Effect of physician training on the X-ray dose delivered during coronary angioplasty

To assess whether physician training helps decrease the amount of radiation delivered to patients undergoing coronary angioplasty with stent placement.

Coronary angioplasty exposes patients to high doses of ionizing radiation, possibly related to equipment misuse or inappropriate training.

Reference point air kerma (K(a,r)) and kerma area product (P(KA)) were prospectively registered during a period of 6 months in patients undergoing coronary angiography and angioplasty with stent ad hoc. All interventionalists were then invited to an informative conference on appropriate use of radiation and changes in x-ray delivery settings. Data were recorded during the following 6 months and then compared for the whole group and for those who did or did not attend the conference.

K(a,r) decreased from 5.44 ± 0.3 Gy (n = 106) to 3.39 ± 0.22 Gy (n = 112); P<.0001 and P(KA) decreased from 365.4 ± 21.1 Gy·cm(-2); to 233.7 ± 13.1 Gy·cm(-2); P<.0001. During the first 6 months, there were no differences in radiation emitted among physicians; however, during the second half of the study, there was a 34% difference in K(a,r) between those that attended the conference and those who did not (2.78 ± 0.23 Gy vs 4.18 ± 0.37 Gy; P=.002), regardless of the fact that both groups lowered radiation emission settings.

Changes in x-ray parameters profoundly reduce the amount of radiation delivered to patients, a situation that was more evident in those who attended an informative conference. It is important to educate cardiologists in the appropriate use of modern x-ray equipment.