Reducing radiation exposure during procedures performed in the electrophysiology laboratory

被引：12
作者：
Thibault, Bernard [1 ,2 ]
Macle, Laurent [1 ,2 ]
Mondesert, Blandine [1 ,2 ]
Dubuc, Marc [1 ,2 ]
Shohoudi, Azadeh [3 ]
Dyrda, Katia [1 ,2 ]
Guerra, Peter G. [1 ,2 ]
Rivard, Lena [1 ,2 ]
Roy, Denis [1 ,2 ]
Talajic, Mario [1 ,2 ]
Khairy, Paul [1 ,2 ]
机构：
[1] Univ Montreal, Montreal Heart Inst, Electrophysiol Serv, Montreal, PQ, Canada
[2] Univ Montreal, Dept Med, Montreal, PQ, Canada
[3] Univ Montreal, Montreal Hlth Innovat Coordinating Ctr, Montreal Heart Innovat Coordinating Ctr, Montrel Heart Inst, Montreal, PQ, Canada
来源：
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY | 2018年 / 29卷 / 02期
关键词：
cardiac implantable electronic device; catheter ablation; fluoroscopy; interventional electrophysiology; radiation exposure; radiation safety; CARDIAC RESYNCHRONIZATION THERAPY; ATRIAL-FIBRILLATION ABLATION; CATHETER TRACKING SYSTEM; IMAGE INTEGRATION MODULE; PULMONARY VEIN ISOLATION; INITIAL-EXPERIENCE; INTERVENTIONAL CARDIOLOGY; RANDOMIZED-TRIAL; IMPLANTATION; PATIENT;
D O I：
10.1111/jce.13373
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Introduction: Expert societies recently published strong recommendations to reduce the exposure of patients and staff to ionizing radiation (IR) during interventional and electrophysiology (EP) procedures. However, adherence to these guidelines remains difficult and the impact of implementing such recommendations is poorly characterized. Methods and results: We conducted a single-center cohort study to quantify radiation exposure over time in three EP laboratories at the Montreal Heart Institute during 5,546 consecutive procedures from 2012 to 2015 by 11 primary operators. Overall, 2,618 (47.2%) procedures were catheter-based and 2,928 (52.8%) were device interventions. Interventions to reduce radiation exposure included educational initiatives to raise awareness (i.e., limiting cine acquisition, patient position, table height), slower frame rate, lower radiation dose per pulse, collimation, and integration with 3-D mapping systems and/or MediGuide technology. An 85% reduction in IR exposure was observed from 2012 to 2015, with the mean dose-area-product (DAP) decreasing from 7.65 +/- 0.05 Gy.cm(2) to 1.15 +/- 0.04 Gy.cm(2) (P < 0.001). This was true for catheter-based procedures (mean DAP 16.99 +/- 0.08 to 2.00 +/- 0.06 Gy.cm(2), P < 0.001) and device interventions (mean DAP 4.18 +/- 0.06 to 0.64 +/- 0.05 Gy.cm(2), P < 0.001). The median effective dose of IR recorded per quarter by 282 cervical dosimeters on EP staff decreased from 0.57 (IQR 0.18, 1.03) mSv in 2012 to 0.00 (IQR 0.00, 0.19) mSv in 2015, P < 0.001. Conclusion: Enforcing good clinical practices with simple measures and low-dose fluoroscopy settings are highly effective in reducing IR exposure in the EP lab. These promising results should encourage other EP labs to adopt similar protective measures.
引用
收藏
页码：308 / 315
页数：8
相关论文
共 35 条
[11]  
Cousins C., 2013, Annals of the ICRP, V42, P9, DOI 10.1016/j.icrp.2012.09.001
[12]   Sensor-Based Electromagnetic Navigation to Facilitate Implantation of Left Ventricular Leads in Cardiac Resynchronization Therapy [J].
Doering, Michael ;
Sommer, Philipp ;
Rolf, Sascha ;
Lucas, Johannes ;
Breithardt, Ole A. ;
Hindricks, Gerhard ;
Richter, Sergio .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2015, 26 (02) :167-175
[13]  
Douglas Pamela S, 2012, J Am Coll Cardiol, V59, P1833, DOI 10.1016/j.jacc.2012.01.005
[14]   Recommendations for occupational radiation protection in interventional cardiology [J].
Duran, Ariel ;
Hian, Sim Kui ;
Miller, Donald L. ;
Le Heron, John ;
Padovani, Renato ;
Vano, Eliseo .
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2013, 82 (01) :29-42
[15]   Coronary sinus side branches for cardiac resynchronization therapy: Prospective evaluation of availability, implant success, and procedural determinants [J].
Duray, Gabor Z. ;
Hohnloser, Stefan H. ;
Israel, Carsten W. .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2008, 19 (05) :489-494
[16]   Obesity is a major determinant of radiation dose in patients undergoing pulmonary vein isolation for atrial fibrillation [J].
Ector, Joris ;
Dragusin, Octavian ;
Adriaenssens, Bert ;
Huybrechts, Wim ;
Willems, Rik ;
Ector, Hugo ;
Heidbuechel, Hein .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2007, 50 (03) :234-242
[17]   Patient-Centered Imaging Shared Decision Making for Cardiac Imaging Procedures With Exposure to Ionizing Radiation [J].
Einstein, Andrew J. ;
Berman, Daniel S. ;
Min, James K. ;
Hendel, Robert C. ;
Gerber, Thomas C. ;
Carr, J. Jeffrey ;
Cerqueira, Manuel D. ;
Cullom, S. James ;
DeKemp, Robert ;
Dickert, Neal W. ;
Dorbala, Sharmila ;
Fazel, Reza ;
Garcia, Ernest V. ;
Gibbons, Raymond J. ;
Halliburton, Sandra S. ;
Hausleiter, Joerg ;
Heller, Gary V. ;
Jerome, Scott ;
Lesser, John R. ;
Raff, Gilbert L. ;
Tilkemeier, Peter ;
Williams, Kim A. ;
Shaw, Leslee J. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2014, 63 (15) :1480-1489
[18]   Approaches to Enhancing Radiation Safety in Cardiovascular Imaging A Scientific Statement From the American Heart Association [J].
Fazel, Reza ;
Gerber, Thomas C. ;
Balter, Stephen ;
Brenner, David J. ;
Carr, J. Jeffrey ;
Cerqueira, Manuel D. ;
Chen, Jersey ;
Einstein, Andrew J. ;
Krumholz, Harlan M. ;
Mahesh, Mahadevappa ;
McCollough, Cynthia H. ;
Min, James K. ;
Morin, Richard L. ;
Nallamothu, Brahmajee K. ;
Nasir, Khurram ;
Redberg, Rita F. ;
Shaw, Leslee J. .
CIRCULATION, 2014, 130 (19) :1730-1748
[19]   The dream of near-zero X-rays ablation comes true [J].
Gaita, Fiorenzo ;
Guerra, Peter G. ;
Battaglia, Alberto ;
Anselmino, Matteo .
EUROPEAN HEART JOURNAL, 2016, 37 (36) :2749-2755B
[20]   Reducing radiation exposure in the electrophysiology laboratory: A work in progress [J].
Gianni, Carola ;
Natale, Andrea .
HEART RHYTHM, 2017, 14 (06) :817-818
1234