Smith Ian R, Rivers John T, Hayes John, Stafford Wayne, Codd Catrina
St Andrew's Medical Institute, C/- St Andrew's War Memorial Hospital, GPO Box 764, Brisbane, QLD 4001, Australia.
Heart Lung Circ. 2009 Jun;18(3):191-9. doi: 10.1016/j.hlc.2008.10.006. Epub 2008 Dec 31.
Electrophysiology (EP) procedures have been reported to carry a significantly greater radiation risk than that of coronary angiography (CA). This is largely due to numerous reports linking severe deterministic radiation effects to long procedure and fluoroscopy times (FTs). This study documents low radiation doses achieved by strategies involving operator training and education as well as equipment and technique optimisation to reduce radiation risks.
Records relating to 732 diagnostic EP and 1744 therapeutic EP procedures performed between January 2002 and December 2007 were analysed. Data from 1458 diagnostic only CA procedures performed in 2006 was used for comparison. For each procedure type, FT, number of digital frames acquired and estimated effective dose (E) were compared.
Although the FT for CA procedures is significantly less than for therapeutic EP procedures (FT for diagnostic EP being similar), EP procedures generally are associated with lower E, the exception being procedures for atrial fibrillation (AF).
Through the application of a comprehensive exposure minimisation strategy, the radiation risk to patients undergoing diagnostic and, therapeutic EP procedures (except AF ablation procedures) is significantly less than that faced by patients undergoing CA. E, however, is heavily dependent on procedure type and as such care must be taken in undertaking generalised comparisons for audit and benchmarking purposes.
据报道，电生理（EP）手术所带来的辐射风险比冠状动脉造影（CA）要高得多。这主要是由于大量报告将严重的确定性辐射效应与较长的手术时间和透视时间（FT）联系起来。本研究记录了通过涉及操作人员培训与教育以及设备和技术优化等策略来降低辐射风险所实现的低辐射剂量。
对2002年1月至2007年12月期间进行的732例诊断性EP手术和1744例治疗性EP手术的记录进行了分析。使用2006年进行的1458例仅诊断性CA手术的数据进行比较。对每种手术类型的FT、采集的数字帧数和估计的有效剂量（E）进行了比较。
尽管CA手术的FT明显少于治疗性EP手术（诊断性EP的FT与之相似），但EP手术通常与较低的E相关，心房颤动（AF）手术除外。
通过应用全面的暴露最小化策略，接受诊断性和治疗性EP手术（AF消融手术除外）的患者所面临的辐射风险明显低于接受CA手术的患者。然而，E在很大程度上取决于手术类型，因此在进行用于审核和基准测试目的的一般性比较时必须谨慎。
