Radiation Safety Performance is More than Simply Measuring Doses! Development of a Radiation Safety Rating Scale

Purpose: Radiation safety performance is often evaluated using dose parameters measured by personal dosimeters and/or the C-arm, which provide limited information about teams’ actual radiation safety behaviors. This study aimed to develop a rating scale to evaluate team radiation safety behaviors more accurately and investigate its reliability. Materials and Methods: A modified Delphi consensus was organized involving European vascular surgeons (VS), interventional radiologists, and interventional cardiologists. Initial items and anchors were drafted a priori and rated using five-point Likert scales. Participants could suggest additional items or adjustments. Consensus was defined as ≥ 80% agreement (rating ≥ 4) with Cronbach’s alpha ≥.80. Two VS with expertise in radiation safety evaluated 15 video-recorded endovascular repairs of infrarenal aortic aneurysms (EVAR) to assess usability, inter and intrarater reliability. Results: Thirty-one of 46 invited specialists completed three rating rounds to generate the final rating scale. Five items underwent major adjustments. In the final round, consensus was achieved for all items (alpha =.804; agreement > 87%): ‘Pre-procedural planning’, ‘Preparation in angiosuite/operating room’, ‘Shielding equipment’, ‘Personal protective equipment’, ’Position of operator/team’, ‘Radiation usage awareness’, ‘C-arm handling’, ‘Adjusting image quality’, ‘Additional dose reducing functions’, ‘Communication/leadership’, and ‘Overall radiation performance and ALARA principle’. All EVARs were rated, yielding excellent Cronbach’s alpha (.877) with acceptable interrater and excellent intrarater reliability (ICC =.782; ICC =.963, respectively). Conclusion: A reliable framework was developed to assess radiation safety behaviors in endovascular practice and provide teams with formative feedback. The final scale is provided in this publication.