title: Radiation peak skin dose to risk stratify electrophysiological procedures for deterministic skin damage.
abstract: Ionising radiation is has the potential to cause harm both by increasing the probability future malignancy (stochastic mechanisms) and by direct physical injury (deterministic mechanisms). Several measures have been developed to quantify radiation exposure during a procedure and cardiologists usually refer to fluoroscopic screening time (FST). FST, however, has limitations for predicting deterministic injury which is directly dependant on peak skin dose (PSD). We compared FST to PSD for a range of interventional cardiac electrophysiology procedures.
  
  
  METHODS
  All patients undergoing electrophysiology procedures during a 2-month period in our institution were studied. Demographic details, nature of procedure, FST and PSD were measured. The FST to PSD ratio was calculated and compared between patient and procedural factors.
  
  
  RESULTS
  67 procedures on patients (23 female) with body mass index (BMI) of 28 (SD 5) Kg/m2 were studied. Screening times ranged from 0.2 to 96.6 min (median 11.2). PSD ranged from <0.1 to 1108 mGy (median 141). There was a positive correlation between PSD to FST ratio and BMI (r = 0.59, p < 0.001). The PSD to FST ratio was higher in cardiac resynchronization therapy (CRT) devices than single or dual chamber ICDs (p = 0.002).
  
  
  CONCLUSIONS
  FST is not a reliable predictor of deterministic skin injury and in high-risk procedures such as CRT devices and those on individuals of high BMI PSD should be measured.
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospitals, UK. johnpaisey@doctors.org.uk
authors.forename: J R
authors.initials: JR
authors.lastname: Paisey
authors.forename: A M
authors.initials: AM
authors.lastname: Yue
authors.forename: A
authors.initials: A
authors.lastname: White
authors.forename: A
authors.initials: A
authors.lastname: Moss
authors.forename: J M
authors.initials: JM
authors.lastname: Morgan
authors.forename: P R
authors.initials: PR
authors.lastname: Roberts
mesh_terms: D015992:Body Mass Index; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D011829:Radiation Dosage; D012307:Risk Factors; D012867:Skin / Q000528:radiation effects*; D012871:Skin Diseases / Q000175:diagnosis* / Q000209:etiology*; D013223:Statistics as Topic; D013997:Time Factors