Attanasio Philipp, Schreiber Tobias, Parwani Abdul, Lacour Philipp, Pieske Burkert, Haverkamp Wilhelm, Blaschke Florian, Huemer Martin
Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Department of Cardiology, German Heart Center Berlin, Germany.
Pacing Clin Electrophysiol. 2017 Dec;40(12):1380-1383. doi: 10.1111/pace.13229. Epub 2017 Nov 28.
Antiscatter grids improve image contrast by absorbing scattered x-ray beams, although by removing the antiscatter grid patient dose can be reduced as more x-ray beams reach the image receptor. Additionally, there is a trend toward ultra-low frame rates for radiation dose reduction during various electrophysiology procedures. As for most cardiac device implantations (CIED) image quality demands are usually modest, the purpose of this study was to assess the safety and efficacy of an ultra-low frame rate and scatter grid-less radiation protocol.
METHODS/RESULTS: A total of 140 patients undergoing CIED implantation between 2014 and 2017 were included in the study. Seventy patients (50%) implanted after implementation of the antiscatter grid-less and ultra-low frame rate protocol were matched to controls before the dose-reduction protocol was established. Forty patients (28.6%) had a one-chamber pacemaker or one-chamber implantable cardioverter defibrillator (ICD) implantation/revision, 60 (42.9%) had a two-chamber pacemaker or two-chamber ICD implantation/revision, and 40 (28.6%) patients had a cardiac resynchronization therapy device implantation/revision. Removing the antiscatter-grid and lowering the frame rate led to a 73% reduction of the overall dose area product (1,206 ± 2,015 vs 324 ± 422 μGym, P < 0.001). Procedural duration (95 ± 51 minutes vs 82 ± 44 minutes, P = 0.053) and rate of complications were not significantly different between the two groups.
The use of an ultra-low frame rate and antiscatter grid-less radiation protocol significantly reduced radiation dose for implantation of CIED and led to very low average patient doses, while procedural duration and complication rates did not increase.
反散射格栅通过吸收散射的X射线束来提高图像对比度，不过去除反散射格栅后，由于更多X射线束到达图像接收器，患者剂量可降低。此外，在各种电生理手术过程中，存在朝着超低帧率以降低辐射剂量的趋势。由于大多数心脏设备植入（CIED）对图像质量的要求通常不高，本研究的目的是评估超低帧率和无散射格栅辐射方案的安全性和有效性。
方法/结果：本研究纳入了2014年至2017年间接受CIED植入的140例患者。在实施无反散射格栅和超低帧率方案后植入的70例患者（50%）与剂量降低方案确立前的对照组进行匹配。40例患者（28.6%）接受了单腔起搏器或单腔植入式心脏复律除颤器（ICD）植入/修复，60例（42.9%）接受了双腔起搏器或双腔ICD植入/修复，40例（28.6%）患者接受了心脏再同步治疗设备植入/修复。去除反散射格栅并降低帧率导致总体剂量面积乘积降低了73%（1206±2015与324±422μGym，P<0.001）。两组之间的手术持续时间（95±51分钟与82±44分钟，P=0.053）和并发症发生率无显著差异。
使用超低帧率和无反散射格栅辐射方案可显著降低CIED植入时的辐射剂量，并使患者平均剂量非常低，同时手术持续时间和并发症发生率并未增加。
