Cath Lab Digest - October 2007 - (Page 21)

OCTOBER 2007 RADIATION SAFETY 21 Radiation Tracking in the Cardiac Catheterization Lab Donna DuRee, RN, BN, CCVNII and Derrick Johnson RN, BS, RCIS, CMRT, St. Luke’s Episcopal Hospital, Houston, Texas Figure 1. Example of query result of next day’s schedule, listing radiation doses of previous procedures. P atient safety is always a primary goal in any hospital and radiation safety ranks high on the list of safety items for a catheterization laboratory. The U.S. Nuclear Regulatory Commission (NCR) and the Food and Drug Association (FDA) regulate the use of radioactive materials in medicine and the manufacture of devices that emit radiation, respectively. The Joint Commission (TJC), more commonly referred to as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), also regulates safety through its accreditation process. JCAHO has made the statement that “prolonged fluoroscopy with cumulative dose >1500 rads to a single field or any delivery of radiotherapy to the wrong region or >25% above the planned dose”1 constitutes a reviewable sentinel event. Since that recommendation, medical facilities have been under intense pressure to provide the safest possible environment for radiation safety for their patients. With all the medical diagnostic procedures performed today that require the use of ionizing radiation, the cath lab at St Luke’s Episcopal Hospital in Houston, Texas, began to develop a plan to meet JCAHO’s recommendations. The American College of Radiology (ACR) also recommends keeping information on radiation doses archived to provide for quality comparisons and to identify patients at risk due to multiple radiation procedures. According to a white paper issued by the ACR in 2007: “…there should be special attention paid to the practical suggestions set forth in this paper, such as education for all stakeholders in the principles of radiation safety, the appropriate utilization of imaging to minimize any associated radiation risk, the standardization of radiation dose data to be archived during imaging for its ultimate use in benchmarking good practice, and, finally, the identification and perhaps alternative imaging of patients who may have already reached threshold levels of estimated exposure from diagnostic imaging.”2 St. Luke’s Episcopal Hospital cath lab performs approximately 10,000 to 12,000 procedures a year. As is the case in most cath labs, many patients come in for repeat procedures. As a result, management teams decided to track the cumulative amounts of radiation received by all patients who had undergone Figure 2. Example of data sent to RSO for review. fluoroscopic and selective cardiac procedures within a six-month period. This plan was initiated because many inpatients and/or outpatients may receive multiple procedures that Figure 3. Deterministic Health Effects of Radiation Organ or tissue Whole body (bone marrow) Skin Thyroid Lens of the eye Gonads Dose in less than 2 days, Gy 1 Deterministic effects Type of effect Time of occurrence Acute Radiation 1 – 2 months Syndrome (ARS) Erythema Hypothyroidism Cataract Permanent sterility 1 – 3 weeks 1st – several years 6 months – several years Weeks 3 5 2 3 Source: Bulgova E. “Radiation Health Effects.” Incident and Emergency Centre Department of Nuclear Safety and Security: International Atomic Energy Agency. Accessed September 17, 2007. Available at: www-pub.iaea.org/mtcd/meetings/PDFplus/2007/Seminar_For_Diplomats/Buglova_Presentation.ppt could expose them to the possibility of significantly more direct radiation than what they would receive in the cath lab in a single case. Our lab made tracking of cumulative radiation doses one of our goals in order to provide for the safety of patients. Our equipment currently displays a total dose in mGy and DAP in cGycm2 at the end of each case. This dose is incorporated into the medical record and stored in a program used to track cumulative doses. This is only a total dose and does not take into account the different angles utilized or areas of the body where the cine runs are taken. Therefore, the Radiation Safety Officer (RSO) at St. Luke’s Episcopal Hospital chooses to review all cases with total dose over 12000 mGy. The department quality coordinator retrospectively reviews all radiation exposure doses received by www-pub.iaea.org/mtcd/meetings/PDFplus/2007/Seminar_For_Diplomats/Buglova_Presentation.ppt

Table of Contents Feed for the Digital Edition of Cath Lab Digest - October 2007

Saints Medical Center Fibromuscular Dysplasia in Children and Adolescents Cerebral Vascular Accident Following a Pulmonary Embolism: Search for the Hidden Patent Foramen Ovale Contents Clinical Editor’s Corner Meetings Calendar CEU Education Center Radiation Tracking in the Cardiac Catheterization Lab Letter to the Editor Carotid Stenting: An update Release from Stent-jail: Beneficial Snow-Plowing? Patient Management Guidelines Searching for a Cardiovascular Position? Tips for Creating a ‘Stand-Out’ Resume Long-Term Implications of Short-Term Closure Decisions – The Evolution to Vascular Access Management and the Boomerang Catalyst System The Ten-Minute Interview with… Angie Bowles, RN, CCRN CMS Issues Final FY 2008 IPPS Rule ACVP• Membership Page Experience with a New Workhorse Guidewire Ask the Clinical Instructor: Q&A for Those New to Cath Lab A Glimpse of the Future of Clinical Education: Boston Scientific’s SimSuite Bus Visits Carnegie Institute 2007 Educational Fair Held at the Washington Hospital Center Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology What Do You Think? A Virtual Cath Lab Viewer (VCL): The Development of an Online 3D C-arm Simulator and Coronary Anatomy Viewer Clinical & Industry News Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization

Cath Lab Digest - October 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.