title: Fluoroscopically guided implantation of modern cardiac resynchronization devices: radiation burden to the patient and associated risks.
abstract: OBJECTIVE
  To establish radiation risks for patients undergoing fluoroscopically guided cardiac resynchronization device implantation.
  
  
  BACKGROUND
  Cardiac resynchonization therapy (CRT) may be associated with extended fluoroscopic exposure.
  
  
  METHODS
  The fluoroscopy time, dose-area product (DAP), exposure parameters, and percentage contribution of the fluoroscopic projections commonly used were recorded in a series of 14 consecutive patients referred for cardiac resynchronization device implantation and compared to corresponding data obtained from a control group of 20 patients who underwent a conventional rhythm device implantation operation. The DAP to peak skin dose, DAP to effective dose, and DAP to gonadal dose conversion factors were determined for biventricular pacing and conventional rhythm device implantation using a humanoid phantom and thermoluminescence dosimetry.
  
  
  RESULTS
  The mean total fluoroscopy time and DAP values were 35.2 min and 4,765 cGy cm2, respectively, for biventricular pacing and 8.2 min and 1,106 cGy cm2, respectively, for conventional rhythm device implantation. Patient skin dose from biventricular pacing procedures requiring extended fluoroscopic exposure may exceed threshold dose for the induction of skin effects only if X-ray source-to-skin distance is kept low. The risk values for fatal cancer and severe hereditary disorders, respectively, associated with a typical CRT procedure were 273 per million and 0.2 per million treated patients.
  
  
  CONCLUSIONS
  Radiation risks associated with fluoroscopically guided CRT procedures may be considerable. Present data may be used for the estimation of patient radiation risks from CRT procedures performed in other institutions.
authors.affiliation: Department of Medical Physics, Faculty of Medicine, University of Crete, Iraklion, Greece. perisina@med.uoc.gr
authors.forename: Kostas
authors.initials: K
authors.lastname: Perisinakis
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theocharopoulos
authors.forename: John
authors.initials: J
authors.lastname: Damilakis
authors.forename: Emmanouel
authors.initials: E
authors.lastname: Manios
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Vardas
authors.forename: Nicholas
authors.initials: N
authors.lastname: Gourtsoyiannis
mesh_terms: D000368:Aged; D001822:Body Burden; D005471:Fluoroscopy / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D010138:Pacemaker, Artificial; D011829:Radiation Dosage; D012307:Risk Factors; D025321:Surgery, Computer-Assisted