A novel complete radiation protection system eliminates physician radiation exposure and leaded aprons.

BACKGROUND: Occupational health hazards associated with fluoroscopic-based procedures are well known, including a high prevalence of orthopedic problems, and those related to radiation exposure, particularly cancer and cataracts. This article reports the "first-in-man" clinical experience with a novel radiation protection system designed to eliminate radiation exposure to operators and thereby obviate the need for orthopedically burdensome leaded aprons. The Trinity Radiation Protection System consists of a combination of fixed shields, radiation drapes, and interconnecting flexible radiation resistant materials creating a complete radiation protection environment for the operators, yet maintaining full and unimpeded contact with the patient and total control of all operational elements of the catheterization equipment. METHODS AND RESULTS: This report constitutes an analysis of 19 nonrandomized cases in which operator radiation exposure data were collected (Trinity Radiation Protection System n = 10 cases versus standard shielding alone n = 9). In all cases performed with the Trinity System, there was neither any measurable significant radiation exposure in any anatomic region nor for the total case, whereas operators performing cases with standard shielding were exposed to radiation in all regions of their bodies (total per case exposure differences P < 0.0001). CONCLUSION: The novel radiation protection system described is the first to provide a complete radiation barrier that eliminates radiation exposure to operators, thereby obviating the need for orthopedically burdensome leaded aprons. This approach to radiation protection has promise to enhance the safety and occupational health of medical personnel in the catheterization laboratory.

Enhancing quality of care for acute myocardial infarction: shifting the focus of improvement from key indicators to process of care and tool use: the American College of Cardiology Acute Myocardial Infarction Guidelines Applied in Practice Project in Michigan: Flint and Saginaw Expansion.

OBJECTIVES: This project evaluated if by focusing on process changes and tool use rather than key indicator rates, the use of evidence-based therapies in patients with acute myocardial infarction (AMI) would increase. BACKGROUND: The use of tools designed to improve quality of care in the American College of Cardiology AMI Guidelines Applied in Practice Pilot Project resulted in improved adherence to evidence-based therapies for patients, but overall, tool use was modest. METHODS: The current project, implemented in five hospitals, was modeled after the previous project, but with greater emphasis on tool use. This allowed early identification of barriers to tool use and strategies to overcome barriers. Main outcome measures were AMI quality indicators in pre-measurement (January 1, 2001 to June 30, 2001) and post-measurement (December 15, 2001 to March 31, 2002) samples. RESULTS: One or more tools were used in 93% of patients (standard orders = 82%, and discharge document = 47%). Tool use was associated with significantly higher adherence to most discharge quality indicator rates with increases in aspirin, angiotensin-converting enzyme inhibitors, and smoking cessation and dietary counseling. Patients undergoing coronary artery bypass grafting (CABG) had low rates of discharge indicators. Patients undergoing percutaneous coronary revascularization were more likely to receive evidence-based therapies. CONCLUSIONS: These data validate the results of the pilot project that quality of AMI care can be improved through the use of guideline-based tools. Identifying and overcoming barriers to tool use led to substantially higher rates of tool use. The low rates of adherence to quality indicators in patients undergoing CABG suggest that these patients should be particularly targeted for quality improvement efforts.