Schnur Miriam, Wannagat Severin, Loehr Lena, Lask Sebastian, Mügge Andreas, Wutzler Alexander
Kardiovaskuläres Zentrum, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland.
Herzschrittmacherther Elektrophysiol. 2018 Dec;29(4):406-410. doi: 10.1007/s00399-018-0589-4.
Radiation exposure in the catherization laboratory is associated with significant health risks. It is unclear whether a reduction of radiation exposure with the use of "near-zero fluoroscopy" protocols is possible when applied by less experienced operators.
Consecutive ablation procedures with the use of a 3D mapping system were analyzed. Three time periods were analyzed. During the first period (standard), no specific radiation-reduction protocol was used. During the second period (initial phase of radiation reduction) a near "near-zero fluoroscopy" protocol was implemented; however, the majority of procedures were performed by an expert. During the third period (routine use of radiation reduction), less experienced operators (fellow and beginner) performed a growing number of procedures with the "near-zero fluoroscopy" protocol.
In all, 290 procedures were analyzed. After implementation of a radiation-reduced protocol, a significant reduction of radiation exposure was observed (standard 850 ± 831.7 vs. initial phase 197.2 ± 481.8 μGy/m, p < 0.001, and vs. routine use 283 ± 493.8 μGy/m, p < 0.001). No significant difference was observed between the initial phase and routine phase (p = 1). Over the three periods, the proportion of procedures performed by less experienced operators grew significantly for complex (fellow: 0% vs. 10% vs. 30%; p < 0.001) and noncomplex procedures (fellow: 30% vs. 39% vs. 49%; beginner: 15% vs. 38% vs. 34%; p = 0.002). Complication rates were not significantly different.
Implementation of a radiation-reduced protocol leads to a significant reduction of radiation exposure even in less experienced operators during training.
心导管实验室中的辐射暴露与重大健康风险相关。目前尚不清楚经验较少的操作人员采用“近零透视”方案时，是否有可能降低辐射暴露。
对使用三维标测系统的连续消融手术进行分析。分析了三个时间段。在第一个时间段（标准期），未使用特定的辐射减少方案。在第二个时间段（辐射减少初期），实施了近“近零透视”方案；然而，大多数手术由一名专家进行。在第三个时间段（辐射减少方案的常规使用期），经验较少的操作人员（进修医生和初学者）使用“近零透视”方案进行的手术数量不断增加。
共分析了290例手术。实施辐射减少方案后，观察到辐射暴露显著减少（标准期850±831.7 vs. 初期197.2±481.8 μGy/m，p<0.001；与常规使用期283±493.8 μGy/m相比，p<0.001）。初期和常规期之间未观察到显著差异（p=1）。在这三个时间段内，经验较少的操作人员进行的复杂手术（进修医生：0% vs. 10% vs. 30%；p<0.001）和非复杂手术（进修医生：30% vs. 39% vs. 49%；初学者：15% vs. 38% vs. 34%；p=0.002）的比例显著增加。并发症发生率无显著差异。
即使在培训期间经验较少的操作人员中，实施辐射减少方案也能显著降低辐射暴露。
