title: Radiation safety protocol using real-time dose reporting reduces patient exposure in pediatric electrophysiology procedures.
abstract: Radiation exposure during pediatric catheterization is significant. We sought to describe radiation exposure and the effectiveness of radiation safety protocols in reducing exposure during catheter ablations with electrophysiology studies in children and patients with congenital heart disease. We additionally sought to identify at-risk patients. We retrospectively reviewed all interventional electrophysiology procedures performed from April 2009 to September 2011 (6 months preceding intervention, 12 months following implementation of initial radiation safety protocol, and 8 months following implementation of modified protocol). The protocols consisted of low pulse rate fluoroscopy settings, operator notification of skin entrance dose every 1,000 mGy, adjusting cameras by >5 at every 1,000 mGy, and appropriate collimation. The cohort consisted of 291 patients (70 pre-intervention, 137 after initial protocol implementation, 84 after modified protocol implementation) at a median age of 14.9 years with congenital heart disease present in 11 %. Diagnoses included atrioventricular nodal reentrant tachycardia (25 %), atrioventricular reentrant tachycardia (61 %), atrial tachycardias (12 %), and ventricular tachycardia (2 %). There were no differences between groups based on patient, arrhythmia, and procedural characteristics. Following implementation of the protocols, there were significant reductions in all measures of radiation exposure: fluoroscopy time (17.8 %), dose area product (80.2 %), skin entry dose (81.0 %), and effective dose (76.9 %), p = 0.0001. Independent predictors of increased radiation exposure included larger patient weight, longer fluoroscopy time, and lack of radiation safety protocol. Implementation of a radiation safety protocol for pediatric and congenital catheter ablations can drastically reduce radiation exposure to patients without affecting procedural success.
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th St. and Civic Center Blvd, Philadelphia, PA, 19104, USA, akash.patel@ucsf.edu.
authors.forename: Akash R
authors.initials: AR
authors.lastname: Patel
authors.forename: Jamie
authors.initials: J
authors.lastname: Ganley
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Zhu
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rome
authors.forename: Maully
authors.initials: M
authors.lastname: Shah
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Glatz
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000601:surgery*; D001835:Body Weight; D006328:Cardiac Catheterization / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004307:Dose-Response Relationship, Radiation; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult