title: Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures.
abstract: Despite the advent of non-fluoroscopic technology, fluoroscopy remains the cornerstone of imaging in most interventional electrophysiological procedures, from diagnostic studies over ablation interventions to device implantation. Moreover, many patients receive additional X-ray imaging, such as cardiac computed tomography and others. More and more complex procedures have the risk to increase the radiation exposure, both for the patients and the operators. The professional lifetime attributable excess cancer risk may be around 1 in 100 for the operators, the same as for a patient undergoing repetitive complex procedures. Moreover, recent reports have also hinted at an excess risk of brain tumours among interventional cardiologists. Apart from evaluating the need for and justifying the use of radiation to assist their procedures, physicians have to continuously explore ways to reduce the radiation exposure. After an introduction on how to quantify the radiation exposure and defining its current magnitude in electrophysiology compared with the other sources of radiation, this position paper wants to offer some very practical advice on how to reduce exposure to patients and staff. The text describes how customization of the X-ray system, workflow adaptations, and shielding measures can be implemented in the cath lab. The potential and the pitfalls of different non-fluoroscopic guiding technologies are discussed. Finally, we suggest further improvements that can be implemented by both the physicians and the industry in the future. We are confident that these suggestions are able to reduce patient and operator exposure by more than an order of magnitude, and therefore think that these recommendations are worth reading and implementing by any electrophysiological operator in the field.
authors.affiliation: Department of Cardiovascular Medicine, University Hospital Gasthuisberg, University of Leuven, 3000 Leuven, Belgium Hein.Heidbuchel@uz.kuleuven.ac.be.
authors.forename: Hein
authors.initials: H
authors.lastname: Heidbuchel
authors.affiliation: Heart Lung Center, Department of Cardiology, University Medical Center, 3584 CX Utrecht, The Netherlands.
authors.forename: Fred H M
authors.initials: FH
authors.lastname: Wittkampf
authors.affiliation: Radiology Department, Medicine School, Complutense University and San Carlos Hospital, IdISSC, Madrid 28040, Spain.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Vano
authors.affiliation: NIHR Biomedical Research Unit and Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, SW3 6NP, London, UK.
authors.forename: Sabine
authors.initials: S
authors.lastname: Ernst
authors.affiliation: Biomedical Research Unit, Bart's Health NHS Trust and the William Harvey Research Institute, London EC1A 7BE, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Schilling
authors.affiliation: CNR Biomedical Sciences Department, Institute of Clinical Physiology, 56124, Pisa, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
authors.affiliation: Department of Cardiology, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia 08036, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Mont
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jais
authors.affiliation: Queen Elizabeth Medical Centre, Department of Cardiology, Birmingham, United Kingdom.
authors.forename: Joseph
authors.initials: J
authors.lastname: de Bono
authors.affiliation: University Dresden, Heart Center, Electrophysiology, Dresden, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.affiliation: Hospital Pró-Cardíaco, Setor de Arritmia Invasiva, Rio de Janeiro, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Saad
authors.affiliation: Biomedical Research Unit, Bart's Health NHS Trust and the William Harvey Research Institute, London EC1A 7BE, UK.
authors.forename: Francisco
authors.initials: F
authors.lastname: Femenia
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D022062:Electrophysiologic Techniques, Cardiac / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D004867:Equipment Design; D005471:Fluoroscopy / Q000592:standards; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control / Q000592:standards*; D016272:Occupational Health / Q000592:standards; D061214:Patient Safety / Q000592:standards; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011834:Radiation Monitoring / Q000592:standards; D011835:Radiation Protection / Q000592:standards; D015641:Radiography, Interventional / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D057188:Workflow
keywords: Exposure; Interventional electrophysiology; Radiation; Radioprotection; Risk