Abstract 18535: Radiation Safety Protocol Using Real-Time Dose Reporting Reduces Patient Exposure in Pediatric Electrophysiology Procedures
Introduction: Radiation exposure during pediatric cardiac catheterization procedures can be significant. Limited data exist on exposure during pediatric electrophysiology studies and catheter ablations (EPSA) and the potential impact of radiation reduction strategies.
Hypothesis: We hypothesize that a radiation safety protocol (RSP) using real-time dose reporting will reduce exposure during EPSA.
Methods: A retrospective cohort study was performed evaluating measures of radiation exposure in patients undergoing EPSA from April 2009 to April 2010. This time period includes 6 months preceding and 6 months following implementation of a RSP. The protocol consisted of using a low-dose fluoroscopy pulse rate setting of 10 pulses/sec, notifying the operator of skin entrance dose at every 1000mGy, adjusting biplane cameras by greater than 5° at every 1000mGy when possible, and appropriate collimation.
Results: The cohort comprised 131 patients (70 pre-intervention, 61 post-intervention) at a median age of 14.5 (range: 4.9-32) years. Diagnoses included AVNRT (21%), AVRT (69%), AT (9%), and VT (1%). Congenital heart disease (CHD) was present in 9%. There were no differences between the groups based on age, gender, mode of sedation, weight, height, procedural time, number of cine acquisitions, arrhythmia type, arrhythmia location, presence of CHD, use of transeptal procedure, use of nonfluoroscopic mapping, repeat procedural rate, and success rate. Following RSP implementation, there was significant reduction in the measures of radiation exposure, as indicated by a 22% reduction in median fluoroscopy time, 44% reduction in median dose area product, 52% reduction in median skin entrance dose and a 51% reduction in median effective dose (see Table).
Conclusions: Implementation of a RSP for pediatric EPSA can drastically reduce radiation exposure to patients. Overall radiation use is significant, though, and further reduction strategies in pediatrics are needed.
- © 2010 by American Heart Association, Inc.