TY - JOUR
T1 - Reducing radiation exposure in the electrophysiology laboratory
T2 - It is more than just fluoroscopy times!
AU - Nof, Eyal
AU - Lane, Christopher
AU - Cazalas, Maxime
AU - Cuchet-Soubelet, Elisabeth
AU - Michaud, Gregory F.
AU - John, Roy M.
AU - Tedrow, Usha
AU - Koplan, Bruce A.
AU - Stevenson, William G.
AU - Epstein, Laurence M.
N1 - Publisher Copyright:
© 2014 Wiley Periodicals, Inc.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Background To exposure in patients undergoing cardiac electrophysiology (EP) ablation. This included the use of a very low dose protocol, and the impact of angulations and patient body mass index (BMI) on radiation dose as a mean to reduce exposure. Methods A total of 212 retrospective patient data sets were collected during EP ablation procedures on a biplane fluoroscopy system. Dose metrics were computed based on dose-area product (DAP) measured by the system for each x-ray acquisition. Results Dose baselines of different ablation procedures were established as DAP and DAP per hour, with respect to patient BMI. The use of a very low dose protocol reduced exposure by 62% while providing adequate image quality. With approximate left anterior oblique (LAO) 50° and right anterior oblique (RAO) 30°, DAP and DAP rate were significantly higher in LAO compared to RAO (11.2 [4.8-25.3] Gy·cm2 vs 5.28 [2.9-11.1] Gy·cm2 and 74.0 [38.2-136.1] Gy·cm2/h vs 25.0 [16.4-44.1] Gy·cm2/h, respectively; P < 0.001). DAP and DAP rate were also significantly higher in patients with BMI > 30 vs BMI ≤ 30 (34.2 [22.3-58.7] Gy·cm2 vs 12.4 [6.0-26.9] Gy·cm2 and 84.9 [68.1-120.4] Gy·cm2/h vs 34.2 [21.7-52.9] Gy·cm2/h, respectively; P < 0.001). Conclusion Protocol setting, system angulation, and BMI, in particular, wider angulation in LAO compared to RAO plane, exposes patients to significant higher radiation doses. Obese patients in standard LAO plane receive six times the radiation dose of nonobese patients in RAO.
AB - Background To exposure in patients undergoing cardiac electrophysiology (EP) ablation. This included the use of a very low dose protocol, and the impact of angulations and patient body mass index (BMI) on radiation dose as a mean to reduce exposure. Methods A total of 212 retrospective patient data sets were collected during EP ablation procedures on a biplane fluoroscopy system. Dose metrics were computed based on dose-area product (DAP) measured by the system for each x-ray acquisition. Results Dose baselines of different ablation procedures were established as DAP and DAP per hour, with respect to patient BMI. The use of a very low dose protocol reduced exposure by 62% while providing adequate image quality. With approximate left anterior oblique (LAO) 50° and right anterior oblique (RAO) 30°, DAP and DAP rate were significantly higher in LAO compared to RAO (11.2 [4.8-25.3] Gy·cm2 vs 5.28 [2.9-11.1] Gy·cm2 and 74.0 [38.2-136.1] Gy·cm2/h vs 25.0 [16.4-44.1] Gy·cm2/h, respectively; P < 0.001). DAP and DAP rate were also significantly higher in patients with BMI > 30 vs BMI ≤ 30 (34.2 [22.3-58.7] Gy·cm2 vs 12.4 [6.0-26.9] Gy·cm2 and 84.9 [68.1-120.4] Gy·cm2/h vs 34.2 [21.7-52.9] Gy·cm2/h, respectively; P < 0.001). Conclusion Protocol setting, system angulation, and BMI, in particular, wider angulation in LAO compared to RAO plane, exposes patients to significant higher radiation doses. Obese patients in standard LAO plane receive six times the radiation dose of nonobese patients in RAO.
KW - catheter ablation
KW - electrophysiology
KW - radiation dosing
UR - http://www.scopus.com/inward/record.url?scp=84920885922&partnerID=8YFLogxK
U2 - 10.1111/pace.12544
DO - 10.1111/pace.12544
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C2 - 25486987
AN - SCOPUS:84920885922
SN - 0147-8389
VL - 38
SP - 136
EP - 145
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
IS - 1
ER -