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

      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•m
      • Hirshfeld Jr, JW
      • Balter S
      • Brinker JA
      • Kern MJ
      • Klein LW
      • Lindsay BD
      • Tommaso CL
      • Tracy CM
      • Wagner LK
      • Creager MA
      • Elnicki M
      • Lorell BH
      • Rodgers GP
      • Weitz HH
      • Foundation American College of Cardiology
      American Heart Association/; HRS, SCAI; American College of Physicians Task Force on Clinical Competence and Training
      ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training.
      ) 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.
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      References

        • Picano E
        • Vañó E
        • Rehani MM
        • Cuocolo A
        • Mont L
        • Bodi V
        • Bar O
        • Maccia C
        • Pierard L
        • Sicari R
        • Plein S
        • Mahrholdt H
        • Lancellotti P
        • Knuuti J
        • Heidbuchel H
        • Di Mario C
        • Badano LP.
        The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC associations of cardiovascular imaging, percutaneous cardiovascular interventions and electrophysiology.
        Eur Heart J. 2014; 35: 665-672
        • Hirshfeld Jr, JW
        • Balter S
        • Brinker JA
        • Kern MJ
        • Klein LW
        • Lindsay BD
        • Tommaso CL
        • Tracy CM
        • Wagner LK
        • Creager MA
        • Elnicki M
        • Lorell BH
        • Rodgers GP
        • Weitz HH
        • Foundation American College of Cardiology
        • American Heart Association/; HRS, SCAI; American College of Physicians Task Force on Clinical Competence and Training
        ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training.
        Circulation. 2005; 111: 511-532
        • Chambers CE
        • Fetterly KA
        • Holzer R
        • Lin PJ
        • Blankenship JC
        • Balter S
        • Laskey WK.
        Radiation safety program for the cardiac catheterization laboratory.
        Catheter Cardiovasc Interv. 2011; 77: 546-556
        • Pickersgill T.
        The European working time directive for doctors in training.
        BMJ. 2001; 323: 1266
        • Cates CU
        • Gallagher AG.
        The future of simulation technologies for complex cardiovascular procedures.
        Eur Heart J. 2012; 33: 2127-2134
        • Babineau TJ
        • Becker J
        • Gibbons G
        • Sentovich S
        • Hess D
        • Robertson S
        • Stone M.
        The “cost” of operative training for surgical residents.
        Arch Surg. 2004; 139 ([discussion 369–370]): 366-369
        • Green SM
        • Klein AJ
        • Pancholy S
        • Rao SV
        • Steinberg D
        • Lipner R
        • Marshall J
        • Messenger JC.
        The current state of medical simulation in interventional cardiology: a clinical document from the Society for Cardiovascular Angiography and Intervention's (SCAI) Simulation Committee.
        Catheter Cardiovasc Interv. 2014; 83: 37-46
        • Holmboe ES
        • Wang Y
        • Meehan TP
        • Tate JP
        • Ho SY
        • Starkey KS
        • Lipner RS.
        Association between maintenance of certification examination scores and quality of care for medicare beneficiaries.
        Arch Intern Med. 2008; 168: 1396-1403
        • Ting HH
        • Bates ER
        • Beliveau ME
        • Drozda Jr, JP
        • Harold JG
        • Krumholz HM
        • Nishimura RA
        • Oetgen WJ
        • Sibley JB
        • Tcheng JE.
        Update on the American Board of Internal Medicine Maintenance of Certification Program: a report of the American College of Cardiology's Educational Quality Review Board.
        J Am Coll Cardiol. 2014; 63: 92-100
        • Lipner RS
        • Messenger JC
        • Kangilaski R
        • Baim DS
        • Holmes Jr, DR
        • DO Williams
        King SB 3rd. A technical and cognitive skills evaluation of performance in interventional cardiology procedures using medical simulation.
        Simul Healthc. 2010; 5: 65-74
        • Bagai A
        • O'Brien S
        • Al Lawati H
        • Goyal P
        • Ball W
        • Grantcharov T
        • Fam N
        Mentored simulation training improves procedural skills in cardiac catheterization: a randomized, controlled pilot study.
        Circ Cardiovasc Interv. 2012; 5: 672-679
        • Jensen UJ
        • Jensen J
        • Olivecrona GK
        • Ahlberg G
        • Tornvall P.
        Technical skills assessment in a coronary angiography simulator for construct validation.
        Simul Healthc. 2013; 8: 324-328
        • Boyle E
        • Al-Akash M
        • Gallagher AG
        • Traynor O
        • Hill AD
        • Neary PC.
        Optimising surgical training: use of feedback to reduce errors during a simulated surgical procedure.
        Postgrad Med J. 2011; 87: 524-528
        • Katz A
        • Shtub A
        • Solomonica A
        • Poliakov A
        • Roguin A.
        Simulator training to minimize ionizing radiation exposure in the catheterization laboratory.
        Int J Cardiovasc Imaging. 2017; 33: 303-310
        • Roguin A
        • Nolan J.
        Radiation protection in the cardiac catheterisation lab: best practice.
        Heart. 2021; 107: 76-82
        • Popovic B
        • Pinelli S
        • Albuisson E
        • Metzdorf PA
        • Mourer B
        • Tran N
        • Camenzind E.
        The simulation training in coronary angiography and its impact on real life conduct in the catheterization laboratory.
        Am J Cardiol. 2019; 123: 1208-1213
        • Tsapaki V
        • Kottou S
        • Vano E
        • Komppa T
        • Padovani R
        • Dowling A
        • Molfetas M
        • Neofotistou V.
        Occupational dose constraints in interventional cardiology procedures: the DIMOND approach.
        Phys Med Biol. 2004; 49: 997-1005
        • Whitby M
        • Martin CJ.
        A study of the distribution of dose across the hands of interventional radiologists and cardiologists.
        Br J Radiol. 2005; 78: 219-229
        • Martin CJ
        • Whitby M.
        Application of ALARP to extremity doses for hospital workers.
        J Radiol Prot. 2003; 23: 405-421
        • Zweers D
        • Geleijns J
        • Aarts NJ
        • Hardam LJ
        • Laméris JS
        • Schultz FW
        • Schultze Kool LJ
        Patient and staff radiation dose in fluoroscopy-guided TIPS procedures and dose reduction, using dedicated fluoroscopy exposure settings.
        Br J Radiol. 1998; 71: 672-676
        • Pusic MV
        • Kessler D
        • Szyld D
        • Kalet A
        • Pecaric M
        • Boutis K.
        Experience curves as an organizing framework for deliberate practice in emergency medicine learning.
        Acad Emerg Med. 2012; 19: 1476-1480
        • Prober CG
        • Heath C.
        Lecture halls without lectures–a proposal for medical education.
        N Engl J Med. 2012; 366: 1657-1659