Patient radiation dose during fluoroscopically guided biventricular device implantation

Area of Science:

• Cardiology
• Medical Imaging
• Radiation Safety

Background:

• Biventricular device (BiV) implantation with transvenous left ventricular leads is complex, often involving significant fluoroscopy time and radiation exposure.
• Current national diagnostic reference levels (DRLs) for BiV procedures in the UK are lacking due to insufficient data, hindering standardization.
• Previous data collection efforts by the Health Protection Agency (HPA) in 2010 did not yield adequate information for BiV devices.

Purpose of the Study:

• To collect a comprehensive dataset on fluoroscopy time and radiation dose (DAP) for BiV device implantation.
• To establish evidence-based national diagnostic reference levels (DRLs) for BiV procedures.
• To guide and improve standards for biventricular device implantation procedures.

Main Methods:

• Retrospective data collection of fluoroscopy time and radiation dose (DAP) for new BiV device implants.
• Data gathered from three high-volume tertiary centers in the North West of England over a three-year period (2009-2011).
• Rigorous scrutiny of databases to ensure data quality and accuracy.

Main Results:

• Data from 1319 patients for radiation dose (DAP) and 1316 for fluoroscopy time were analyzed.
• The combined 75th percentile fluoroscopy time was 24.2 minutes.
• The combined 75th percentile radiation dose (DAP) was 27.7 Gy cm2.

Conclusions:

• A large dataset for new biventricular device implants has been presented.
• Suggested national diagnostic reference levels (DRLs) are 24.2 minutes for fluoroscopy time and 27.7 Gy cm2 for radiation dose.
• These proposed DRLs can inform radiation safety standards in cardiac device implantation.