Predictors of fluoroscopy time and estimated radiation exposure during radiofrequency catheter ablation procedures

Rosenthal, Lawrence; Mahesh, Mahadevappa; Beck, Thomas; Saul, J.Phillip; Miller, John M.; Kay, N. H.; Klein, Lawrence S.; Huang, S. Z.; Gillette, Paul C.; Prystowsky, Eric N.; Carlson, Mark D.; Berger, Ronald D.; Lawrence, John H.; Yong, Patrick; Calkins, Hugh

doi:10.1016/s0002-9149(98)00356-7

Cited by 116 publications

(57 citation statements)

References 23 publications

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“…Calkins et al 9 and Koovor et al 11 used 6 and 41 TLDs, respectively, attached to the skin for direct recording of radiation exposure. A third study by Rosenthal et al 12 used fluoroscopy times and technical factors of the x-ray equipment for estimation of radiation exposure. We refer to this method as the estimation method and used this calculation to compare with the direct and extrapolation methods.…”

Section: Methods To Determine Radiation Exposurementioning

confidence: 99%

Radiation Exposure During Catheter Ablation of Atrial Fibrillation

et al. 2004

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Background-The purpose of this study was to determine the radiation exposure during catheter ablation of atrial fibrillation (AF) using the pulmonary vein (PV) approach. Methods and Results-The study included 15 patients with AF and 5 patients each with atrial flutter and atrioventricular nodal reentrant tachycardia (AVNRT) who underwent fluoroscopically guided procedures on a biplane x-ray system operated at a low-frame pulsed fluoroscopy (7.5 frames per second). Radiation exposure was measured directly with 50 to 60 thermoluminescent dosimeters (TLDs). Peak skin doses (PSDs), effective radiation doses, and risk of fatal malignancies were all computed. Mean fluoroscopy durations for AF procedures were 67.8Ϯ21 minutes in the right anterior oblique (RAO) and 61.9Ϯ16.6 minutes in the left anterior oblique (LAO) projection, significantly different from that required for atrial flutter and AVNRT. The mean PSDs measured with the TLDs were 1.0Ϯ0.5 Gy in the RAO and 1.5Ϯ0.4 Gy in the LAO projection. The lifetime risk of excess fatal malignancies normalized to 60 minutes of fluoroscopy was 0.07% for women and 0.1% for men. Conclusions-The relatively small amounts of the patient's radiation exposure in this study, despite the prolonged fluoroscopy durations, can be attributed to the use of very-low-frame pulsed fluoroscopy, the avoidance of magnification, and optimal adjustments of the fluoroscopy exposure rates. The resulting lifetime risk of fatal malignancy is within the range previously reported for standard supraventricular arrhythmias.

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Section: Methods To Determine Radiation Exposurementioning

confidence: 99%

Radiation Exposure During Catheter Ablation of Atrial Fibrillation

et al. 2004

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“…2 The procedure is highly operator dependent and usually requires prolonged fluoroscopic exposure times. 3 The cardiovascular complications, at the time of catheter ablation procedures and during short-term follow-up, have been described in the literature. 4 -6 Recently, the issue of potential harmful radiation effects from catheter ablation procedures has gained increased concern, given that patients are commonly young adults, and fluoroscopy occasionally exceeds 1 hour and even results in skin injuries in some extremely rare cases.…”

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Accurate Assessment of Patient Effective Radiation Dose and Associated Detriment Risk From Radiofrequency Catheter Ablation Procedures

et al. 2001

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Background-Radiofrequency (RF) cardiac catheter ablation procedures may require extended fluoroscopic exposure resulting in elevated radiation risk. The aim of the present study was to accurately establish RF ablation radiation risk levels and to provide means for accurate patient risk estimation from studies performed in any electrophysiology laboratory. Methods and Results-Fluoroscopy required during cardiac ablation was classified into 4 types identified by beam orientation and irradiated tissue: (1) posteroanterior exposure during catheter advancing from the groin to the heart, (2) posteroanterior heart exposure, (3) left anterior oblique heart exposure, and (4) right anterior oblique heart exposure. The duration of each exposure was monitored in 24 patients undergoing RF cardiac ablation. Dose per minute of fluoroscopy was measured at 15 organs/tissues for each projection with the use of anthropomorphic phantom and thermoluminescence dosimetry. The effective dose rate was 219, 144, 136, and 112 Gy/min for groin-to-heart posteroanterior, posteroanterior, left anterior oblique, and right anterior oblique exposure, respectively. A typical ablation procedure results in a total effective dose of 8.3 mSv per hour of fluoroscopy. The average excess of fatal cancers was estimated to be 650 and 480 per million patients undergoing RF ablation requiring 1 hour of fluoroscopy for US and UK populations, respectively. The average risk for genetic defects was determined to be 1 per million births. Conclusions-Radiation risk from RF cardiac ablation is moderate compared with other complications, but it may highly exceed radiation risk from common radiological procedures. Efforts should be made toward minimization of patient radiation risk from RF ablation procedures. (Circulation. 2001;104:58-62.)

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“…High doses result from the prolonged fluoroscopy time often required for these studies. [1][2][3] The majority of patients who undergo catheter ablation procedures are young, with a mean age of Ϸ36 years. 4 Despite careful precautions, there will always be a few cases of catheter ablation procedures carried out in female patients of childbearing age when, during the first postconception weeks, a conceptus will be irradiated accidentally.…”

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Conceptus Radiation Dose and Risk From Cardiac Catheter Ablation Procedures

et al. 2001

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Background-The aim of the current study was to estimate the conceptus radiation dose and risk associated with fluoroscopic imaging during a catheter ablation procedure for supraventricular tachycardia performed on the expectant mother. Methods and Results-Exposure parameters and fluoroscopy times for each projection of the cardiac ablation procedure performed in 20 female patients of childbearing age were recorded. Radiation doses for a potential conceptus were estimated by using dose data obtained in anthropomorphic phantoms simulating pregnancy at the first, second, and third trimesters. Dose measurements were carried out using thermoluminescent dosimeters. For a typical examination, the average radiation dose to the conceptus was Ͻ1 mGy in all periods of gestation. Average excess fatal cancer was 14.5/10 6 unborn children irradiated during the first postconception weeks. Corresponding values for the second and third trimesters were 30 and 55.7/10 6 , respectively. The risk for hereditary effects in future generations was 1.5/10 6 cases for conceptus irradiation during the first postconception weeks. Corresponding values for the second and third trimesters were 3.0 and 5.6/10 6 , respectively. Formulas and dose data are presented for estimating the conceptus risk from any technique and x-ray system used for catheter ablation procedures. Conclusions-A typical catheter ablation procedure results in a very small increase in risk of harmful effects to the conceptus. However, estimation of conceptus dose from catheter ablation procedures is always needed to assess the risk to the individual developing in utero.

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Predictors of fluoroscopy time and estimated radiation exposure during radiofrequency catheter ablation procedures

Cited by 116 publications

References 23 publications

Radiation Exposure During Catheter Ablation of Atrial Fibrillation

Radiation Exposure During Catheter Ablation of Atrial Fibrillation

Accurate Assessment of Patient Effective Radiation Dose and Associated Detriment Risk From Radiofrequency Catheter Ablation Procedures

Conceptus Radiation Dose and Risk From Cardiac Catheter Ablation Procedures

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