Radiation protection training for cardiologists in the era of multiple imaging techniques and complex interventions

Focus on Radiation Protection Improves Both Correct Behavior and Procedural Performance During Simulation-Based Training - A Randomized Comparison

BACKGROUND

To explore whether simulation-based endovascular training with focus on radiation safety could improve correct behavior without jeopardizing the learning of procedural skills.

METHODS

Twenty-four residents without previous endovascular experience completed 10 clinical scenarios on a virtual-reality endovascular simulator with software for peripheral endovascular interventions. Participants were randomized to receive feedback (n = 12) or not (n = 12) on radiation protection (RP) performance after each case. Expert assessments were done at the first, second, fourth, seventh, and 10th case on RP and endovascular skills (ES). Automatic simulator metrics on procedure time, contrast dose, handling errors, and estimated radiation exposure to patient and operator were registered. Outcome metrics were analyzed by two-way mixed analysis of variance pairwise comparisons with independent t-tests. Correlations were explored using Pearson's r for internal consistency reliability.

RESULTS

The RP performance was similar in both groups at their first attempt (P = 0.61), but the feedback group significantly outperformed the control group over time (P < 0.001 for all comparisons). The feedback group was however slower to learn the ES at start (P = 0.047 at second performance), but after 7 attempts no difference was shown (P = 0.59). The feedback group used more time (19.5 vs. 15.3 min; P = 0.007) but less contrast (60 vs. 100 mL; P < 0.001). The number of errors was the same in both groups, but all metrics regarding radiation exposure favored the feedback group (P-values from 0.001 to 0.008).

CONCLUSIONS

Simulation-based training (SBT) is effective to acquire basic endovascular intervention skills and concurrently learn RP behavior when feedback on radiation culture is provided.

Radiation awareness in an Italian multispecialist sample assessed with a web-based survey

INTRODUCTION

The awareness of radiation doses and risks, also during interventional cardiology procedures, is essential today in order to apply the risk-benefit assessment and to reinforce the principles of justification and optimisation in clinical practice.

METHODS

A voluntary survey with 10 questions and multiple-choice answers was run on a popular cardiology website (www.cardiolink.it) independently by a scientific publisher, in order to evaluate the contemporary level of radiation awareness in a multi-speciality sample of physicians in Italy.

RESULTS

One thousand eight hundred and sixty-one physicians completed the test. The survey showed good results since both prescribers and practitioners (mostly cardiologists) working in Italy are largely aware of the cancer and non-cancer risks of medical radiation use, regardless of their subspecialty background.

CONCLUSION

Physicians are largely aware of the cancer and non-cancer risks of medical radiation use, regardless of their subspecialty background. However, there is still broad space for improvement; in the future, the awareness of radiation risk is a prerequisite to create a culture of respect for radiation hazard and a commitment to minimise exposure and maximise protection.

Team perception of the radiation safety climate in the hybrid angiography suite: A cross-sectional study

BACKGROUND

Good radiation safety practice in the angiosuite is essential to protect patients and healthcare workers. Most strategies aim to advance radiation safety through technological upgrades and educational initiatives. However, safety literature suggests that additional ways to improve radiation safety in the angiosuite do exist. The safety climate reflects the way team members perceive various key characteristics of their work environment and is closely related to relevant safety outcomes. A specific 'radiation safety climate' has not been described nor studied in the hybrid angiosuite. This study explores the radiation safety climate in the hybrid angiosuite and its relation to team members' radiation safety behavior, knowledge and motivation.

MATERIALS AND METHODS

Vascular surgeons, fellows/trainees and operating room nurses active in the angiosuite at five hospitals were invited to complete an online self-report questionnaire assessing the radiation safety climate (28 items); radiation safety behavior; radiation safety knowledge and radiation safety motivation. Relations between climate scores and behavior were investigated using Pearson correlations. Mediation was analyzed using the Baron and Kenny analysis. P-Values < 0.05 were considered statistically significant.

RESULTS

No major differences were identified in total radiation safety climate scores between centers or team member functions. Scale reliability for radiation safety climate was good to excellent (α > 0.663). Total radiation safety climate scores were positively related to the radiation safety behavior score (r = 0.403; p = 0.015). This relation was partially mediated by radiation safety knowledge (β = 0.1730; 95% CI: [0.0475; 0.3512]), while radiation safety motivation did not act as a mediator: (β = 0.010; 95% CI: [-0.0561; 0.0998]).

CONCLUSION

A well-developed radiation safety climate in the hybrid angiosuite fosters positive radiation safety behaviors, which may partially be explained through improved radiation safety knowledge transfer. Further research on (radiation) safety climate and its impact on radiation safety-related outcome measures for patients is recommended.

Radiation protection knowledge and practices in interventional cardiologists practicing in Africa: a cross sectional survey

We conducted a survey of doctors working in the cardiac catheterisation laboratories in Africa on their knowledge, attitude and practice with respect to radiation protection. Of seventy-two respondents contacted, 61 (84.7%) completed the questionnaire. Twenty-eight, (45.9%) were younger than 45 years. Thirty-seven, (60.6%) had less than 10 years of experience in the laboratory. Only 28 (45.9%) had undertaken radiation protection training. Fifty-eight, (95.1%) consistently used lead aprons. Forty-seven, (77%) reported consistently using thyroid shields. Ten (16.4%) consistently used radiation protection eyeglasses, whilst 36 (59%) never used them. Thermoluminescent Dosimeter badges were consistently used in 23 (37.7%). Forty-two, (68.9%) reported having ceiling mounted lead/acrylic shields. Level of radiation exposure in the most recent one year was ≤2 mSv in 14, between 2 and 20 mSv in 8 and between 20 and 30 mSv in 2, whilst 33 did not know their dose readings. The use of basic radiation protection tools as well as the knowledge and measurement of radiation exposure among interventional cardiologists working in Africa is low. The unavailability of some of the protective tools and a knowledge gap in terms of radiation protection and monitoring of self-exposure were some of the reasons for suboptimal self-protection against ionising radiation among our respondents. We suggest that initiatives be taken by all stakeholders to train this group of medical professionals in basic radiation protection to avoid unnecessary exposure to themselves, co-workers and patients.

SURVEY OF KEY RADIATION SAFETY PRACTICES IN INTERVENTIONAL RADIOLOGY: AN IRISH AND ENGLISH STUDY

Interventional radiology is a rapidly evolving speciality with potential to deliver high patient radiation doses, as a result high standards of radiation safety practice are imperative. IR radiation safety practice must be considered before during and after procedures through appropriate patient consent, dose monitoring and patient follow-up. This questionnaire-based study surveyed fixed IR departments across Ireland and England to establish clinical practice in relation to radiation safety. Pre-procedure IR patient consent includes all radiation effects in 11% of cases. The patient skin dose surrogate parameter of Kerma to air at a reference point (Kar) is under-reported. Only 39% of respondents use a substantial radiation dose level and inform patients after these have been reached. Poor compliance with unambiguous, readily available best practice guidance was observed throughout highlighting patient communication, patient dose quantification and subsequent patient dose management concerns.