Impact of collimation on radiation exposure during interventional electrophysiology

Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
Europace (Impact Factor: 3.67). 04/2012; 14(11). DOI: 10.1093/europace/eus095
Source: PubMed


AIMS: Fluoroscopy remains a cornerstone imaging technique in contemporary electrophysiology practice. We evaluated the impact of collimation to the 'minimal required field size' on clinically significant parameters of radiation exposure.METHODS AND RESULTS: Radiation dose measured by dose area product (DAP) and radiation dose rate measured by DAP per minute of fluoroscopy were determined for all 571 electrophysiology procedures performed in a single electrophysiology laboratory from January 2010 to December 2010. Data from 205 procedures performed by one interventional electrophysiologist, who instituted a practice of routinely collimating to the minimum required visual fluoroscopy field on a case-by-case basis, were compared with data from 366 procedures performed by the three other experienced interventional electrophysiologists using the laboratory who continued their existing practice of ad hoc collimation. Significant reductions in radiation exposure were seen with the practice of routine maximal collimation. The largest reductions were seen during 'simple' ablation procedures.CONCLUSION: A practice of routinely collimating to the minimum required visual fluoroscopy field results in significant reductions in radiation exposure when compared with a usual approach to collimation. This may have important implications for risk of malignancy in patients and operators.

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    • "e l s e v i e r . c o m / i j c -h e a r t -a n d -v a s c u l a t u r e principles in terms of patient radiation safety, such as short imaging time, avoidance of field overlap in repeated acquisitions, low SID, tight collimation, use of intra-procedural echocardiography, and a frame rate for fluoroscopy acquisitions of maximum 15 frames/s [19] [20] [21] [22] [23] [24]. Moreover, our cath lab has been recently upgraded to a novel X-ray imaging technology (AlluraClarity; Philips Healthcare, Best, Netherlands) developed for fluoroscopy and cine exposure for interventional cardiology for the entire patient size population, including pediatric. "
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    ABSTRACT: Background: Pediatric catheterization exposes patients to varying radiation doses. Concerns over the effects of X-ray radiation dose on the patient population have increased in recent years. This study aims at quantifying the patient radiation dose reduction after the introduction of an X-ray imaging technology using advanced real time image noise reduction algorithms and optimized acquisition chain for fluoroscopy and exposure in a pediatric and adult population with congenital heart disease. Methods: Patient and radiation dose data was retrospectively collected (July 2012-February 2013) for 338 consecutive patients treated with a system using state of the art image processing and reference acquisition chain (referred as "reference system"). The same data was collected (March-October 2013) for 329 consecutive patients treated with the new imaging technology (Philips AlluraClarity, referred as "new system"). Patients were divided into three weight groups: A) below 10. kg, B) 10-40. kg, and C) over 40. kg. Radiation dose was quantified using dose area product (DAP), while procedure complexity using fluoroscopy time, procedure duration and volume of contrast medium. Results: The new system provides significant patient dose reduction compared to the reference system. Median DAP values were reduced in group A) from 140.6cGy·cm2 to 60.7cGy·cm2, in group B) from 700.0cGy·cm2 to 202.2cGy·cm2 and in group C) from 4490.4cGy·cm2 to 1979.8cGy·cm2 with reduction of 57%, 71% and 56% respectively (p<0.0001 for all groups). Conclusions: Despite no other changes in procedural approach, the novel X-ray imaging technology provided substantial radiation dose reduction of 56% or higher.
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    • "Walters et al. evaluated the impact of collimation of the "minimal required field size" on the clinically significant parameters of radiation exposure. There was a significant 60% reduction in the total radiation dose with collimation of the minimum required visual field [13]. In this study, we used a 14.5 cm width of collimation because the width easily permitted physicians to see the target point in the L3, 4 and 5 MBBs as shown in Fig. 1A. "
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    ABSTRACT: C-arm fluoroscope has been widely used to promote more effective pain management; however, unwanted radiation exposure for operators is inevitable. We prospectively investigated the differences in radiation exposure related to collimation in Medial Branch Block (MBB). This study was a randomized controlled trial of 62 MBBs at L3, 4 and 5. After the patient was laid in the prone position on the operating table, MBB was conducted and only AP projections of the fluoroscope were used. Based on a concealed random number table, MBB was performed with (collimation group) and without (control group) collimation. The data on the patient's age, height, gender, laterality (right/left), radiation absorbed dose (RAD), exposure time, distance from the center of the field to the operator, and effective dose (ED) at the side of the table and at the operator's chest were collected. The brightness of the fluoroscopic image was evaluated with histogram in Photoshop. There were no significant differences in age, height, weight, male to female ratio, laterality, time, distance and brightness of fluoroscopic image. The area of the fluoroscopic image with collimation was 67% of the conventional image. The RAD (29.9 ± 13.0, P = 0.001) and the ED at the left chest of the operators (0.53 ± 0.71, P = 0.042) and beside the table (5.69 ± 4.6, P = 0.025) in collimation group were lower than that of the control group (44.6 ± 19.0, 0.97 ± 0.92, and 9.53 ± 8.16), resepectively. Collimation reduced radiation exposure and maintained the image quality. Therefore, the proper use of collimation will be beneficial to both patients and operators.
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