Butter Christian, Schau Thomas, Meyhoefer Juergen, Neumann Klaus, Minden Hans H, Engelhardt Joerg
Heart Center Brandenburg, Department of Cardiology, Bernau/Berlin, Germany.
Pacing Clin Electrophysiol. 2010 Aug;33(8):1003-12. doi: 10.1111/j.1540-8159.2010.02765.x. Epub 2010 May 4.
Cardiac resynchronization therapy (CRT) is often associated with extended fluoroscopic exposure during placement of the devices. The objective of this study was to measure the radiation exposure sustained by different parts of the body of patients and operators during fluoroscopically guided cardiac resynchronization device implantation.
Dosimetry data were prospectively recorded in a series of 104 consecutive patients, who underwent resynchronization device implantation or upgrade in our cardiac catheterization laboratory. Five Chipstrate dosimeters were fixed to the patient's skin around the thorax (right and left paravertebral, right and left parasternal, and sternal positions), one dosimeter was attached to the forehead, and one to the pubis. The operator was equipped with one dosimeter on the forehead at eye level and a ring dosimeter was worn on the right hand.
Based on the maximum radiation dose of 9.2 mSv measured at the operator's hand in a single implantation session, it might be recommended to conservatively limit the number of implantations to four per month (an annual limit value of 500 mSv). At a mean dose of 1.2 mSv, this number can be increased sevenfold.
In patients, incipient deterministic radiation effects can theoretically be observed at dose area product >400 Gy*cm(2), a dose applied in 2.9% of CRT implantation procedures. Special follow-up programs are considered necessary for these patients and for operators, as the latter may be exposed over many years given the unknown long-term impact of chronic radiation exposure and the nature of current complex electrophysiology and device procedures.
心脏再同步治疗（CRT）在设备植入过程中常常伴随着较长时间的透视曝光。本研究的目的是测量在透视引导下进行心脏再同步设备植入时患者和操作人员身体不同部位所承受的辐射暴露。
前瞻性记录了在我们心脏导管实验室接受再同步设备植入或升级的连续104例患者的剂量测定数据。五个芯片式剂量仪固定在患者胸部周围的皮肤上（左右椎旁、左右胸骨旁和胸骨位置），一个剂量仪附着在前额，一个附着在耻骨上。操作人员在前额眼睛水平处配备一个剂量仪，右手佩戴一个指环式剂量仪。
基于在单次植入过程中操作人员手部测得的最大辐射剂量9.2毫希沃特，建议保守地将每月植入次数限制为4次（年限值500毫希沃特）。在平均剂量为1.2毫希沃特时，这个次数可以增加到7倍。
在患者中，理论上在剂量面积乘积>400戈瑞·平方厘米时可观察到早期确定性辐射效应，该剂量在2.9%的CRT植入手术中应用。考虑到慢性辐射暴露的未知长期影响以及当前复杂的电生理和设备手术的性质，这些患者和操作人员需要特殊的随访计划，因为操作人员可能会在多年内受到辐射暴露。
