Physicians’ exposure to radiation during electrophysiology procedures

Faroux, Laurent; Daval, Charline; Lesaffre, François; Blanpain, Thierry; Chabert, Jean-Pierre; Martin, Angeline; Guinot, Mathias; Luconi, Nicolas; Espinosa, Marisa González Montero de; Nazeyrollas, Pierre; Tourneux, Christophe; Metz, Damien

doi:10.1007/s10840-019-00568-1

Cited by 8 publications

(6 citation statements)

References 20 publications

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“…procedures are associated with increasing the radiation doses. Estimation of the radiation doses in staff have a wide variation across the literatures as a result of the levels of complexity of the procedures [1,3,[23][24][25]. This phenomenon is comparable with our staff radiation doses.…”

Section: Plos Onesupporting

confidence: 69%

Cardiac catheterization real-time dynamic radiation dose measurement to estimate lifetime attributable risk of cancer

Lin

Yang

et al. 2020

PLoS ONE

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Cardiac catheterization procedure is the gold standard to diagnose and treat cardiovascular disease. However, radiation safety and cancer risk remain major concerns. This study aimed to real-time dynamic radiation dose measurement to estimate lifetime attributable risk (LAR) of cancer incidence and mortality in operators. Coronary angiography (CA) with percutaneous coronary intervention (PCI), CA, and others (radiofrequency ablation, pacemaker and defibrillator implantation) procedures with different beam directions, were undertaken on x-ray angiography system. A real-time electronic personal dosimeter (EPD) system was used to measure the radiation dose of staff during all procedures. We followed the Biological Effects of Ionizing Radiation (BEIR) VII report to estimate the LAR of all cancer incidence and mortality. Primary operators received radiation dose in CA with PCI, CA, and others procedures were 59.33 ± 95.03 μSv, 39.81 ± 103.85 μSv, and 21.92 ± 37.04 μSv, respectively. As to the assistant operators were 30.03 ± 55.67 μSv, 14.67 ± 14.88 μSv, and 4 μSv, respectively. LAR of all cancer incidences for staffs aged from 18 to 65 are varied from 0.40% for males to 1.50% for females. LAR of all cancer mortality for staffs aged from 18 to 65 are varied from 0.22% for males to 0.83% for females. Our study provided an easy, realtime and dynamic radiation dose measurement to estimate LAR of cancer for staff during the cardiac catheterization procedures. The LAR for all cancer incidence is about twice that for cancer mortality. Although the radiation doses of staff are lower during each procedure, the increased years of service leads to greater radiation risk to the staff.

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Section: Plos Onesupporting

confidence: 69%

Cardiac catheterization real-time dynamic radiation dose measurement to estimate lifetime attributable risk of cancer

Lin

Yang

et al. 2020

PLoS ONE

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“…Scant data exist on personal dosimetry regarding atrial fibrillation ablation. A 2019 study reported mean values of 3 µSv with a mean DAP of 429.6 cGy ∙ cm 2 [ 10 ]. Those results were achieved by using a frame rate of 4 FPS.…”

Section: Discussionmentioning

confidence: 99%

Results from a real-time dosimetry study during left atrial ablations performed with ultra-low dose radiation settings

