title: Impact of a comprehensive safety program on radiation exposure during catheter ablation of atrial fibrillation: a prospective study.
abstract: BACKGROUND
  Pulmonary vein antral isolation (PVAI) is an effective treatment for atrial fibrillation and involves prolonged procedure and fluoroscopy times. This study assesses the impact of a comprehensive radiation safety program on patient and operator radiation exposure during PVAI.
  
  
  RESULTS
  We evaluated a comprehensive radiation safety program including: (1) verbal reinforcement of previous fluoroscopy times (2) effective collimation (3) minimizing source-intensifier distance and (4) effective lead shield use. Exposure doses in 41 consecutive patients without (group-I, n = 21) and with (group-II, n = 20) the use of radiation safety program were assessed. PVAI was done using intracardiac echo (ICE) guided roving circular mapping catheter. A 3-dimensional mapping system was used in 27% cases for additional guidance. Operator and patient exposure was measured during the PVAI. The age, gender, body mass index and AF duration were similar in both of the groups. The total procedure (166 +/- 56 vs 178 +/- 38 min, p = 0.54) and fluoroscopy times (74 +/- 24 vs 70 +/- 20 min, p = 0.72) were comparable. Group-II had significantly lower dose area product (234 +/- 120 vs 548 +/- 363 Gy cm(2), p = 0.03) compared to group-I. The mean operator exposure was reduced by half and mean patient peak skin dose by three to ten times with comprehensive radiation safety program. None of the patients were noted to have radiation related skin injuries. Additional lifetime cancer risk was significantly lower in group-II patients (0.08 vs 0.2%, p < 0.001) than group-I.
  
  
  CONCLUSIONS
  Implementation of a comprehensive radiation safety program described above significantly decreases the radiation exposure to the patient as well as the operator.
authors.affiliation: Mid America Cardiology, University of Kansas Hospital, Kansas City, KS, USA.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.forename: George
authors.initials: G
authors.lastname: Nadzam
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Subramanya
authors.initials: S
authors.lastname: Prasad
authors.forename: Kay
authors.initials: K
authors.lastname: Ryschon
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Mohammed
authors.initials: M
authors.lastname: Khan
authors.forename: David
authors.initials: D
authors.lastname: Burkhardt
authors.forename: Robert
authors.initials: R
authors.lastname: Schweikert
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D001822:Body Burden; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011835:Radiation Protection / Q000379:methods*; D015641:Radiography, Interventional / Q000009:adverse effects*; D012062:Relative Biological Effectiveness