schweiz, Ebermannstadt, Germany
- †Institute for Community Medicine, Ernst Moritz Arndt University, Greifswald, Germany
- ‡Division of Internal Medicine, Ernst Moritz Arndt University, Greifswald, Germany
- ↵∗Reprint requests and correspondence:
Dr. Eberhard Kuon, Klinik Fraenkische Schweiz, Feuersteinstr. 2, D-91320 Ebermannstadt, Germany.
Objectives Our goal was to validate an educational 90-min minicourse in lower-irradiating cardiac invasive techniques.
Background Despite comprehensive radiation safety programs, patient radiation exposure in invasive cardiology remains considerable.
Methods Before and at a median period of 3.7 months after the minicourse at 32 German cardiac centers, 177 interventionalists consistently documented radiation parameters for 10 coronary angiographies: dose area product (DAP), radiographic and fluoroscopic fractions, fluoroscopy time, and number of radiographic frames and runs.
Results A total of 154 cardiologists attended the minicourse and achieved significant (p < 0.001) decrease in patients' median overall DAP (–48.4%), from baseline 26.5 to 13.7 Gy × cm2. They reduced fluoroscopy times (–20.8%), radiographic runs (–9.1%), frames/run (–18.6%) and frames (–29.6%), and both radiographic DAP/frame (–27.4%) and fluoroscopic DAP/s (–39.3%), which indicate improved collimation, reduced-irradiation angulations, or adequate image quality. Dose-related parameters for the remaining 23 invited cardiologists unable to attend the workshop did not change significantly in univariate comparison. Multilevel analysis (p < 0.001) confirmed the efficacy of the minicourse itself (–14.7 Gy × cm2) and revealed higher DAP for increasing body mass index (+1.5 Gy × cm2 per kg/m2), male sex (+5.8 Gy × cm2), age (+1.5 Gy × cm2/decade), and—owing to different settings during image acquisition—for advanced flat-panel detector systems (+9.0 Gy × cm2) versus older, traditional image intensifier systems.
Conclusions Despite significant required training in radiation safety for all interventional cardiologists, the presented additional 90-min minicourse significantly reduced patient dose.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 8, 2013.
- Revision received October 26, 2013.
- Accepted November 7, 2013.
- American College of Cardiology Foundation