Efficacy of a Minicourse in Radiation-Reducing Techniques in Invasive Cardiology : A Multicenter Field Study

ObjectivesOur goal was to validate an educational 90-min minicourse in lower-irradiating cardiac invasive techniques.BackgroundDespite comprehensive radiation safety programs, patient radiation exposure in invasive cardiology remains considerable.MethodsBefore 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.ResultsA 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.ConclusionsDespite significant required training in radiation safety for all interventional cardiologists, the presented additional 90-min minicourse significantly reduced patient dose.