Fluoroscopically guided implantation of modern cardiac resynchronization devices - Radiation burden to the patient and associated risks
Fluoroscopically guided implantation of modern cardiac resynchronization devices - Radiation burden to the patient and associated risks
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DOI：
10.1016/j.jacc.2005.01.070
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发表时间：
2005-12-20
影响因子：
24
通讯作者：
Gourtsoyiannis, N
中科院分区：
文献类型：
--
作者：
Perisinakis, K;Theocharopoulos, N;Gourtsoyiannis, N
目的 确定接受荧光镜引导心脏再同步装置植入的患者的辐射风险。 背景 心脏再同步治疗 (CRT) 可能与延长荧光镜暴露有关。 方法 在转诊进行心脏再同步装置植入的一系列连续 14 名患者中记录荧光镜检查时间、剂量面积乘积 (DAP)、暴露参数和常用荧光镜投影的百分比贡献，并与从对照组20例，接受常规节律装置植入手术。使用人形体模和热释光剂量测定法确定双心室起搏和常规节律装置植入的 DAP 至峰值皮肤剂量、DAP 至有效剂量以及 DAP 至性腺剂量换算系数。 结果 对于双心室起搏，平均总透视时间和 DAP 值分别为 35.2 分钟和 4,765 cGy cm(2)，对于双心室起搏为 8.2 分钟和 1,106 cGy cm(2)，分别用于常规节律装置植入。仅当 X 射线源到皮肤的距离保持较低时，需要延长荧光透视曝光的双心室起搏程序的患者皮肤剂量可能会超过诱导皮肤效应的阈值剂量。与典型 CRT 手术相关的致命癌症和严重遗传性疾病的风险值分别为每百万接受治疗的患者 273 例和每百万接受治疗的患者 0.2 例。 结论 与荧光镜引导的 CRT 手术相关的辐射风险可能相当大。目前的数据可用于估计其他机构进行的 CRT 手术的患者辐射风险。
OBJECTIVES To establish radiation risks for patients undergoing fluoroscopically guided cardiac resynchronization device implantation.BACKGROUND Cardiac resynchonization therapy (CRT) may be associated with extended fluoroscopic exposure.METHODS The fluoroscopy time, dose-area product (DAP), exposure parameters, and percentage contribution of the fluoroscopic projections commonly used were recorded in a series of 14 consecutive patients referred for cardiac resynchronization device implantation and compared to corresponding data obtained from a control group of 20 patients who underwent a conventional rhythm device implantation operation. The DAP to peak skin dose, DAP to effective dose, and DAP to gonadal dose conversion factors were determined for biventricular pacing and conventional rhythm device implantation using a humanoid phantom and thermoluminescence dosimetry.RESULTS The mean total fluoroscopy time and DAP values were 35.2 min and 4,765 cGy cm(2), respectively, for biventricular pacing and 8.2 min and 1,106 cGy cm(2), respectively, for conventional rhythm device implantation. Patient skin dose from biventricular pacing procedures requiring extended fluoroscopic exposure may exceed threshold dose for the induction of skin effects only if X-ray source-to-skin distance is kept low. The risk values for fatal cancer and severe hereditary disorders, respectively, associated with a typical CRT procedure were 273 per million and 0.2 per million treated patients.CONCLUSIONS Radiation risks associated with fluoroscopically guided CRT procedures may be considerable. Present data may be used for the estimation of patient radiation risks from CRT procedures performed in other institutions.