title: Reducing patient radiation dosage during pediatric SVT ablations using an "ALARA" radiation reduction protocol in the modern fluoroscopic era.
abstract: BACKGROUND
  Ablation for supraventricular tachycardia (SVT) relies upon fluoroscopy (fluoro), which exposes the patient and staff to ionizing radiation. The objective of this work was to present a new "ALARA--As Low As Reasonably Achievable" protocol with alterations to fluoroscopic x-ray parameters to reduce dose without an electroanatomical (EAM) approach.
  
  
  METHODS
  All patients <21 years of age undergoing ablation of SVT at our institution from June 2011 to April 2012 were included. EAM was not utilized in any case. An ALARA protocol of low frame rates (2 or 3 fps), low fluoro dose/frame (10-18 nGy/frame), and other techniques aimed at reducing use of fluoroscopy were employed. Demographics, procedural, and radiation data were analyzed.
  
  
  RESULTS
  Forty-two patients underwent ablation and were studied. Median age was 14.1 years (range 4.8-21.1 years), weight was 51 kg (range 18.2-75 kg), and body surface area was 1.51 m(2) (range 0.72- 1.94 m(2)). Seventeen (41%) had Wolff-Parkinson-White syndrome, 14 (33%) atrioventricular nodal reentrant tachycardia, and 11 (26%) concealed pathways. Median procedural time was 114 minutes (57-246 minutes). Median dose area product (DAP) for posterioanterior and lateral fluoroscopy was 343.2 uGym(2) (range 38.2-3,172 uGym(2)); the median air Kerma product (K) was 45.4 mGy (range 6.7-567.5 mGy). DAP and K are lower than prior data from EAM and fluoroscopy techniques. The acute success rate was 95%; no procedural complications.
  
  
  CONCLUSIONS
  An ALARA protocol for ablation of SVT reduced radiation to below levels previously reported for combined EAM/fluoro approaches. Success rates were excellent with no complications and without the costs of EAM.
authors.affiliation: Pediatric Electrophysiology Service, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefior, Albert Einstein College of Medicin, Bronx, New York 10467, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Gellis
authors.forename: Scott R
authors.initials: SR
authors.lastname: Ceresnak
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Gates
authors.forename: Lynn
authors.initials: L
authors.lastname: Nappo
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pass
mesh_terms: D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005471:Fluoroscopy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000453:epidemiology* / Q000517:prevention & control*; D011835:Radiation Protection; D011874:Radiometry / Q000706:statistics & numerical data; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data; D013617:Tachycardia, Supraventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult