Statewide Initiative to Reduce Patient Radiation Doses During Percutaneous Coronary Intervention

BACKGROUND: Improved radiation safety practices are needed across hospitals performing percutaneous coronary intervention (PCI). This study was performed to assess the temporal trend in PCI radiation doses concurrent with the conduct of a statewide radiation safety initiative. METHODS: A statewide initiative to reduce PCI radiation doses was conducted in Michigan between 2017 and 2021 and included focused radiation safety education, reporting of institutional radiation doses, and implementation of radiation performance metrics for hospitals. Using data from a large statewide registry, PCI discharges between July 1, 2016, and July 1, 2022, having a procedural air kerma (AK) recorded were analyzed for temporal trends. A multivariable regression analysis was performed to determine whether declines in procedural AK over time were attributable to changes in known predictors of radiation doses. RESULTS: Among 131 619 PCI procedures performed during the study period, a reduction in procedural AK was observed over time, from a median dose of 1.46 (0.86–2.37) Gy in the first year of the study to 0.97 (0.56–1.64) Gy in the last year of the study (P<0.001). The proportion of cases with an AK ≥5 Gy declined from 4.24% to 0.86% over the same time period (P<0.0001). After adjusting for variables known to impact radiation doses, a 1-year increase in the date of PCI was associated with a 7.61% (95% CI, 7.38%–7.84%) reduction in procedural AK (P<0.0001). CONCLUSIONS: Concurrent with the conduct of a statewide initiative to reduce procedural radiation doses, a progressive and significant decline in procedural radiation doses was observed among patients undergoing PCI in the state of Michigan.

背景：在进行经皮冠状动脉介入治疗（PCI）的医院中，需要改进辐射安全措施。本研究旨在评估在全州开展辐射安全倡议的同时，PCI辐射剂量的时间趋势。 方法：2017年至2021年在密歇根州开展了一项降低PCI辐射剂量的全州倡议，包括有针对性的辐射安全教育、机构辐射剂量报告以及医院辐射性能指标的实施。利用来自一个大型全州登记处的数据，对2016年7月1日至2022年7月1日期间记录了操作空气比释动能（AK）的PCI出院病例进行时间趋势分析。进行多变量回归分析以确定操作AK随时间的下降是否归因于辐射剂量已知预测因素的变化。 结果：在研究期间进行的131619例PCI手术中，随着时间推移观察到操作AK降低，从研究第一年的中位剂量1.46（0.86 - 2.37）戈瑞降至研究最后一年的0.97（0.56 - 1.64）戈瑞（P < 0.001）。在同一时期，AK≥5戈瑞的病例比例从4.24%降至0.86%（P < 0.0001）。在对已知影响辐射剂量的变量进行调整后，PCI日期每增加1年，操作AK降低7.61%（95%置信区间，7.38% - 7.84%）（P < 0.0001）。 结论：在开展全州降低操作辐射剂量倡议的同时，在密歇根州接受PCI的患者中观察到操作辐射剂量逐渐且显著下降。