Radiation dose reference levels for the most common image-guided interventional cardiac electrophysiology and pacing
Joël Greffier1, Elodie Dhombres1, Djamel Dabli1
1IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, Nîmes, France.
Insights
National interventional reference levels (IRLs) were established for common cardiac electrophysiology and pacing procedures. These IRLs aim to standardize radiation dose monitoring and patient safety in interventional cardiology.
Area of Science:
- Medical Imaging
- Radiation Safety
- Interventional Cardiology
Background:
- Cardiac electrophysiology and pacing procedures are increasingly common.
- Standardized radiation dose metrics are essential for patient safety.
- National reference levels are needed to guide clinical practice.
Purpose of the Study:
- To establish national interventional reference levels (IRLs) for adults undergoing common cardiac electrophysiology and pacing procedures.
- To provide benchmarks for radiation dose monitoring in these interventions.
Main Methods:
- A national multicentre survey was conducted across 33 French departments.
- Data on Air Kerma (AK), kerma-area product (PKA), and fluoroscopy time (T) were collected for 11 procedures.
- IRLs were calculated using the 3rd quartiles and medians of the collected data.
Main Results:
- IRLs were proposed for three dosimetric indicators across 11 procedures involving 4219 adult patients.
- Dose levels varied with procedure complexity; e.g., pacemaker IRLs ranged from 4.10 Gy.cm² to 12.90 Gy.cm².
- Left bundle branch area pacing increased radiation dose metrics, while accessory pathway ablation had the lowest IRLs.
Conclusions:
- This study reports the first national IRLs for common image-guided cardiac electrophysiology and pacing procedures.
- The established IRLs can serve as benchmarks for radiation dose optimization.
- Findings support the need for ongoing monitoring and potential reduction of radiation exposure in these procedures.
Purpose:
To set national dose interventional reference levels (IRLs) for adults undergoing the most common cardiac electrophysiology and pacing procedures.
Materials And Methods:
A national multicentre survey was performed in 33 French cardiac electrophysiology and pacing departments. Eleven standard image-guided interventional procedures in cardiac electrophysiology and pacing were analysed. Air Kerma (AK), kerma-area product (PKA) and fluoroscopy time (T) were recorded for 10 to 30 patients per procedure and per centre. IRLs were calculated as the 3rd quartiles and medians of distributions.
Results:
A total of 4219 patients (70.4 ± 14.4 years old, 32% women) were included. IRLs were suggested for three dosimetric indicators in the eleven procedures. For endovascular implantation (pacemaker and defibrillator), IRLs increased with the complexity of procedures. In terms of PKA and T, IRLs were 4.10 Gy.cm2 and 5.5 min for single-chamber pacemakers, 11.50 Gy.cm2 and 16.5 min for bi-ventricular pacemakers, 2.25 Gy.cm2 and 4.0 min for single-chamber defibrillators and 12.90 Gy.cm2 and 18.0 min for bi-ventricular defibrillators. For all pacemaker procedures, left bundle branch area pacing significantly increased PKA, AK, and T values (p < 0.05). For ablations, the lowest IRLs were found for accessory pathway ablation (4.10 Gy.cm2 and 10.5 min) and the highest for ablation of persistent atrial fibrillation (12.65 Gy.cm2 and 15.5 min). For all ablations, the main energy source used was radiofrequency (>75% of procedures). For most procedures, the IRLs proposed were close to most of those already published, or lower.
Conclusion:
This national multicentre study reports IRLs for the most common image-guided interventional cardiac electrophysiology and pacing procedures.
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