Cardiology fellows can be exposed to high radiation levels during procedures. Proper radiation training and implementation of safety procedures is of critical importance in lowering physician health risks associated with radiation exposure. Participants were cardiology fellows in the United States (n = 2,545) who were contacted by e-mail to complete an anonymous survey regarding the knowledge and practice of radiation protection during catheterization laboratory procedures. An on-line survey engine, SurveyMonkey, was used to distribute and collect the results of the 10-question survey. The response rate was 10.5%. Of the 267 respondents, 82% had undergone formal radiation safety training. Only 58% of the fellows were aware of their hospital’s pregnancy radiation policy and 60% knew how to contact the hospital’s radiation safety officer. Although 52% of the fellows always wore a dosimeter, 81% did not know their level of radiation exposure in the previous year and only 74% of fellows knew the safe levels of radiation exposure. The fellows who had received formal training were more likely to be aware of their pregnancy policy, to know the contact information of their radiation safety officer, to be aware of the safe levels of radiation exposure, to use dosimeters and RadPad consistently, and to know their own level of radiation exposure in the previous year. In conclusion, cardiology fellows have not been adequately educated about radiation safety. A concerted effort directed at physician safety in the workplace from the regulatory committees overseeing cardiology fellowships should be encouraged.
Providing formalized training in radiation safety is one of the most effective methods of protecting healthcare workers against the harmful effects of radiation. The biologic effects of radiation are a concern at any level of exposure and can result in erythema, cataracts, and cancer. Long-term exposure is a major concern because the accumulation of radiation for the duration of a cardiologist’s career can lead to a significant cumulative risk. No contemporary studies have been done of whether cardiology fellows have received the proper training in radiation exposure minimization and management. The present study was conducted to evaluate the level of training provided to fellows and to identify possible shortcomings in the current system.
Methods
The respondents were cardiology fellows training in programs from various institutions throughout the United States. A total of 2,545 first-year to fifth-year general and subspecialty cardiology fellows were invited to participate in the survey using e-mail addresses acquired through the American College of Cardiology Web site. A comprehensive 10-question survey ( Appendix A ) was designed and distributed in a bulk e-mail that contained a cover letter using SurveyMonkey, an on-line Web site engine ( www.surveymonkey.com ). An initial survey request was sent to all cardiology fellows, followed by a second request 2 weeks later to those fellows who had not responded to the initial request. The participants were informed that the survey was anonymous and voluntary. No incentive was offered for participation, and no penalty ensued for nonparticipation. The surveys were completed from June 8 to July 8, 2009. The Institutional Review Board at the University of Illinois at Chicago approved present study.
The responses were automatically entered into a database and tabulated by SurveyMonkey as frequencies and used for descriptive statistics. Chi-square analyses and Fisher’s exact tests were used to perform group comparisons of the categorical outcomes. t tests were performed to compare continuous variables. A p value of <0.05 was considered significant for all tests. The data were analyzed using Statistical Analysis Systems, version 9.1 (SAS Institute, Cary, North Carolina).
Results
Of the 2,545 cardiology fellows invited to participate, 286 (11%) completed the survey forms. Of the 286 respondents, 19 were excluded from the study because they were not fellows. Of the 267 remaining respondents, 82% had received formal radiation safety training, 58% of fellows were aware of their hospital’s pregnancy radiation work policy, and 60% knew how to contact their hospital’s radiation safety officer. Slightly >1/2 of the fellows (52%) always wore a dosimeter; however, 81% did not know their level of radiation exposure in the past academic year. Only 74% of the fellows knew the safe levels of radiation exposure ( Table 1 ).
| Question | Cardiology Fellowship Year | p Value | |||
|---|---|---|---|---|---|
| 1 (n = 61) | 2 (n = 84) | 3 (n = 92) | 4/5 (n = 29) | ||
| Undergone formal radiation safety training | 78% | 78% | 89% | 79% | 0.2191 |
| Aware of hospital’s pregnancy radiation work policy | 48% | 52% | 67% | 66% | 0.0680 |
| Know contact information of hospital’s radiation safety officer | 51% | 63% | 58% | 76% | 0.1366 |
| Aware of safe levels of radiation exposure | 61% | 73% | 81% | 79% | 0.0556 |
| 100% Use radiation protection goggles | 42% | 26% | 32% | 24% | 0.1625 |
| 100% Use radiation badge | 60% | 58% | 53% | 48% | 0.6946 |
| 100% Use RadPad for procedures | 44% | 27% | 24% | 4% | 0.0011 |
| Aware of radiation exposure in past academic year | 20% | 15% | 24% | 17% | 0.5078 |
| Concerned about effect of radiation to your health | 0.5203 | ||||
| Never | 9% | 3% | 9% | 7% | |
| Always | 39% | 52% | 48% | 45% | |
| Sometimes | 53% | 46% | 43% | 48% | |
Regarding protective measures, 62% worked with attending physicians who always practiced the “as low as reasonably achievable” (ALARA) strategy during catheterization procedures, and the following equipment was always used by the corresponding percentage of cardiology fellows: radiation protection goggles by 31%, thyroid collar by 94%, lead shield by 93%, dosimeter by 55%, and RadPad by 27% ( Table 2 and Figure 1 ).
| Question | Received Formal Radiation Safety Training | p Value | |
|---|---|---|---|
| Yes (n = 226) | No (n = 50) | ||
| Aware of hospital’s pregnancy radiation work policy | 66% | 21% | <0.0001 |
| Know contact information of hospital’s radiation safety officer | 66% | 34% | <0.0001 |
| Aware of safe levels of radiation exposure | 79% | 51% | 0.0001 |
| 100% Use radiation protection goggles | 31% | 36% | 0.4475 |
| 100% Use radiation badge | 60% | 35% | 0.0020 |
| 100% Use RadPad for procedures | 30% | 14% | 0.0287 |
| Aware of radiation exposure in past academic year | 0.0009 | ||
| Do not know | 77% | 98% | |
| Know | 23% | 2% | |
| Concerned about effects of radiation to your health | 0.0110 | ||
| Never | 8% | 2% | |
| Sometimes | 50% | 32% | |
| Always | 42% | 66% | |
On univariate analysis, the use of RadPads for procedures was significantly associated with the year of cardiology fellow training, with fellows in a higher year of training less likely to use RadPads for all procedures (p = 0.0011). Stepwise multivariate analysis found 6 factors that were significantly associated with having undergone formal radiation training: awareness of the pregnancy work policy (p <0.0001), knowledge of radiation safety officer contact information (p <0.0001), awareness of safe levels of radiation exposure (p = 0.0001), 100% use of a dosimeter (p = 0.002), 100% use of RadPads (p = 0.0287), and knowledge of own radiation exposure in the past academic year (p = 0.0009; Table 3 ).
| Variable | Do Attending Cardiologists Practice ALARA Strategy During Catheterization Laboratory Procedures | p Value | |||
|---|---|---|---|---|---|
| Never/Almost Never (n = 8) | Sometimes (n = 33) | Usually (n = 57) | Almost Always/Always (n = 158) | ||
| 100% Of fellows use radiation protection goggles | 38% | 30% | 30% | 32% | 0.9654 |
| 100% Of fellows use radiation badge | 38% | 25% | 44% | 68% | <0.0001 |
| 100% Of fellows use RadPad for procedures | 38% | 9% | 14% | 35% | 0.0014 |
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