Radiation Exposure of Patient and Physician during Implantation and Upgrade of Cardiac Resynchronization Devices

Methods: Dosimetry data were prospectively recorded in a series of 104 consecutive patients, who underwent resynchronization device implantation or upgrade in our cardiac catheterization laboratory. Five Chipstrate dosimeters were fixed to the patient's skin around the thorax (right and left paravertebral, right and left parasternal, and sternal positions), one dosimeter was attached to the forehead, and one to the pubis. The operator was equipped with one dosimeter on the forehead at eye level and a ring dosimeter was worn on the right hand. Results: Based on the maximum radiation dose of 9.2 mSv measured at the operator's hand in a single implantation session, it might be recommended to conservatively limit the number of implantations to four per month (an annual limit value of 500 mSv). At a mean dose of 1.2 mSv, this number can be increased sevenfold. Conclusion: In patients, incipient deterministic radiation effects can theoretically be observed at dose area product > 400 Gy center dot cm2, a dose applied in 2.9% of CRT implantation procedures. Special follow-up programs are considered necessary for these patients and for operators, as the latter may be exposed over many years given the unknown long-term impact of chronic radiation exposure and the nature of current complex electrophysiology and device procedures. (PACE 2010; 1003-1012).