Key result
Ultra-low frame rate, grid-less radiation protocol linked to ~73% lower dose area product vs. controls.
Why the study?
Most cardiac device implantations have modest image quality demands, and the safety and efficacy of an ultra-low frame rate and antiscatter grid-less radiation protocol needed assessment.
Does an ultra-low frame rate and antiscatter grid-less radiation protocol reduce radiation dose in patients undergoing CIED implantation?
Observational (n=140)
Does an ultra-low frame rate and antiscatter grid-less radiation protocol reduce radiation dose in patients undergoing CIED implantation?
An ultra-low frame rate and antiscatter grid-less radiation protocol significantly reduces radiation exposure during CIED implantation without increasing procedural time or complications.
Answers are grounded in this paper and cite their sources.
May reduce radiation exposure in CIED implantation; supports prospective trials before practice change.
AbstractBackground and aimsAntiscatter grids improve image contrast by absorbing scattered x‐ray beams, although by removing the antiscatter grid patient dose can be reduced as more x‐ray beams reach the image receptor. Additionally, there is a trend toward ultra‐low frame rates for radiation dose reduction during various electrophysiology procedures. As for most cardiac device implantations (CIED) image quality demands are usually modest, the purpose of this study was to assess the safety and efficacy of an ultra‐low frame rate and scatter grid‐less radiation protocol.Methods/resultsA total of 140 patients undergoing CIED implantation between 2014 and 2017 were included in the study. Seventy patients (50%) implanted after implementation of the antiscatter grid‐less and ultra‐low frame rate protocol were matched to controls before the dose‐reduction protocol was established. Forty patients (28.6%) had a one‐chamber pacemaker or one‐chamber implantable cardioverter defibrillator (ICD) implantation/revision, 60 (42.9%) had a two‐chamber pacemaker or two‐chamber ICD implantation/revision, and 40 (28.6%) patients had a cardiac resynchronization therapy device implantation/revision. Removing the antiscatter‐grid and lowering the frame rate led to a 73% reduction of the overall dose area product (1,206 ± 2,015 vs 324 ± 422 μGym, P < 0.001). Procedural duration (95 ± 51 minutes vs 82 ± 44 minutes, P = 0.053) and rate of complications were not significantly different between the two groups.ConclusionThe use of an ultra‐low frame rate and antiscatter grid‐less radiation protocol significantly reduced radiation dose for implantation of CIED and led to very low average patient doses, while procedural duration and complication rates did not increase.
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Attanasio et al. (2017) conducted an observational in Cardiac device implantation (n=140). Ultra-low frame rate and antiscatter grid-less radiation protocol vs. Standard radiation protocol with antiscatter grid and higher frame rate was evaluated on Overall dose area product (μGym) (p=<0.001). An ultra-low frame rate and antiscatter grid-less radiation protocol reduced overall dose area product by 73% compared to historical controls (324 vs 1,206 μGym; P<0.001).
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