Author + information
- Received September 21, 2018
- Revision received November 30, 2018
- Accepted December 3, 2018
- Published online January 30, 2019.
- Anthony Aizer, MD, MSc∗ (, )
- Jessica K. Qiu, BS,
- Austin V. Cheng, BS,
- Patrick B. Wu, MD,
- Douglas S. Holmes, MD,
- Steven R. Wagner, MS,
- Scott A. Bernstein, MD,
- David S. Park, MD, PhD,
- Barbara Cartolano, RN,
- Chirag R. Barbhaiya, MD and
- Larry A. Chinitz, MD
- New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Medical Center, New York, New York
- ↵∗Address for correspondence:
Dr. Anthony Aizer, New York University Heart Rhythm Center, New York University Langone Medical Center, Tisch Hospital, Electrophysiology Laboratory, 560 First Avenue, 5th Floor, New York, New York, 10016.
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. We 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.
Dr. Aizer has served as a consultant for Biosense Webster; received research support from Abbott and SentreHEART; and received fellowship support from Abbott, Biotronic, Boston Scientific, and Medtronic. Dr. Park has received grant support from the National Institutes of Health (R01 HL132073). Dr. Barbhaiya has received speaking fees/honoraria from Abbott, Biotronic, Medtronic, and Zoll; and received research support from Biotronic. Dr. Chinitz has received speaking fees/honoraria from Abbott, Biosense Webster, Biotronik, Boston Scientific, and Medtronic; and served as a consultant for Abbott, Biosense Webster, Biotronik, Medtronic, and Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received September 21, 2018.
- Revision received November 30, 2018.
- Accepted December 3, 2018.
- 2019 American College of Cardiology Foundation
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