Utilization of a Radiation Safety Time-Out Reduces Radiation Exposure During Electrophysiology Procedures

Abstract

Objectives: This study sought to determine whether a radiation safety time-out reduces radiation exposure in electrophysiology procedures.

Background: Time-outs are integral to improving quality and safety. The authors hypothesized that a radiation safety time-out would reduce radiation exposure levels for patients and the health care team members.

Methods: The study was performed at the New York University Langone Health Electrophysiology Lab. Baseline data were collected for 6 months prior to the time-out. On implementation of the time-out, data were collected prospectively with analyses to be performed every 3 months. The primary endpoint was dose area product. The secondary endpoints included reference point dose, fluoroscopy time, use of additional shielding, and use of alternative imaging such as intracardiac and intravascular ultrasound.

Results: A total of 1,040 patient cases were included. The median dose area product prior to time-out was 18.7 Gy∙cm², and the median during the time-out was 14.7 Gy∙cm², representing a 21% reduction (p = 0.007). The median reference point dose prior to time-out was 163 mGy, and during the time-out was 122 mGy (p = 0.011). The use of sterile disposable protective shields and ultrasound imaging for access increased significantly during the time-out.

Conclusions: A radiation safety time-out significantly reduces radiation exposure in electrophysiology procedures. Electrophysiology laboratories, as well as other areas of cardiovascular medicine using fluoroscopy, should strongly consider the use of radiation safety time-outs to reduce radiation exposure and improve safety.

Keywords: check list; fluoroscopy; procedure; radiation; time-out.