title: Radiation exposure of patient and physician during implantation and upgrade of cardiac resynchronization devices.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) is often associated with extended fluoroscopic exposure during placement of the devices. The objective of this study was to measure the radiation exposure sustained by different parts of the body of patients and operators during fluoroscopically guided cardiac resynchronization device implantation.
  
  
  METHODS
  Dosimetry data were prospectively recorded in a series of 104 consecutive patients, who underwent resynchronization device implantation or upgrade in our cardiac catheterization laboratory. Five Chipstrate dosimeters were fixed to the patient's skin around the thorax (right and left paravertebral, right and left parasternal, and sternal positions), one dosimeter was attached to the forehead, and one to the pubis. The operator was equipped with one dosimeter on the forehead at eye level and a ring dosimeter was worn on the right hand.
  
  
  RESULTS
  Based on the maximum radiation dose of 9.2 mSv measured at the operator's hand in a single implantation session, it might be recommended to conservatively limit the number of implantations to four per month (an annual limit value of 500 mSv). At a mean dose of 1.2 mSv, this number can be increased sevenfold.
  
  
  CONCLUSIONS
  In patients, incipient deterministic radiation effects can theoretically be observed at dose area product >400 Gy*cm(2), a dose applied in 2.9% of CRT implantation procedures. Special follow-up programs are considered necessary for these patients and for operators, as the latter may be exposed over many years given the unknown long-term impact of chronic radiation exposure and the nature of current complex electrophysiology and device procedures.
authors.affiliation: Heart Center Brandenburg, Department of Cardiology, Bernau/Berlin, Germany. c.butter@immanuel.de
authors.forename: Christian
authors.initials: C
authors.lastname: Butter
authors.forename: Thomas
authors.initials: T
authors.lastname: Schau
authors.forename: Juergen
authors.initials: J
authors.lastname: Meyhoefer
authors.forename: Klaus
authors.initials: K
authors.lastname: Neumann
authors.forename: Hans H
authors.initials: HH
authors.lastname: Minden
authors.forename: Joerg
authors.initials: J
authors.lastname: Engelhardt
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D017147:Defibrillators, Implantable; D005123:Eye / Q000528:radiation effects; D005260:Female; D005471:Fluoroscopy; D006225:Hand / Q000528:radiation effects; D006801:Humans; D008297:Male; D016273:Occupational Exposure; D010138:Pacemaker, Artificial; D011829:Radiation Dosage; D011835:Radiation Protection; D015641:Radiography, Interventional; D012867:Skin / Q000528:radiation effects; D013819:Thermoluminescent Dosimetry