A Simple Teaching Intervention Significantly Decreases Radiation Exposure during Transbronchial Biopsy

The objective of this study was to assess the need for formal instruction on radiation safety and on a means to decrease radiation exposure during pulmonary procedures for healthcare workers and patients. Radiation safety is a major healthcare concern. No studies have examined the use of fluoroscopy and adherence to established safety guidelines in pulmonary medicine. We conducted our study at a tertiary university-affiliated referral center with a busy bronchoscopy unit. Patients underwent transbronchial biopsy with fluoroscopy guidance in a standard fashion. Data was collected unbeknownst to the operator and included patient demographics, fluoroscopy use in seconds, number of biopsies and attempts, established diagnosis, and complications. This was followed by a teaching intervention for all involved personnel, and the same data was obtained postintervention. Fluoroscopy use varied widely before the intervention and safety guidelines were not adhered to consistently. After intervention, the average exposure dropped from 121.5 seconds (range, 18-306 sec) to 41.7 seconds (range, 6-108 sec) (P <0.05), and accepted guidelines were uniformly followed. There was no change in complication rate or ability to establish a diagnosis. Formal training in radiation safety and in use of fluoroscopy should be mandatory. It decreases patient and staff exposure, and thus contributes to patient safety without sacrificing yield.