Patients and operators are routinely exposed to high doses of ionizing radiation during catheterization procedures. This increased exposure to ionizing radiation is partially due to a lack of awareness to the effects of ionizing radiation, and lack of knowledge on the distribution and behaviour of scattered radiation. Our study aimed to evaluate the effectiveness of mentored simulation training (ST) in ionizing radiation protection during coronary angiography and to assess the transferability of acquired skills from virtual reality to the real world. Ten cardiology residents performed 5 consecutive real-life coronary angiographies in the catheterization laboratory before and after ST. Skill metrics measures concerned global procedure skill score and radiation procedure score.

During virtual ST, fluoroscopic time (P<0.01) significantly decreased and global radioprotection score (3±2.1 vs. 7±3.9, P<0.01) significantly improved. In real-life cases, procedure time was shorter (P<0.01), contrast amount lower (P<0.04) and the global procedure skill score were higher (P=0.001) after ST as compared to the control (before ST) group. Moreover, fluoroscopic time (5.4±3.6 vs. 3.6±2.7min, P<0.04), dose area product (2600±25,000 vs. 1715±2552μGy.m², P<0.02) and air Kerma product (159±219 vs. 116±194mGy, P=0.05) were significantly lower after ST. In total, radioprotection score (2±1.9 vs. 4±1.9, P<0.01) also improved after ST.

In conclusion, simulator-based training in coronary angiography improved operator skills compared to traditional in catheterization laboratory mentor-based training including education in radiation protection. As a result of simulator training, the operator gains knowledge, which can then be applied in the catheterization laboratory in order to reduce radiation doses to the patient and to the operator.