title: Reducing operator radiation exposure during cardiac resynchronization therapy.
abstract: OBJECTIVE
  To quantify the reduction in equivalent dose at operator's hand that can be achieved by placement of a radiation-absorbing drape (RADPAD) during long-lasting cardiac resynchronization therapy (CRT) procedures.
  
  
  RESULTS
  This is a prospective observational study that included 22 consecutive patients with drug-refractory heart failure who underwent implantation of a CRT device. The cases were randomly assigned to Group A (11 cases), performed without RADPAD, and to Group B (11 cases), performed using RADPAD. Dose equivalent at the examiner's hand was measured as H(p)(0.07) and as a time-adjusted H(p)(0.07) rate (mGy/min) with a direct reading dosimeter. The mean fluoroscopy time was 20.8 ± 7.7 min and the mean dose area product (DAP) was 118.6 ± 45.3 Gy cm(2). No significant differences were found between body mass index, fluoroscopy time, and DAP between patients examined with or without RADPAD. The correlation between the fluoroscopy time and the DAP was high (R(2) = 0.94, P < 0.001). Mean dose and dose rate measurement without the RADPAD at the finger and hand were H(p)(0.07) = 1.27 ± 0.47 mGy per procedure and H(p)(0.07) rate = 0.057 ± 0.011 mGy/min, respectively. The dosage was reduced with the RADPAD to H(p)(0.07) = 0.48 ± 0.20 (P < 0.05) and to H(p)(0.07) rate = 0.026 ± 0.008 (P < 0.001), respectively.
  
  
  CONCLUSIONS
  A mean reduction of 54% in the equivalent dose rate to the operator's hand can be achieved with the use of RADPAD. The use of the RADPAD in CRT devices implantation will make unlikely the necessity of limiting the yearly number of implants for high volume operators.
authors.affiliation: Department of Medical Physics, University Hospital Maggiore della Carità, Novara, Italy. marco.brambilla@maggioreosp.novara.it
authors.forename: Marco
authors.initials: M
authors.lastname: Brambilla
authors.forename: Eraldo
authors.initials: E
authors.lastname: Occhetta
authors.forename: Martina
authors.initials: M
authors.lastname: Ronconi
authors.forename: Laura
authors.initials: L
authors.lastname: Plebani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Carriero
authors.forename: Paolo
authors.initials: P
authors.lastname: Marino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005471:Fluoroscopy; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011832:Radiation Injuries / Q000517:prevention & control*; D011834:Radiation Monitoring / Q000379:methods*; D011835:Radiation Protection / Q000379:methods*