Multicenter Long-Term Validation of a Minicourse in Radiation-Reducing Techniques in the Catheterization Laboratory

•Patient radiation exposure in invasive cardiology remains high. However, all existing radiation safety concepts have lacked consistent documentation of relevant dose parameters that characterize the underlying various individual radiation-reducing efforts by single cardiologists in clinical routine. Until now, there has been no multicenter long-term validation of an educational radiation-reducing program in clinical routine.•This shortcoming is resolved by the presented educational “Encourage Less-Irradiation Cardiac Interventional Techniques” long-term approach: consistent collimation and realization of adequate image resolution, radiographic acquisition, and fluoroscopy time proved to be within the reach of every interventionalist, and if available, encouraged radiation-reducing technical settings—that is, preselectable pulse rates and detector entrance doses—that were evidently implemented over the years. A comprehensive, pseudonymized feedback for patient exposure results achieved at baseline and follow-up evaluations supported the significant efficacy of our minicourse and was accessible to each interventionalist by use of her or his individual code number.•The interactive 90-minute minicourse presented here, designated “Encourage Less-Irradiation Cardiac Interventional Techniques”, enabled significant short-term (−54.6%) and—without further training—long-term (−64.1%) patient dose reduction from the marker intervention of coronary angiography. It consequently represents the first validation of the long-term efficacy of such a course in a multicenter field study (18 operators at 5 heart centers) in clinical routine. Multivariate linear regression analysis indicated—over the years—increasing efficacy of the minicourse itself and a minor and slightly decreasing influence of interventionists' experience. Interventional workload after the minicourse did not influence long-term dose area product results.•Nevertheless, extremely great differences among the cardiologists remained after the program. Our evaluation moreover illustrates both median values for dose parameters, realizable benchmarks, and borderstones for best practice. Because—over the course of a few coronary angiographies—the program qualifies operators to enable reliable self-monitoring and iterative radiation-saving improvements; it implemented a new culture of individual autonomy in radiation safety according to the “plan-do-check-act” principles of sustained quality management.•In conclusion, autonomous self-surveillance of various dose parameters and feedback on individual radiation safety efforts supported the efficacy of a 90-minute course program toward long-lasting and ongoing patient dose reduction.

Patient radiation exposure in invasive cardiology is considerable. We aimed to investigate, in a multicenter field study, the long-term efficacy of an educational 90-minute workshop in cardiac invasive techniques with reduced irradiation. Before and at a median period of 2.5 months and 2.0 years after the minicourse (periods I, II, and III, respectively) at 5 German cardiac centers, 18 interventionalists documented various radiation parameters for 10 coronary angiographies. The median patient dose area product (DAP) for periods I, II, and III amounted to 26.6, 12.2, and 9.6 Gy × cm2, respectively. The short-term and long-term effects were related to shorter median fluoroscopy times (180, 138, and 114 seconds), fewer radiographic frames (745, 553, and 417) because of fewer (11, 11, and 10) and shorter (64, 52, and 44 frames/run) runs, consistent collimation, and restriction to an adequate image quality; both radiographic DAP/frame (27.7, 17.3, and 18.4 mGy × cm2) and fluoroscopic DAP/second (26.6, 12.9, and 14.9 mGy × cm2) decreased significantly. Multivariate analysis over time indicated increasing efficacy of the minicourse itself (−55% and −64%) and minor influence of interventionist experience (−4% and −3% per 1,000 coronary angiographies, performed lifelong until the minicourse and until period III). In conclusion, autonomous self-surveillance of various dose parameters and feedback on individual radiation safety efforts supported the efficacy of a 90-minute course program toward long-lasting and ongoing patient dose reduction.