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.
Competing Interests: Disclosures Dr Madder received speaker honoraria from Abbott Vascular, Corindus, and Infraredx; has served as a consultant to Abbott Vascular, Angiowave Imaging, Corindus, Infraredx, and SpectraWAVE; received research support from Corindus and Infraredx; and serves on the advisory boards of Medtronic and SpectraWAVE. Dr Sukul receives salary support for his role in the Blue Cross Blue Shield of Michigan Cardiovascular Collaborative. Dr Gurm receives research support from Blue Cross Blue Shield of Michigan. He is a co-founder of, owns equity in, and is a consultant to Amplitude Vascular Systems. He also owns equity in Jiaxing Bossh Medical Technology Partnership and is a consultant for Osprey Medical. He is the chair of the Clinical Events Committee for the PERFORMANCE trial (Protection Against Emboli During Carotid Artery Stenting Using a 3-in-1 Delivery System Comprised of a Post-Dilation Balloon, Integrated Embolic Filter, and a Novel Carotid Stent II) sponsored by Contego Medical. The other authors report no conflicts.