This post was authored by Aimee K. Armstrong, MD, FACC, co-director of the ACC’s Reducing Radiation Risk Quality Improvement Initiative

The treatment of congenital heart disease (CHD) often includes multiple diagnostic and interventional cardiac catheterizations, which give repeated patient exposure to ionizing radiation. There is growing concern regarding the adverse effects of the cumulative radiation exposure, particularly in children, whose organs are still developing. Developing organs are more sensitive than mature organs to the induction of certain cancers from radiation exposure. In addition, children have a longer life span than adults, during which to manifest the possible detrimental effects of the exposure. The long-term effects (stochastic injuries) are not the only concern, as large skin doses can also lead to radiation burns (deterministic effects). In fact, the Joint Commission has deemed a peak skin dose of >1500 rads a sentinel event. With interventional catheterizations for CHD becoming more complex and lengthy, particularly with the introduction of transcatheter valve therapy, there is a need to pay particular attention to the cumulative radiation dose that our patients receive and we need to seek ways to decrease this dose whenever possible.

To that end, the ACC’s Reducing Radiation Risk quality improvement initiative was launched in 2013 and is the first NCDR quality initiative with the focus of reducing the amount of radiation exposure received by the patient. This activity offersAmerican Board of Pediatrics (ABP) Maintenance of Certification (MOC) Part IV credit, with the goals of(1) improving CHD patient outcomes by reducing radiation exposure received by patients undergoing congenital cardiac cath by 25 percent from baseline and (2) cultivating quality improvement program capabilities in catheterization programs and hospitals.

The Reducing Radiation Risk initiative was the focus of a special session at ACC.14 in Washington, DC. The session co-chairs: Robert Beekman III, MD, FACC, Kathy Jenkins, MD, MPH, FACC, and Gerard Martin, MD, FACC, introduced the project and gave an overview of the key driver strategies and data collection. Lisa Bergersen, MD, MPH, FACC, reviewed the science of quality improvement, and then Jack Rome, MD, Robert Vincent, MD, CM, FACC, and I gave talks on specific change strategies within the key drivers, as well as tips for forming cath lab quality improvement teams.  Lessons learned from early team formation and project initiation were also shared. Participation by all centers participating in the IMPACT Registry is encouraged, even if ABP MOC is not needed.

The first and second quarters of IMPACT Registry data from 2014 have been released, and we are excited to share these results with all participating IMPACT Centers. Currently, 15 of the 90 IMPACT Registry centers are engaged in the initiative.  If you are participating in an IMPACT Center and care for patients in the cath lab, please enroll with the Reducing Radiation Risk quality improvement initiative. Your support and involvement with improving the care of CHD patients is critical.

All CHD team members, including cath technicians and nurses, are encouraged to sign up for the initiative at CardioSource.org/ReducingRadiationRiskMOD.

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