Division of Cardiology, Klinik Fraenkische Schweiz, Ebermannstadt, Germany.
Institute for Community Medicine, Ernst Moritz Arndt University, Greifswald, Germany.
JACC Cardiovasc Interv. 2014 Apr;7(4):382-90. doi: 10.1016/j.jcin.2013.11.016. Epub 2014 Mar 14.
Our goal was to validate an educational 90-min minicourse in lower-irradiating cardiac invasive techniques.
Despite comprehensive radiation safety programs, patient radiation exposure in invasive cardiology remains considerable.
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.
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 × cm(2). 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 × cm(2)) and revealed higher DAP for increasing body mass index (+1.5 Gy × cm(2) per kg/m(2)), male sex (+5.8 Gy × cm(2)), age (+1.5 Gy × cm(2)/decade), and-owing to different settings during image acquisition-for advanced flat-panel detector systems (+9.0 Gy × cm(2)) versus older, traditional image intensifier systems.
Despite significant required training in radiation safety for all interventional cardiologists, the presented additional 90-min minicourse significantly reduced patient dose.
我们旨在验证一项时长 90 分钟的心脏介入技术辐射防护知识小型培训课程的教育效果。
尽管有全面的辐射安全计划，但介入心脏病学患者的辐射暴露仍然相当大。
在德国 32 个心脏中心的小型培训课程之前和之后的中位数 3.7 个月期间，177 名介入心脏病专家始终记录了 10 次冠状动脉造影的辐射参数：剂量面积乘积（DAP）、放射和荧光分数、荧光透视时间以及放射帧数和运行次数。
共有 154 名心脏病专家参加了小型课程，患者的中位数总 DAP（从基线的 26.5 减少到 13.7Gy×cm²）显著降低（p<0.001）。他们还减少了荧光透视时间（-20.8%）、放射运行次数（-9.1%）、帧数/运行（-18.6%）和帧数（-29.6%），以及放射 DAP/帧（-27.4%）和荧光透视 DAP/s（-39.3%），这表明准直度得到改善，减少了辐射角度或获得了足够的图像质量。由于工作坊邀请的 23 名未能参加的心脏病专家未发生变化，因此在单变量比较中未发生显著变化。多水平分析（p<0.001）证实了小型课程本身的有效性（-14.7Gy×cm²），并揭示了更高的剂量相关参数，包括体重指数增加（每 kg/m²增加 1.5Gy×cm²）、男性（+5.8Gy×cm²）、年龄增加（每十年增加 1.5Gy×cm²）以及由于图像采集期间的不同设置，高级平板探测器系统（+9.0Gy×cm²）比旧的传统影像增强器系统更高。
尽管所有介入心脏病专家都需要进行大量的辐射安全培训，但本研究提供的额外 90 分钟小型课程显著降低了患者的剂量。
