Reassessment of radiation risks from electrophysiology procedures compared to coronary angiography.
BACKGROUND
Electrophysiology (EP) procedures have been reported to carry a significantly greater radiation risk than that of coronary angiography (CA). This is largely due to numerous reports linking severe deterministic radiation effects to long procedure and fluoroscopy times (FTs). This study documents low radiation doses achieved by strategies involving operator training and education as well as equipment and technique optimisation to reduce radiation risks.


METHODS
Records relating to 732 diagnostic EP and 1744 therapeutic EP procedures performed between January 2002 and December 2007 were analysed. Data from 1458 diagnostic only CA procedures performed in 2006 was used for comparison. For each procedure type, FT, number of digital frames acquired and estimated effective dose (E) were compared.


RESULTS
Although the FT for CA procedures is significantly less than for therapeutic EP procedures (FT for diagnostic EP being similar), EP procedures generally are associated with lower E, the exception being procedures for atrial fibrillation (AF).


CONCLUSIONS
Through the application of a comprehensive exposure minimisation strategy, the radiation risk to patients undergoing diagnostic and, therapeutic EP procedures (except AF ablation procedures) is significantly less than that faced by patients undergoing CA. E, however, is heavily dependent on procedure type and as such care must be taken in undertaking generalised comparisons for audit and benchmarking purposes.
Smith
Ian R
IR
St Andrew's Medical Institute, C/- St Andrew's War Memorial Hospital, GPO Box 764, Brisbane, QLD 4001, Australia. ismith@sawmh.org.au
Rivers
John T
JT
Hayes
John
J
Stafford
Wayne
W
Codd
Catrina
C
D001822:Body Burden; D017023:Coronary Angiography / Q000009:adverse effects*; D022062:Electrophysiologic Techniques, Cardiac / Q000009:adverse effects*; D005471:Fluoroscopy / Q000009:adverse effects*; D006801:Humans; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology*; D011874:Radiometry; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000009:adverse effects