Background:
Radiation exposure to Veterans from invasive cardiac procedures is high and accounts for a substantial proportion of their overall exposure from medical imaging. The patient, provider and hospital factors associated with increased fluoroscopy time are unclear.
Methods:
From the National VA CART program database of catheterization laboratories, we evaluated the distribution of fluoroscopy time in patients undergoing coronary angiography (CA), bypass graft angiography (BGA) and/or PCI. Using multivariable logistic regression, we evaluated the patient, provider and hospital factors associated with the highest quartile of fluoroscopy time.
Results:
We examined 87,658 CA, BGA and PCI procedures performed by 362 operators at 58 VA facilities from 2007 through 2010. There is wide variation in fluoroscopy time by operator regardless of procedure performed (Table 1). Multiple patient, provider and hospital factors were associated with fluoroscopy times in the highest quartile. Patient factors included age and a history of peripheral arterial disease; provider factors included operator volume and experience; and hospital factors included whether or not they were associated with a teaching program.
Conclusion:
In a large VA national registry of all cardiac catheterization procedures, fluoroscopy time is highly variable and dependent on multiple factors, many of which may be modifiable. Quality improvement programs targeted at modifiable behaviors may lead to decreased fluoroscopy times and thus radiation exposure for our veterans.
An analysis of factors associated with increased fluoroscopy time or the need for complex techniques at IVC filter retrieval
