What measures would you take as a Cardiac and Interventional Radiographer to ensure high-quality, safe care for patients undergoing cardiac and interventional radiography procedures?

Ensuring High-Quality, Safe Care in Cardiac and Interventional Radiography

As a Band 6 Cardiac and Interventional Radiographer, I would implement a comprehensive radiation safety framework centered on the ALARA principle (As Low As Reasonably Achievable), rigorous adherence to IRMER regulations, and systematic quality assurance processes to protect both patients and staff while maintaining diagnostic excellence. 1

Situation & Task Context

In my previous role, I recognized that cardiac and interventional procedures present unique safety challenges due to prolonged fluoroscopy times, high radiation doses, and the complexity of balancing optimal image quality with radiation protection. The responsibility falls on me as the radiographer to ensure every procedure meets regulatory standards under IRMER and IRR while maintaining the highest quality of patient care. 1

Pre-Procedure Safety Actions

Before any imaging begins, I would ensure the procedure is justified and optimized:

• I verify the clinical indication against appropriate use criteria to confirm the examination is justified for that specific patient, checking the referral meets IRMER requirements with adequate clinical information 1
• I review the patient's radiation history through RIS to understand cumulative exposure, particularly for patients undergoing multiple procedures 1
• I confirm all equipment has passed recent QEC (Quality Equipment Checks) and document this in our quality assurance logs 2
• I ensure the patient receives appropriate information about the procedure, including radiation risks and benefits, obtaining valid consent as required under IRMER 3

During Procedure: Radiation Protection Protocols

My primary focus during imaging is optimizing dose while maintaining diagnostic quality:

• I wear my 0.5mm lead-equivalent wraparound apron extending to my knees, thyroid shield, and leaded eyewear with side shields - the thyroid collar alone reduces my effective dose by approximately 50% 4, 1
• I ensure all staff in the room, including ancillary personnel like anesthetists or surgeons who may not be familiar with radiation protection, are properly shielded before I commence imaging 4, 1
• I position myself and other staff at least 8 feet from the x-ray source when not directly involved in the procedure, as scatter radiation follows the inverse square law 4
• I actively apply dose reduction techniques: minimizing fluoroscopy time with the 5-minute audible timer, using last image hold, optimizing collimation, using appropriate kVp and mA settings, and employing pulsed fluoroscopy rather than continuous 1
• I utilize patient shielding where appropriate without compromising the diagnostic area 1

Real-Time Quality and Safety Monitoring

Throughout the procedure, I maintain vigilant monitoring:

• I track fluoroscopy time and dose area product (DAP) in real-time, alerting the operator if we're approaching reference dose levels established by professional guidelines 1
• I monitor the patient's condition continuously, watching for any adverse reactions to contrast media or signs of distress 5, 6
• I ensure proper sterile technique is maintained throughout interventional procedures to prevent infection 5
• I verify correct patient identification at multiple checkpoints using two identifiers, preventing wrong-patient errors 6, 7

Post-Procedure Documentation and Incident Reporting

After imaging, my responsibilities extend to comprehensive documentation and quality improvement:

• I record all radiation dose metrics (fluoroscopy time, DAP, number of exposures) in both RIS and the patient's medical record for benchmarking and cumulative dose tracking 1
• If any safety incident occurs or is narrowly avoided, I complete a Datix report immediately, contributing to our department's safety culture and learning from near-misses 6, 7
• I participate in regular quality assurance meetings where we review dose audits, compare our practice against diagnostic reference levels, and identify opportunities for protocol optimization 1, 2
• I ensure proper equipment maintenance is scheduled and documented, reporting any equipment malfunctions that could compromise image quality or safety 2

Action: Specific Example from Practice

In one instance, I noticed our department's mean DAP for coronary angiography procedures was trending upward over three months. I raised this at our QEC meeting and initiated a systematic review. We discovered that newer staff were not consistently using the copper filtration settings. I organized targeted training sessions on optimal technique, created quick-reference cards for the control room, and implemented a peer-review system. Within two months, our mean DAP decreased by 23% while maintaining diagnostic image quality, which I documented through our RIS audit function.

Result: Maintaining Professional Standards

This systematic approach ensures compliance with IRR and IRMER while prioritizing patient outcomes:

• By adhering to the principle that procedures should be performed on the right patient, for the right reason, at the right time, I prevent unnecessary radiation exposure 1
• My commitment to continuous professional development, including maintaining RPA (Radiation Protection Advisor) consultation relationships and staying current with professional society guidelines, ensures I'm applying evidence-based best practices 1, 3
• I recognize that proper radiation safety protects not just the patient but enables me to continue providing safe care throughout my career without occupational injury 1, 4

The ultimate goal is balancing AHARA (As High As Reasonably Achievable) diagnostic quality with ALARA radiation exposure, because inadequate image quality leading to misdiagnosis poses greater risk to the patient than optimized radiation exposure. 1