Proposing national diagnostic reference levels for electrophysiology studies and catheter ablation procedures in Bulgaria

Abstract

Introduction: The implementation of diagnostic reference levels (DRLs) is an essential tool for optimisation of the routine practice, better management of patient exposure while maintaining sufficient image quality. National DRLs for electrophysiology (EP) procedures are not available in our country.

Purpose: The main purpose of the study was to propose, for first time in Bulgaria, national DRLs (NDRLs) for EP studies and ablation procedures of two different levels of complexity. The proposed DRLs can be later used to establish NDRLs by the national authority with regulatory functions related to medical exposure.

Method: A retrospective study was done with the three highest volume Bulgarian EP centers, where over 95% of all cardiac ablations were performed. Data were extracted from the electronic registry for invasive electrophysiology BG-EPHY. Independently of the proposed NDRLs, we also compared the air kerma-area product (KAP) between the participating centers for procedures of the same level of complexity.

Results: The proposed NDRL in terms of KAP were: 5.2 Gy.cm² for diagnostic EP studies, 25.5 Gy.cm² for simple ablations, and 52.1 Gy.cm² for complex ablations. There was a significant variation in KAP for procedures with the same degree of complexity within each center.

Conclusion: This study is the first to propose NDLRs for EP studies and ablation procedures of two levels of complexity in Bulgaria. The results identified EP procedures requiring further optimization of patient protection and provided a basis for future comparisons and standardization with further investigations on the topic. The proposed NDRLs are recommended to be used for better management of radiation exposure during EP procedures of different levels of complexity.

Keywords: Catheter Ablation; Electrophysiological Study; National Diagnostic Reference Levels (NDRL).