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. 2021 Jun;32(2):244-249.
doi: 10.1007/s00399-021-00762-7. Epub 2021 May 11.

Results from a real-time dosimetry study during left atrial ablations performed with ultra-low dose radiation settings

T Schreiber  1 , N Kähler  2 , S Biewener  2 , V Tscholl  2 , P Nagel  2 , P Attanasio  2 , U Landmesser  2 , M Huemer  2
Affiliations

Results from a real-time dosimetry study during left atrial ablations performed with ultra-low dose radiation settings

T Schreiber et al. Herzschrittmacherther Elektrophysiol. 2021 Jun.

Abstract
in English, German

Background: Three-dimensional mapping systems and the use of ultra-low dose radiation protocols have supported minimization of radiation dose during left atrial ablation procedures. By using optimal shielding, scattered radiation reaching the operator can be further reduced. This prospective study was designed to determine the remaining operator radiation exposure during left atrial catheter ablations using real-time dosimetry.

Methods: Radiation dose was recorded using real-time digital dosimetry badges outside the lead apron during 201 consecutive left atrial fibrillation ablation procedures. All procedures were performed using the same X‑ray system (Siemens Healthineers Artis dBc; Siemens Healthcare AG, Erlangen, Germany) programmed with ultra-low dose radiation settings including a low frame rate (two frames per second), maximum copper filtration, and an optimized detector dose. To reduce scattered radiation to the operators, table-suspended lead curtains, ceiling-suspended leaded plastic shields, and radiation-absorbing shields on the patient were positioned in an overlapping configuration.

Results: The 201 procedures included 139 (69%) pulmonary vein isolations (PVI) (20 cryoballoon ablations, 119 radiofrequency ablations, with 35 cases receiving additional ablation of the cavotricuspid isthmus) and 62 (31%) PVI plus further left atrial substrate ablation. Mean radiation dose measured as dose area product for all procedures was 128.09 ± 187.87 cGy ∙ cm2 with a mean fluoroscopy duration of 9.4 ± 8.7 min. Real-time dosimetry showed very low average operator doses of 0.52 ± 0.10 µSv. A subanalysis of 51 (25%) procedures showed that the radiation burden for the operator was highest during pulmonary vein angiography.

Conclusion: The use of ultra-low dose radiation protocols in combination with optimized shielding results in extremely low scattered radiation reaching the operator.

Zusammenfassung: HINTERGRUND: Der Einsatz von dreidimensionalen Mapping-Systemen und von Niedrigdosiseinstellungen der Röntgenanlage führte zu einer Minimierung der Strahlenbelastung bei linksatrialen Ablationen. Optimierte Abschirmung kann die Streustrahlung als Strahlenbelastung des Untersuchers weiter reduzieren. In dieser prospektiven Studie wurde untersucht, welcher Strahlenbelastung der Untersucher unter Anwendung dieser Maßnahmen während linksatrialer Ablationen noch ausgesetzt ist.

Methoden: Die Strahlenbelastung wurde mittels Echtzeitdosimetrie an der Außenseite der Bleischürze während 201 konsekutiven linksatrialen Ablationen gemessen. Alle Prozeduren wurden mit demselben Röntgensystem (Siemens Healthineers Artis dBc; Siemens Healthcare AG, Erlangen, Deutschland) und mit strahlensparenden Einstellungen durchgeführt, unter anderem mit einer niedrigen Bildrate von 2 Bildern/s, maximaler Kupferfilterung und angepasster Detektoreingangsdosis. Um Streustrahlung zu reduzieren, wurden die Seitenlamellen, die mobile Acrylscheibe und die strahlenabsorbierenden Schilde auf dem Patienten überlappend angeordnet.

Ergebnisse: Die 201 Prozeduren umfassten 139 (69 %) Pulmonalvenenisolationen (PVI; 20 Kryoballonablationen, 119 Radiofrequenzablationen, in 35 Fällen mit zusätzlicher Ablation des kavotrikuspidalen Isthmus) und 62 (31 %) PVI mit zusätzlicher linksatrialer Substratmodifikation. Die Strahlendosis als Dosis-Flächen-Produkt (DAP) betrug durchschnittlich 128,09 ± 187,87 cGy ∙ cm2 bei einer Fluoroskopiedauer von im Mittel 9,4 ± 8,7 min. Die per Echtzeitdosimetrie erhobene mittlere Strahlendosis des Untersuchers zeigte sich mit 0,52 ± 0,10 µSv als sehr gering. Eine Subanalyse bei 51 (25 %) Prozeduren zeigte, dass die Strahlendosis des Untersuchers während der Pulmonalvenenangiographie am höchsten war.

Schlussfolgerung: Die Kombination von Niedrigdosiseinstellungen und optimierter Abschirmung führt zu einer extrem niedrigen Streustrahlung als Strahlenbelastung des Untersuchers.

Keywords: Ablation; Dosimetry; Frame-rate reduction; Radiation dose; Radiation protection.

PubMed Disclaimer

Conflict of interest statement

T. Schreiber, N. Kähler, S. Biewener, V. Tscholl, P. Nagel, P. Attanasio, U. Landmesser, and M. Huemer declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overlapping shielding with table-suspended lead curtains and ceiling-suspended leaded plastic shields during pulmonary vein isolation
Fig. 2
Fig. 2
Radiation dispersion during a standard pulmonary vein isolation ablation procedure. The highest peaks can be observed during transseptal puncture and left atrial angiography
Fig. 3
Fig. 3
Distribution of radiation throughout the different parts of the ablation procedure
Fig. 4
Fig. 4
Comparison between annual background radiation and different interventions. PCI percutaneous coronary intervention, FRA-JFK Frankfurt-John F. Kennedy
See this image and copyright information in PMC

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