Abstract
AimsThis study presents and evaluates the impact of a new lowest-dose fluoroscopy protocol (Siemens AG), especially designed for electrophysiology (EP) procedures, on X-ray dose levels.Methods and resultsFrom October 2014 to March 2015, 140 patients underwent an EP study on an Artis zee angiography system. The standard low-dose protocol was operated at 23 nGy (fluoroscopy) and at 120 nGy (cine-loop), the new lowest-dose protocol was operated at 8 nGy (fluoroscopy) and at 36 nGy (cine-loop). Procedural data, X-ray times, and doses were analysed in 100 complex left atrial and in 40 standard EP procedures. The resulting dose–area products were 877.9 ± 624.7 µGym² (n = 50 complex procedures, standard low dose), 199 ± 159.6 µGym² (n = 50 complex procedures, lowest dose), 387.7 ± 36.0 µGym² (n = 20 standard procedures, standard low dose), and 90.7 ± 62.3 µGym² (n = 20 standard procedures, lowest dose), P < 0.01. In the low-dose and lowest-dose groups, procedure times were 132.6 ± 35.7 vs. 126.7 ± 34.7 min (P = 0.40, complex procedures) and 72.3 ± 20.9 vs. 85.2 ± 44.1 min (P = 0.24, standard procedures), radiofrequency (RF) times were 53.8 ± 26.1 vs. 50.4 ± 29.4 min (P = 0.54, complex procedures) and 10.1 ± 9.9 vs. 12.2 ± 14.7 min (P = 0.60, standard procedures). One complication occurred in the standard low-dose and lowest-dose groups (P = 1.0).ConclusionThe new lowest-dose imaging protocol reduces X-ray dose levels by 77% compared with the currently available standard low-dose protocol. From an operator standpoint, lowest X-ray dose levels create a different, reduced image quality. The new image quality did not significantly affect procedure or RF times and did not result in higher complication rates. Regarding radiological protection, operating at lowest-dose settings should become standard in EP procedures.
Highlights
Fluoroscopy is the basic imaging modality in the electrophysiology (EP) catheterization laboratory
Regarding radiological protection, operating at lowest-dose settings should become standard in EP procedures
Since fluoroscopy systems are technically optimized for high-resolution angiography, there is room for dose reduction when used for EP interventions not requiring detailed
Summary
Fluoroscopy is the basic imaging modality in the electrophysiology (EP) catheterization laboratory. Previous studies showed that the use of 3D navigation systems significantly decreases radiation exposure in EP procedures.[1,2,3,4]. Adaptive use of X-ray collimation and principles of radiological protection should generally be applied to keep radiation exposure as low as possible.[5] Since fluoroscopy systems are technically optimized for high-resolution angiography, there is room for dose reduction when used for EP interventions not requiring detailed What’s new?. The lowest available clinical acquisition settings for fluoroscopic EP procedures on an Artis zee angiography system (Siemens AG, Forchheim, Germany) are operated at 23 nGy detector entrance dose per fluoroscopy pulse. We present and evaluate a new very low dose fluoroscopy protocol (Siemens AG), which was especially designed for EP interventions, offering fluoroscopy operated at 8 nGy detector entrance dose per fluoroscopy pulse
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Schedule a callMore From: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
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