RSNA: Fluoro times for CVC procedures doubled when performed by resident vs. staff rad

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 -  Follow-Up of Radiologically Totally Implanted Central Venous Access Ports of the Upper Arm
64-year-old woman. Angiography confirmed appropriate placement of totally implanted central venous access port.
Source: AJR 2012;199(2):447-452

CHICAGO—Fluoroscopy times for image-guided central venous catheters (CVC) by radiology residents are double those of staff radiologists, according to a study presented Nov. 26 at the annual Radiological Society of North America (RSNA) meeting. The researchers recommended that the initiation of programs to monitor and manage trainee fluoroscopy may minimize patient and staff dose.

During the study presentation, Interventional Radiologist, Richard L. Duszak, Jr., MD, noted the “scrutiny of medical radiation both for the medical community and for the patients.” Based on Medicare trending data, radiologists are now the dominant providers for CVC procedures. In training institutions, residents frequently serve as the primary operator for interventional rotation for many of these procedures. “Despite this common practice, radiation exposure both to the patient and resident associated with cases conducted by physicians-in-training has received very little attention,” he added.

Thus, Duszak and his colleagues at Radiology of Mid South Imaging and Therapeutics in Memphis, Tenn., sought to evaluate differences in CVC fluoroscopy time for interventional radiology procedures performed by residents vs. staff radiologists. “While flouroscopy time is the least useful metric of radiation exposure, it is the simplest and easiest to track that Medicare has put forth,” he said.

To minimize inter-service and complexity variables, the researchers targeted stand-alone temporary internal jugular CVC procedures for analysis, and used CPT codes to screen index services. “We tried to keep the procedures as simple as possible to minimize compounding variables,” Duszak said.

For the study, they reviewed reports and images from 1,067 temporary central venous catheter services from two hospitals over two years (2008-2009). They also compiled and analyzed insertion site, catheter type (e.g., smaller triple lumen vs. larger hemodialysis), resident identification, staff identification and documented fluoroscopy times.

With clinical (e.g., concomitant venous angioplasty) and anatomic (e.g., subclavian access) exclusions, 537 cases with complete records were available for analysis. In 128 procedures, 19 residents were primary operators (1-29 each). In 409 procedures, seven staff radiologists were the primary operators (1-130 each). Distribution of resident procedures (82 percent right, 66 percent large lumen) was similar to that of staff (79 percent right, 63 percent large lumen).  

The research team found that mean fluoroscopy times for resident services were twice as long as that for staff services (1.24 minutes vs. 0.63 minutes)—a statistically significant difference. Fluoroscopy times varied little by post-graduate year status (PGY-2 through PGY-5: 1.16, 1.45, 1.25, 1.21 minutes), but varied much more by supervising staff (range: 0.70 to 1.43 minutes).

When central venous catheters are placed by radiology residents, fluoroscopy time is double that for identical procedures performed by staff radiologists, the researchers found. “Similar discrepancies likely exist for other interventional radiologic procedures,” they concluded. “Residency training programs should initiate measures to monitor and manage fluoroscopy during interventional procedures, so as to minimize dose to both patients and trainees alike.”