Nof Eyal, Lane Christopher, Cazalas Maxime, Cuchet-Soubelet Elisabeth, Michaud Gregory F, John Roy M, Tedrow Usha, Koplan Bruce A, Stevenson William G, Epstein Laurence M
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
Pacing Clin Electrophysiol. 2015 Jan;38(1):136-45. doi: 10.1111/pace.12544. Epub 2014 Dec 9.
To exposure in patients undergoing cardiac electrophysiology (EP) ablation. This included the use of a "very low" dose protocol, and the impact of angulations and patient body mass index (BMI) on radiation dose as a mean to reduce exposure.
A total of 212 retrospective patient data sets were collected during EP ablation procedures on a biplane fluoroscopy system. Dose metrics were computed based on dose-area product (DAP) measured by the system for each x-ray acquisition.
Dose baselines of different ablation procedures were established as DAP and DAP per hour, with respect to patient BMI. The use of a "very low dose" protocol reduced exposure by 62% while providing adequate image quality. With approximate left anterior oblique (LAO) 50° and right anterior oblique (RAO) 30°, DAP and DAP rate were significantly higher in LAO compared to RAO (11.2 [4.8-25.3] Gy · cm(2) vs 5.28 [2.9-11.1] Gy · cm(2) and 74.0 [38.2-136.1] Gy · cm(2)/h vs 25.0 [16.4-44.1] Gy · cm(2)/h, respectively; P < 0.001). DAP and DAP rate were also significantly higher in patients with BMI > 30 vs BMI ≤ 30 (34.2 [22.3-58.7] Gy · cm(2) vs 12.4 [6.0-26.9] Gy · cm(2) and 84.9 [68.1-120.4] Gy · cm(2)/h vs 34.2 [21.7-52.9] Gy · cm(2)/h, respectively; P < 0.001).
Protocol setting, system angulation, and BMI, in particular, wider angulation in LAO compared to RAO plane, exposes patients to significant higher radiation doses. Obese patients in standard LAO plane receive six times the radiation dose of nonobese patients in RAO.
关于心脏电生理（EP）消融患者的辐射暴露情况。这包括使用“极低”剂量方案，以及角度和患者体重指数（BMI）对辐射剂量的影响，以此作为减少暴露的一种手段。
在双平面荧光透视系统的EP消融手术过程中，共收集了212例患者的回顾性数据集。剂量指标是根据系统对每次X射线采集测量的剂量面积乘积（DAP）计算得出的。
根据患者BMI，确定了不同消融手术的剂量基线，以DAP和每小时DAP表示。使用“极低剂量”方案可在提供足够图像质量的同时将暴露减少62%。在大约左前斜（LAO）50°和右前斜（RAO）30°时，LAO的DAP和DAP率显著高于RAO（分别为11.2 [4.8 - 25.3] Gy·cm² 对5.28 [2.9 - 11.1] Gy·cm² 以及74.0 [38.2 - 136.1] Gy·cm²/h对25.0 [16.4 - 44.1] Gy·cm²/h；P < 0.001）。BMI > 30的患者的DAP和DAP率也显著高于BMI≤30的患者（分别为34.2 [22.3 - 58.7] Gy·cm² 对12.4 [6.0 - 26.9] Gy·cm² 以及84.9 [68.1 - 120.4] Gy·cm²/h对34.2 [21.7 - 52.9] Gy·cm²/h；P < 0.001）。
方案设置、系统角度和BMI，特别是与RAO平面相比LAO平面角度更大，会使患者接受显著更高的辐射剂量。标准LAO平面的肥胖患者接受的辐射剂量是非肥胖患者在RAO平面的六倍。
