title: Evaluation of Entrance Skin Dose during Catheter Ablation Procedures by Use of Reference Air-Kerma Displayed on Angiography Systems.
abstract: BACKGROUND
  Our aim in this study was to estimate entrance skin doses (ESDs) to patients who underwent catheter ablation procedures, by using a reference air-kerma (RAK) displayed on the monitor of an angiography system (displayed RAK).
  
  
  METHODS
  The displayed RAK was calibrated with use of an air-kerma value measured on a 20-cm-thick acrylic plate at the interventional reference point for the inclusion of backscattered x-rays (calibrated RAK). The ESD evaluated from the calibrated RAK (evaluated ESD) was verified through direct ESD measurements on an anthropomorphic phantom. The values of the evaluated ESD agreed with those of the measured ESD within a statistical error of 10% for both fluoroscopy and digital cine. The patient population included 356 consecutive patients (108 female and 248 male) who underwent catheter ablation procedures in the catheter laboratory of the Nagoya Daini Red-Cross Hospital from January 2013 to February 2014, where ablation procedures were performed for seven types of arrhythmias, i.e., atrial fibrillation (AF), atrial flutter (AFL), atrial tachycardia (AT), atrioventricular nodal reentrant tachycardia (AVNRT), ventricular premature contraction (VPC), ventricular tachycardia (VT), and Wolff-Parkinson-White syndrome (WPW).
  
  
  RESULTS
  Patients who had arrhythmias that received the highest evaluated ESD were those for AF, followed by those for VPC, AT, WPW, AFL, VT, and AVNRT.
  
  
  CONCLUSIONS
  Despite extremely long fluoroscopy times of up to 66.6 minutes in left anterior oblique projection, only one patient was considered to exceed a threshold dose of 2 Gy for the onset of radiation-induced skin injuries.
authors.affiliation: Division of Radiology, Department of Medical Technology, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Shigenobu
authors.initials: S
authors.lastname: Seguchi
authors.affiliation: Division of Radiology, Department of Medical Technology, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Takaya
authors.initials: T
authors.lastname: Saijo
authors.affiliation: Division of Radiology, Department of Medical Technology, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Ishikawa
authors.affiliation: Division of Radiology, Department of Medical Technology, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Tatsuji
authors.initials: T
authors.lastname: Nagao
mesh_terms: D065638:Absorption, Radiation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000706:statistics & numerical data*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D002648:Child; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000032:analysis / Q000706:statistics & numerical data*; D011874:Radiometry / Q000706:statistics & numerical data*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012869:Skin Absorption; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D014965:X-Rays; D055815:Young Adult
keywords: air-kerma; arrhythmia; catheter ablation; entrance skin dose; fluoroscopy