Schreiber

Kähler

Biewener

et al. 2021

Herzschr Elektrophys

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Background Three-dimensional mapping systems and the use of ultra-low dose radiation protocols have supported minimization of radiation dose during left atrial ablation procedures. By using optimal shielding, scattered radiation reaching the operator can be further reduced. This prospective study was designed to determine the remaining operator radiation exposure during left atrial catheter ablations using real-time dosimetry. Methods Radiation dose was recorded using real-time digital dosimetry badges outside the lead apron during 201 consecutive left atrial fibrillation ablation procedures. All procedures were performed using the same X‑ray system (Siemens Healthineers Artis dBc; Siemens Healthcare AG, Erlangen, Germany) programmed with ultra-low dose radiation settings including a low frame rate (two frames per second), maximum copper filtration, and an optimized detector dose. To reduce scattered radiation to the operators, table-suspended lead curtains, ceiling-suspended leaded plastic shields, and radiation-absorbing shields on the patient were positioned in an overlapping configuration. Results The 201 procedures included 139 (69%) pulmonary vein isolations (PVI) (20 cryoballoon ablations, 119 radiofrequency ablations, with 35 cases receiving additional ablation of the cavotricuspid isthmus) and 62 (31%) PVI plus further left atrial substrate ablation. Mean radiation dose measured as dose area product for all procedures was 128.09 ± 187.87 cGy ∙ cm2 with a mean fluoroscopy duration of 9.4 ± 8.7 min. Real-time dosimetry showed very low average operator doses of 0.52 ± 0.10 µSv. A subanalysis of 51 (25%) procedures showed that the radiation burden for the operator was highest during pulmonary vein angiography. Conclusion The use of ultra-low dose radiation protocols in combination with optimized shielding results in extremely low scattered radiation reaching the operator.

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“…Reducing patient radiation exposure during an ablation procedure is important because ablation procedure is sometimes required repeat procedures to eliminate arrhythmia for one patient. Furthermore, operators' radiation exposure is also not negligible 17 . Operators wear radiation‐protective equipment, neck guard, and eye glasses, although chronically exposed ionizing increases the risk of cardiovascular events and cancer 18‐20 .…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, operators' radiation exposure is also not negligible. 17 Operators wear radiation‐protective equipment, neck guard, and eye glasses, although chronically exposed ionizing increases the risk of cardiovascular events and cancer. 18 , 19 , 20 We should keep making efforts to reduce radiation exposure during ablation procedures.…”

Section: Discussionmentioning

confidence: 99%

The impact of current strategy using intracardiac echocardiography, lesion index, and minimum substrate ablation on clinical outcomes after catheter ablation procedure for atrial fibrillation

Kawaji

Aizawa

Hojo

et al. 2021

Journal of Arrhythmia

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Purpose We developed the intracardiac echocardiography (ICE) technique to minimize radiation exposure and other recent technology during ablation procedure for atrial fibrillation (AF). The aim of this study was to validate the impact of the current strategy using the recent technology for AF ablation on outcomes after procedure. Methods We evaluated the safety and efficacy of the current strategy in consecutive set of patients undergoing first‐time ablation for AF (N = 233) compared with the conventional strategy in earlier consecutive set of patients (N = 223). The current strategy included the technique of ICE to reduce radiation exposure, Ablation Index®‐guided pulmonary veins isolation, and minimum substrate ablation targeting only for induced AF. Outcome measures were radiation exposure, procedure time, in‐hospital adverse outcomes, and event‐free survival from tachyarrhythmias. Results Puncture‐to‐ablation time was slightly, but significantly increased in the current strategy than in the conventional strategy (48.0 minutes vs 44.7 minutes, P = .002), although total procedure time was significantly decreased in the current strategy (143.9 minutes vs 156.9 minutes, P < .001). Likewise, radiation time and absorbed dose were significantly decreased in the current strategy (9.8 minutes vs 38.8 minutes, P < .001; 102.3 mGy vs 490.5 mGy, P < .001). The incidence of overall in‐hospital adverse outcomes was 3.9% in the current strategy and each complication rate was comparable with the conventional protocol. The event‐free survival from recurrent atrial tachyarrhythmias was not significantly different between two groups (72.3% vs 77.1% at 2‐year, P = .32). Conclusion The current strategy using the recent technology with ICE, lesion index, and minimum substrate ablation was feasible and reduced total procedure time and radiation exposure. However, the arrhythmia‐free survival could not be improved.

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Physicians’ exposure to radiation during electrophysiology procedures

Cited by 8 publications

References 20 publications

Cardiac catheterization real-time dynamic radiation dose measurement to estimate lifetime attributable risk of cancer

Cardiac catheterization real-time dynamic radiation dose measurement to estimate lifetime attributable risk of cancer

Results from a real-time dosimetry study during left atrial ablations performed with ultra-low dose radiation settings

The impact of current strategy using intracardiac echocardiography, lesion index, and minimum substrate ablation on clinical outcomes after catheter ablation procedure for atrial fibrillation

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