Ultra‐low radiation dose during electrophysiology procedures using optimized new generation fluoroscopy technology

Crowhurst, J.; Haqqani, Haris M.; Wright, D.; Whitby, M.; Lee, Adam F.; Betts, J.; Denman, R.

doi:10.1111/pace.13141

Cited by 11 publications

(7 citation statements)

References 22 publications

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“…On the other hand, our favorable results in reducing median DAP using customized parameters are encouraging, as also shown by the latest published studies assessing the effect of new technologies dedicated to dose reduction …”

Section: Discussionsupporting

confidence: 60%

“…Nonfluoroscopic mapping systems with electromagnetic guidance or new shielding equipment result in dose reduction, but they are not commonly used. Improvements in X‐ray generator software, the use of low frame rate fluoroscopy, new generators, and recent technological advances in coronary sinus leads have been shown to reduce radiation exposure, particularly in young patients . The objectives of this study were to describe current radiation protection practices during the implantation of cardiac devices, define dose reference levels, and assess radiation exposure based on the devices currently in use.…”

Section: Introductionmentioning

confidence: 99%

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Radiation exposure during cardiac device implantation: Lessons learned from a multicenter registry

Bru

Dompnier

Amara

et al. 2019

Pacing Clinical Electrophis

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Background:Little data are available about radiation exposure during cardiac electrical device implantation, and no dose reference levels have been published. This multicenter, prospective, observational study assesses patient and staff radiation exposure during cardiac device implantations, and aims at defining dose reference levels. Methods: Patient demographic, procedural, and radiation data were obtained for 657 procedures from nine institutions. Physician and staff exposure were measured using real-time dosimeters worn beneath and above lead apron. Statistical analysis included fluoroscopy time (FT), dose-area product (DAP), and DAP adjusted for FT and body mass index. Results: Pacemakers and cardioverter defibrillators were implanted in 481 and 176 patients, respectively. Of these, 152 were treated with cardiac resynchronization therapy (CRT). Median FTs were 837s (interquartile range [IQR]: 480-1323), 117s (IQR: 69-209), and 101s (IQR: 58-162), and median DAPs were 1410 (IQR: 807-2601), 150 (IQR: 72-338), and 129 (IQR: 72-332) cGy.cm 2 for biventricular, dual chamber, and ventricular device implantation, respectively. Dose reference levels correspond to the third quartile values. During CRT, higher exposure was observed with four X-ray systems than with the two newer and customizable ones (adjusted DAP of 0.90 [IQR: 0.26-1.01] and 0.29 [IQR: 0.23-0.39], respectively; P < .001). Conclusion: Based on real-life measurements, this multicenter registry provides dose reference levels and may help centers assess radiation exposure. Although biventricular device implantation was responsible for the highest radiation exposure, FT was meaningfully shortened compared to previously reported values. For a same FT, the use of new generators and custom settings has significantly reduced DAP. K E Y W O R D S cardiac resynchronization therapy, defibrillators, implantable, radiation exposure, radiation monitoring1 BACKGROUND Patient exposure to X-rays during cardiac interventions is high and may have deleterious effects, including an increased risk of develop-ing cancer. 1 Unlike most diagnostic procedures using ionizing radiation, dose reference levels in cardiology for coronary angioplasty have only recently been established from multicenter studies. 2 The complexity of cardiac rhythm device implantations is steadily increasing, Pacing Clin Electrophysiol. 2020;43:87-92. c

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Radiation exposure during cardiac device implantation: Lessons learned from a multicenter registry

Bru

Dompnier

Amara

et al. 2019

Pacing Clinical Electrophis

View full text Add to dashboard Cite

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“…There is far less radiation incurred for pacemaker implantation or revision, EP study, or standard radiofrequency ablation, although variances are wide between reported doses. 22…”

Section: Specific Task-based Alternativesmentioning

confidence: 99%

Minimizing Radiation in the Modern Electrophysiology Laboratory

Rogers¹,

Brodt²

2018

J Innov Cardiac Rhythm Manage.

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Historically, the electrophysiology laboratory has relied heavily on the use of ionizing radiation in the form of fluoroscopy for a broad range of interventions and diagnostics. As the harmful effects of radiation have become increasingly recognized and procedural technologies have advanced, electrophysiologists have adopted new workflows. The purpose of this article is to review the available literature and experience in minimizing radiation in the modern electrophysiology laboratory. This review first covers general approaches to reducing fluoroscopy radiation in the electrophysiology suite, with concepts that apply across all procedure types. These include the reduction of infrared emission through fastidious fluoroscopy settings, new and proven solutions for radiation shielding, and methods of creating distance between the radiation source and the operator to reduce exposure. Following this discussion, we review specific task-based techniques for reducing radiation during special electrophysiologic procedures and workflows such as vascular access, coronary sinus lead placement, catheter manipulation, and periprocedural planning studies.

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“…Lowering fluoroscopy pulse rates are also a particularly important dose reduction tool during electrophysiology procedures as electrophysiology procedures perform few digital acquisitions so the majority of the radiation exposure comes from fluoroscopy. In a previous study, a modern X‐ray system, with low fluoroscopy pulse rates and a low dose per pulse was demonstrated to reduce DAP by over 90%, when compared to an older generation system . That study also tailored the image processing to this low pulse rate and low dose rate protocol.…”

Section: Electrophysiology Proceduresmentioning

confidence: 99%

Lowering fluoroscopy pulse rates to reduce radiation dose during cardiac procedures

Crowhurst

Whitby

2018

J of Medical Radiation Sci

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Radiation dose to patients undergoing cardiac imaging procedures in cardiac catheterisation laboratories (cath labs) can be relatively high, so implementing strategies to reduce dose is important. Lowering the fluoroscopy pulse rate is a simple, yet effective method to reduce radiation dose. Sensible, iterative changes made in this area have the potential for significant patient and staff radiation dose reduction.

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Ultra‐low radiation dose during electrophysiology procedures using optimized new generation fluoroscopy technology

Abstract: An optimized contemporary digital fluoroscopy system, with low radiation dose configuration and continued good procedural practice, can result in ultra-low radiation levels for all electrophysiology procedures, without compromising procedural time or procedural success.

Cited by 11 publications

References 22 publications

Radiation exposure during cardiac device implantation: Lessons learned from a multicenter registry

Radiation exposure during cardiac device implantation: Lessons learned from a multicenter registry

Minimizing Radiation in the Modern Electrophysiology Laboratory

Lowering fluoroscopy pulse rates to reduce radiation dose during cardiac procedures

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