Reducing Patient Radiation Dosage during Pediatric SVT Ablations Using an “ALARA” Radiation Reduction Protocol in the Modern Fluoroscopic Era

Gellis, Laura A.; Ceresnak, Scott R.; Gates, Gregory J.; Nappo, Lynn; Pass, Robert H.

doi:10.1111/pace.12124

Cited by 38 publications

(26 citation statements)

References 22 publications

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“…37 In particular, a combination of very low frame rates (2-3 frames per second), antiscatter grid removal and avoidance of magnification was found to produce an excellent dose reduction for EPS procedures. 38 It should be noted, however, that higher doses can be justified if it can be demonstrated that patient outcome is improved accordingly.…”

Section: 4mentioning

confidence: 98%

Radiation doses from fluoroscopically guided cardiac catheterization procedures in children and young adults in the United Kingdom: a multicentre study

Harbron¹,

Pearce²,

Ja³

et al. 2015

BJR

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Section: 4mentioning

confidence: 98%

Radiation doses from fluoroscopically guided cardiac catheterization procedures in children and young adults in the United Kingdom: a multicentre study

Harbron¹,

Pearce²,

Ja³

et al. 2015

BJR

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“…18–23 Also the removal of the scatter grid, which resulted in poorer image quality, has been shown to reduce radiation by as much as two-fold. 24 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of a new very low dose imaging protocol: feasibility and impact on X-ray dose levels in electrophysiology procedures

Bourier¹,

Reents²,

Ammar-Busch³

et al. 2015

Europace

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AimsThis study presents and evaluates the impact of a new lowest-dose fluoroscopy protocol (Siemens AG), especially designed for electrophysiology (EP) procedures, on X-ray dose levels.Methods and resultsFrom October 2014 to March 2015, 140 patients underwent an EP study on an Artis zee angiography system. The standard low-dose protocol was operated at 23 nGy (fluoroscopy) and at 120 nGy (cine-loop), the new lowest-dose protocol was operated at 8 nGy (fluoroscopy) and at 36 nGy (cine-loop). Procedural data, X-ray times, and doses were analysed in 100 complex left atrial and in 40 standard EP procedures. The resulting dose–area products were 877.9 ± 624.7 µGym² (n = 50 complex procedures, standard low dose), 199 ± 159.6 µGym² (n = 50 complex procedures, lowest dose), 387.7 ± 36.0 µGym² (n = 20 standard procedures, standard low dose), and 90.7 ± 62.3 µGym² (n = 20 standard procedures, lowest dose), P < 0.01. In the low-dose and lowest-dose groups, procedure times were 132.6 ± 35.7 vs. 126.7 ± 34.7 min (P = 0.40, complex procedures) and 72.3 ± 20.9 vs. 85.2 ± 44.1 min (P = 0.24, standard procedures), radiofrequency (RF) times were 53.8 ± 26.1 vs. 50.4 ± 29.4 min (P = 0.54, complex procedures) and 10.1 ± 9.9 vs. 12.2 ± 14.7 min (P = 0.60, standard procedures). One complication occurred in the standard low-dose and lowest-dose groups (P = 1.0).ConclusionThe new lowest-dose imaging protocol reduces X-ray dose levels by 77% compared with the currently available standard low-dose protocol. From an operator standpoint, lowest X-ray dose levels create a different, reduced image quality. The new image quality did not significantly affect procedure or RF times and did not result in higher complication rates. Regarding radiological protection, operating at lowest-dose settings should become standard in EP procedures.

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“…Additionally, studies published in research literature have demonstrated that NMSs can confer the extra benefit of significantly reducing radiation exposure [10,14,32,33] during CA and also during paediatric electrophysiological procedures [9,13,24,25,26,30]. However, the use of NMSs during paediatric electrophysiological procedures is not a standard in many EP laboratories, and some colleagues are trying to reduce fluoroscopy exposure using low-dose fluoroscopy rather than utilizing NMSs [17,27,31].…”

Section: Introductionmentioning

confidence: 93%

The Benefit of a General, Systematic Use of Mapping Systems During Electrophysiological Procedures in Children and Teenagers: The Experience of an Adult EP Laboratory

et al. 2016

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Standard imaging during electrophysiological procedures (EPs) uses fluoroscopy. The aim of this study was to evaluate the feasibility, efficacy, safety and effect of an extended use of non-fluoroscopic mapping systems (NMSs) for imaging during paediatric EPs in an adult EP laboratory focusing on the amount of X-ray exposure. This study is a retrospective analysis that includes consecutive young patients (83 pts, aged between 8 and 18) who underwent EPs from March 2005 to February 2015. We compare the fluoroscopy data of two groups of pts: Group I, pts who underwent EPs from 2005 to 2008 using only fluoroscopy and Group II, pts who underwent EPs from 2008 to 2015 performed also using NMSs. The use of an NMS resulted in reduced fluoroscopy time in Group II {median value 0.1 min (95 % CI [0.00-1.07])} compared to Group I {median value 3.55 min (95 % CI [1.93-7.83]) (MW test, P < 0.05)}. There was a complementary reduction in the total X-ray exposure from 2.53 Gy cm(2) (95 % CI [1.51-4.66]) in Group I to 0.05 Gy cm(2) in Group II (95 % CI [0.00-1.22]) (MW test, P < 0.05). Regarding ablation procedures, the median effective dose decreased from 3.04 mSv (95 % CI [1.22-6.89]) to 0.25 mSv (95 % CI [0.00-0.60]) (MW test, P < 0.05). The use of an NMS dramatically reduces fluoroscopy time and total X-ray exposure during EPs in children and teenagers in an adult EP laboratory. In our experience, this reduction is mainly related to the systematic day-to-day use of NMSs.

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Reducing Patient Radiation Dosage during Pediatric SVT Ablations Using an “ALARA” Radiation Reduction Protocol in the Modern Fluoroscopic Era

Abstract: An ALARA protocol for ablation of SVT reduced radiation to below levels previously reported for combined EAM/fluoro approaches. Success rates were excellent with no complications and without the costs of EAM.

Cited by 38 publications

References 22 publications

Radiation doses from fluoroscopically guided cardiac catheterization procedures in children and young adults in the United Kingdom: a multicentre study

Radiation doses from fluoroscopically guided cardiac catheterization procedures in children and young adults in the United Kingdom: a multicentre study

Evaluation of a new very low dose imaging protocol: feasibility and impact on X-ray dose levels in electrophysiology procedures

The Benefit of a General, Systematic Use of Mapping Systems During Electrophysiological Procedures in Children and Teenagers: The Experience of an Adult EP Laboratory

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