Elsevier

The American Journal of Cardiology

Volume 181, 15 October 2022, Pages 25-31
The American Journal of Cardiology

Impact of Simulation-Based Training on Radiation Exposure of Young Interventional Cardiologists

https://doi.org/10.1016/j.amjcard.2022.07.014Get rights and content

Reducing radiation exposure during cardiovascular catheterization is of paramount importance to ensure patient and staff safety. Our study aimed to assess the transferability of acquired skills from virtual reality to the real world, including radioprotection measures during mentored simulation training (ST) in coronary angiography. A total of 10 cardiology residents were evaluated during real-life cases in the catheterization laboratory before (group A) and after mentored ST. The educational effect of mentored simulator training on real-life case performance was evaluated at 2 different time points: within the first week (group B) and after 12 weeks (group C). Compared with group A, the total dose area product (DAP) (µGy•m2) and total air kerma (mGy) were lower after ST: group A: 2,633 (1,723 to 3,617) versus group B: 1,618 (1,032 to 2,562), p <0.05 and 214 (136 to 297) versus 135 (84 to 222), p <0.05, respectively. Concerning operator radiation exposure (µSv), left finger dose: 1,090 (820 to 1,460) versus 635 (300 to 900), p = 0.028; left leg dose 80 (0 to 110) versus 0 (0 to 0), p = 0.027; left eye lens dose: 39 (24 to 69) versus 11 (8 to 20), p <0.0001; and chest dose outside the lead apron: 50 (34 to 88) versus 29 (21 to 50), p <0.003 were significantly lower in the group B than group A. A total of 12 weeks after ST, the total DAP and total air kerma remained stable along with operator exposure except left eye lens dose (µSv): group B: 11 (8 to 20) versus group C: 16 (12 to 27), p = 0.02. In addition, left eye lens dose, left wrist dose, and chest dose outside the lead apron were significantly correlated with total DAP (rs = 0.635, rs = 0.729, and rs = 0, 629, respectively) and total air kerma (rs = 0.488, rs = 0.514, and rs = 0.548, respectively) at 12 weeks. In conclusion, ST for coronary angiography may improve radioprotection learning and should be incorporated into training curricula.

Section snippets

Methods

Between March 2021 and January 2022, a group of 10 trainees with similar case volumes and experience in coronary angiography (CA) was evaluated in our prospectively designed trial, with radiation exposure measurements as an end point. All participants were cardiology residents from our university hospital who were in their second half of their residency. Our study included 3 real-life phases, including an evaluation before simulation-based training (phase 1), within the following week (phase

Results

A total of 10 trainees were participating in our study (5 women, mean age 26.1 ± 1.8 years). Table 1 lists the demographic, procedural, and ionizing data in the 3 different patient groups during the 3 real-life study phases. Compared with group A, group B had better procedural performance, as evidenced by a higher global procedural score. Fluoroscopic time was significantly lower after ST, and radioprotective measures (collimation, distance between tube and operator, operator body position, and

Discussion

The key findings of our study are as follows: (1) we demonstrated here, for the first time, that simulator-based training significantly improves diagnostic coronarography proficiency as demonstrated by the reduction of the ionizing radiation exposure to operator as well as patient in real life, (2) and the simulator-based training resulted in a benefit in diagnostic coronarography proficiency that is retained over at least a 12 week-period by the trainees, as reflected by the radioprotection

Disclosures

The authors have no conflicts of interest to declare.

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    Funding: None.

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