Patient Exposure during Fluoroscopy-guided Pacemaker Implantation Procedures.

Area of Science:

• Medical Imaging and Radiation Oncology
• Cardiology and Electrophysiology
• Health Physics and Radiation Protection

Background:

• Pacemaker implantation is increasingly common worldwide for managing clinical conditions.
• Patients undergoing pacemaker procedures face potential risks from excessive radiation exposure.
• Previous studies indicate variability in radiation doses, suggesting a need for procedure optimization.

Purpose of the Study:

• To evaluate and quantify patient radiation exposure during cardiac pacemaker procedures.
• To determine the effective dose for various pacemaker types (VVI, VVIR, VVD, VVDR, DDDR).
• To assess the associated cancer risk in patients undergoing these procedures.

Main Methods:

• Conducted a study involving 145 pacemaker implantation procedures across two hospitals.
• Measured patient doses using a kerma-area product meter.
• Estimated effective doses using Monte Carlo simulation software and analyzed demographic and exposure parameters.

Main Results:

• Mean patient doses (Gycm²) varied by pacemaker type: VVI (1.52 ± 0.13), VVIR (3.28 ± 2.34), VVD (3.04 ± 1.67), VVDR (6.04 ± 2.33), and DDDR (8.8 ± 3.6).
• The overall mean effective dose was 1.1 mSv per procedure, with DDDR procedures resulting in the highest exposure.
• Patient doses were found to be lower than previously reported values, and cancer risk was deemed low compared to other cardiac interventions.

Conclusions:

• Radiation doses from pacemaker procedures are generally lower than historical data suggest.
• The type of pacemaker procedure and clinical indication are primary drivers of patient radiation exposure.
• While DDDR procedures involve higher doses, the overall patient risk associated with pacemaker implantation is considered low.