Key result
Left anterior oblique angulation and BMI > 30 were associated with higher radiation doses during EP ablation compared to right anterior oblique angulation and BMI ≤ 30.
Why the study?
How do fluoroscopy protocol settings, system angulation, and patient BMI impact radiation exposure during cardiac electrophysiology ablation?
Observational (n=212)
How do fluoroscopy protocol settings, system angulation, and patient BMI impact radiation exposure during cardiac electrophysiology ablation?
Radiation exposure during EP ablation is significantly increased by higher BMI and LAO angulation, but can be substantially reduced using a very low dose protocol.
Answers are grounded in this paper and cite their sources.
LAO angulation and BMI >30 were associated with higher radiation in EP ablation; leaves open optimal protocol adjustments for prospective validation.
BACKGROUND: To exposure in patients undergoing cardiac electrophysiology (EP) ablation. This included the use of a "very low" dose protocol, and the impact of angulations and patient body mass index (BMI) on radiation dose as a mean to reduce exposure. METHODS: A total of 212 retrospective patient data sets were collected during EP ablation procedures on a biplane fluoroscopy system. Dose metrics were computed based on dose-area product (DAP) measured by the system for each x-ray acquisition. RESULTS: Dose baselines of different ablation procedures were established as DAP and DAP per hour, with respect to patient BMI. The use of a "very low dose" protocol reduced exposure by 62% while providing adequate image quality. With approximate left anterior oblique (LAO) 50° and right anterior oblique (RAO) 30°, DAP and DAP rate were significantly higher in LAO compared to RAO (11.2 [4.8-25.3] Gy · cm(2) vs 5.28 [2.9-11.1] Gy · cm(2) and 74.0 [38.2-136.1] Gy · cm(2)/h vs 25.0 [16.4-44.1] Gy · cm(2)/h, respectively; P < 0.001). DAP and DAP rate were also significantly higher in patients with BMI > 30 vs BMI ≤ 30 (34.2 [22.3-58.7] Gy · cm(2) vs 12.4 [6.0-26.9] Gy · cm(2) and 84.9 [68.1-120.4] Gy · cm(2)/h vs 34.2 [21.7-52.9] Gy · cm(2)/h, respectively; P < 0.001). CONCLUSION: Protocol setting, system angulation, and BMI, in particular, wider angulation in LAO compared to RAO plane, exposes patients to significant higher radiation doses. Obese patients in standard LAO plane receive six times the radiation dose of nonobese patients in RAO.
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Nof et al. (2014) conducted an observational in Cardiac electrophysiology (EP) ablation (n=212). Left anterior oblique (LAO) angulation vs. Right anterior oblique (RAO) angulation was evaluated on Dose-area product (DAP) (p=<0.001). Left anterior oblique angulation and BMI > 30 were associated with higher radiation doses during EP ablation compared to right anterior oblique angulation and BMI ≤ 30.
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