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Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
Published on: May 26, 2015
Sustained radiation reduction following initial quality improvement intervention in a paediatric cardiac
Anthony McKeiver1, Jennifer Marshall2, Peter Churchill2
1College of Medicine, Kansas City University, Kansas City, MO, USA.
Insights
Quality improvement initiatives significantly reduced radiation exposure in pediatric cardiac catheterizations. These radiation dose reductions for patients and providers were sustained long-term.
Area of Science:
- Medical Imaging and Radiology
- Pediatric Cardiology
- Radiation Safety
Background:
- A quality improvement project was initiated in October 2011 to decrease radiation exposure during pediatric cardiac catheterizations.
- Initial project phases demonstrated significant reductions in patient radiation doses.
- The study aimed to assess the long-term sustainability of these radiation reduction efforts starting in April 2016.
Purpose of the Study:
- To evaluate the sustained impact of implemented changes on radiation exposure in pediatric cardiac catheterization procedures.
- To determine if initial reductions in radiation dose were maintained over an extended period.
Main Methods:
- Implemented interventions included weight-based frame rate reductions, increased use of collimators and shields, utilization of stored fluoroscopy and virtual magnification, and dedicated radiation technician support.
- Data collected included patient weight, fluoroscopy time, and radiation dosage for 1889 procedures between October 2011 and September 2019.
- Procedures were categorized into pre-intervention, post-intervention, and long-term groups for analysis.
Main Results:
- While fluoroscopy times did not significantly differ across groups, patient mean radiation dose per kilogram decreased by 39.7% post-intervention and was sustained long-term (p = 0.039).
- Provider radiation exposure saw a significant overall decrease of 73% from the project's onset through the long-term period (p < 0.01).
- No significant difference in fluoroscopy times was observed between the pre-intervention, post-intervention, and long-term groups.
Conclusions:
- Implementing technical and clinical practice changes effectively reduces radiation exposure for both patients and providers in pediatric cardiac catheterization labs.
- These significant radiation dose reductions can be successfully maintained over the long term through sustained quality improvement efforts.
Background:
As part of a quality improvement project beginning in October 2011, our centre introduced changes to reduce radiation exposure during paediatric cardiac catheterisations. This led to significant initial decreases in radiation to patients. Starting in April 2016, we sought to determine whether these initial reductions were sustained.
Methods:
After a 30-day trial period, we implemented (1) weight-based reductions in preset frame rates for fluoroscopy and angiography, (2) increased use of collimators and safety shields, (3) utilisation of stored fluoroscopy and virtual magnification, and (4) hiring of a devoted radiation technician. We collected patient weight (kg), total fluoroscopy time (min), and procedure radiation dosage (cGy-cm2) for cardiac catheterisations between October, 2011 and September, 2019.
Results:
A total of 1889 procedures were evaluated (196 pre-intervention, 303 in the post-intervention time period, and 1400 in the long-term group). Fluoroscopy times (18.3 ± 13.6 pre; 19.8 ± 14.1 post; 17.11 ± 15.06 long-term, p = 0.782) were not significantly different between the three groups. Patient mean radiation dose per kilogram decreased significantly after the initial quality improvement intervention (39.7% reduction, p = 0.039) and was sustained over the long term (p = 0.043). Provider radiation exposure was also significantly decreased from the onset of this project through the long-term period (overall decrease of 73%, p < 0.01) despite several changes in the interventional cardiologists who made up the team over this time period.
Conclusion:
Introduction of technical and clinical practice changes can result in a significant reduction in radiation exposure for patients and providers in a paediatric cardiac catheterisation laboratory. These reductions can be maintained over the long term.
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