Abstract
Background: Fluoroscopy is the main visualization technique for EP procedures. A radiation protection cabin (RPC) shielded with 2 mm lead-equivalent walls was tested as an alternative protection tool (Cathpax®, Lemer Pax). Methods: To assess the scattered radiation to the operator inside the RPC an electronic personal dosimeter (EPD; Mk2, Thermo Electron) was placed at the neck level of the operator. A second EPD was located outside the RPC at 150 cm height from the floor, to record the presumable head radiation dose. Results: Radiation doses were measured in a total of 138 consecutive patients (age 54±16 yrs, BMI 28±5 kg/m2 (18-45), 64% male) undergoing a variety of ablation procedures (SVT=75, AFL=32, AF=17, VT=14). Median fluoroscopy time was 39 min (7-140), the cumulative dose-area product (DAP) 4702 cGy.cm2 (493-65620). Doses outside the RPC showed a median of 135 µSv (1-4881). Doses inside the RPC were detected only at sensitivity threshold or background levels (mean 0.2SD0.7 µSv, median 0.0, range 0-4). The dose reduction to the operator was highest for AF ablations (354 vs 0.5 µSv, respectively; p<0.001). The total accumulated dose outside the RPC was 37883 µSv for all 138 procedures, whereas for the protected operator inside only 30 µSv. Conclusions: There were highly concordant low dose values measured for the operator inside the RPC in comparison to high doses outside the RPC. The use of a RPC represents a major benefit over a lead apron and contributes to a significant dose reduction as low as reasonably achievable (ALARA principle).
Highlights
Despite introduction of three-dimensional mapping and improved ablation technology, fluoroscopy will remain the main visualization technique for electrophysiological (EP) procedures
Ablation of atrial fibrillation (AF) is a complex and prolonged procedure and associated with high radiation doses due to prolonged fluoroscopy times of more than 120 minutes depending on anatomic variations and operator experience [1,2]
All ablation procedures were performed with the radiation protection cabin (RPC) in use without compromising catheter manipulations of the operator
Summary
Despite introduction of three-dimensional mapping and improved ablation technology, fluoroscopy will remain the main visualization technique for electrophysiological (EP) procedures. Ablation of atrial fibrillation (AF) is a complex and prolonged procedure and associated with high radiation doses due to prolonged fluoroscopy times of more than 120 minutes depending on anatomic variations and operator experience [1,2]. In this study a radiation protection cabin (RPC) (Cathpax®, Lamer Pax, Carquefou, France) shielded with 2 mm leadequivalent walls was tested as an alternative protection tool (Figure 1). The main objective was the comparison of radiation doses inside the RPC versus outside the RPC for different ablation procedures. A radiation protection cabin (RPC) shielded with 2 mm lead-equivalent walls was tested as an alternative protection tool (Cathpax®, Lemer Pax)
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