title: Evaluation of a new very low dose imaging protocol: feasibility and impact on X-ray dose levels in electrophysiology procedures.
abstract: OBJECTIVE
  This study presents and evaluates the impact of a new lowest-dose fluoroscopy protocol (Siemens AG), especially designed for electrophysiology (EP) procedures, on X-ray dose levels.
  
  
  RESULTS
  From October 2014 to March 2015, 140 patients underwent an EP study on an Artis zee angiography system. The standard low-dose protocol was operated at 23 nGy (fluoroscopy) and at 120 nGy (cine-loop), the new lowest-dose protocol was operated at 8 nGy (fluoroscopy) and at 36 nGy (cine-loop). Procedural data, X-ray times, and doses were analysed in 100 complex left atrial and in 40 standard EP procedures. The resulting dose-area products were 877.9 ± 624.7 µGym² (n = 50 complex procedures, standard low dose), 199 ± 159.6 µGym² (n = 50 complex procedures, lowest dose), 387.7 ± 36.0 µGym² (n = 20 standard procedures, standard low dose), and 90.7 ± 62.3 µGym² (n = 20 standard procedures, lowest dose), P < 0.01. In the low-dose and lowest-dose groups, procedure times were 132.6 ± 35.7 vs. 126.7 ± 34.7 min (P = 0.40, complex procedures) and 72.3 ± 20.9 vs. 85.2 ± 44.1 min (P = 0.24, standard procedures), radiofrequency (RF) times were 53.8 ± 26.1 vs. 50.4 ± 29.4 min (P = 0.54, complex procedures) and 10.1 ± 9.9 vs. 12.2 ± 14.7 min (P = 0.60, standard procedures). One complication occurred in the standard low-dose and lowest-dose groups (P = 1.0).
  
  
  CONCLUSIONS
  The new lowest-dose imaging protocol reduces X-ray dose levels by 77% compared with the currently available standard low-dose protocol. From an operator standpoint, lowest X-ray dose levels create a different, reduced image quality. The new image quality did not significantly affect procedure or RF times and did not result in higher complication rates. Regarding radiological protection, operating at lowest-dose settings should become standard in EP procedures.
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany fbourier@gmail.com.
authors.forename: Felix
authors.initials: F
authors.lastname: Bourier
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany.
authors.forename: Tilko
authors.initials: T
authors.lastname: Reents
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ammar-Busch
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Buiatti
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Kottmaier
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Semmler
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany.
authors.forename: Marta
authors.initials: M
authors.lastname: Telishevska
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany.
authors.forename: Amir
authors.initials: A
authors.lastname: Brkic
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Grebmer
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Lennerz
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Hessling
authors.affiliation: Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002932:Cineangiography / Q000009:adverse effects / Q000379:methods*; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000009:adverse effects / Q000295:instrumentation; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control*; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Catheter ablation; Dose reduction; Fluoroscopy; Imaging; X-ray