Heidbuchel Hein, Wittkampf Fred H M, Vano Eliseo, Ernst Sabine, Schilling Richard, Picano Eugenio, Mont Lluis, Jais Pierre, de Bono Joseph, Piorkowski Christopher, Saad Eduardo, Femenia Francisco
Department of Cardiovascular Medicine, University Hospital Gasthuisberg, University of Leuven, 3000 Leuven, Belgium
Heart Lung Center, Department of Cardiology, University Medical Center, 3584 CX Utrecht, The Netherlands.
Europace. 2014 Jul;16(7):946-64. doi: 10.1093/europace/eut409. Epub 2014 May 2.
Despite the advent of non-fluoroscopic technology, fluoroscopy remains the cornerstone of imaging in most interventional electrophysiological procedures, from diagnostic studies over ablation interventions to device implantation. Moreover, many patients receive additional X-ray imaging, such as cardiac computed tomography and others. More and more complex procedures have the risk to increase the radiation exposure, both for the patients and the operators. The professional lifetime attributable excess cancer risk may be around 1 in 100 for the operators, the same as for a patient undergoing repetitive complex procedures. Moreover, recent reports have also hinted at an excess risk of brain tumours among interventional cardiologists. Apart from evaluating the need for and justifying the use of radiation to assist their procedures, physicians have to continuously explore ways to reduce the radiation exposure. After an introduction on how to quantify the radiation exposure and defining its current magnitude in electrophysiology compared with the other sources of radiation, this position paper wants to offer some very practical advice on how to reduce exposure to patients and staff. The text describes how customization of the X-ray system, workflow adaptations, and shielding measures can be implemented in the cath lab. The potential and the pitfalls of different non-fluoroscopic guiding technologies are discussed. Finally, we suggest further improvements that can be implemented by both the physicians and the industry in the future. We are confident that these suggestions are able to reduce patient and operator exposure by more than an order of magnitude, and therefore think that these recommendations are worth reading and implementing by any electrophysiological operator in the field.
尽管非荧光透视技术已经出现，但在大多数介入性电生理手术中，荧光透视仍然是成像的基石，从诊断研究到消融干预再到设备植入。此外，许多患者还接受额外的X射线成像，如心脏计算机断层扫描等。越来越复杂的手术有增加患者和操作人员辐射暴露的风险。对于操作人员来说，职业寿命归因的额外癌症风险可能约为1/100，与接受重复性复杂手术的患者相同。此外，最近的报告还暗示介入心脏病学家患脑肿瘤的风险增加。除了评估使用辐射辅助手术的必要性和合理性外，医生还必须不断探索减少辐射暴露的方法。在介绍了如何量化辐射暴露以及与其他辐射源相比确定其在电生理学中的当前水平之后，本立场文件希望就如何减少患者和工作人员的暴露提供一些非常实用的建议。本文描述了如何在导管实验室中实现X射线系统的定制、工作流程的调整和屏蔽措施。讨论了不同非荧光透视引导技术的潜力和陷阱。最后，我们建议了未来医生和行业都可以实施的进一步改进措施。我们相信这些建议能够将患者和操作人员的暴露减少一个数量级以上，因此认为这些建议值得该领域的任何电生理操作人员阅读和实施。
