Evaluation of a new very low dose imaging protocol: feasibility and impact on X-ray dose levels in electrophysiology procedures

Europace. 2016 Sep;18(9):1406-10. doi: 10.1093/europace/euv364. Epub 2015 Nov 20.

Abstract

Aims: This 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 results: From 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).

Conclusion: The 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.

Keywords: Catheter ablation; Dose reduction; Fluoroscopy; Imaging; X-ray.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Arrhythmias, Cardiac / diagnostic imaging
  • Arrhythmias, Cardiac / physiopathology
  • Arrhythmias, Cardiac / surgery*
  • Cardiac Catheters
  • Catheter Ablation / adverse effects
  • Catheter Ablation / instrumentation
  • Catheter Ablation / methods*
  • Cineangiography / adverse effects
  • Cineangiography / methods*
  • Coronary Angiography / adverse effects
  • Coronary Angiography / methods*
  • Electrophysiologic Techniques, Cardiac* / adverse effects
  • Electrophysiologic Techniques, Cardiac* / instrumentation
  • Feasibility Studies
  • Female
  • Fluoroscopy
  • Humans
  • Male
  • Middle Aged
  • Operative Time
  • Radiation Dosage*
  • Radiation Exposure / adverse effects
  • Radiation Exposure / prevention & control*
  • Radiography, Interventional / adverse effects
  • Radiography, Interventional / methods*
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome