Reduction of radiation exposure in the cardiac electrophysiology laboratory

The purpose of this study was to determine the effects of various protectiv e measures on patient and operator radiation dose levels in catheter ablati on procedures. Catheter ablation procedures are associated with significant radiation levels. The patient's skin and operator radiation levels were me asured (1) at baseline, (2) offer primary beam filtration by 0.3-mm copper sheer and 2-mm aluminium plate and implementation of the LocaLisa system, a nd (3) after reduction of the left anterior oblique fluoroscopic pulse rate and installation of a lead glass screen. Additionally, a comparative analy sis of radiation exposure levels was performed in the seven Dutch catheter ablation centers. Filtration of both primary beams resulted in a more than two-fold reduction in patient skin dose. Together with the LocaLisa system, this resulted in a six-fold reduction in patient and operator dose. As exp ected, lowering of the lep anterior oblique pulse rate from 25 to 12.5 Hz r educed the corresponding patient skin dose with a factor 2 while the lead-g lass profection caused an extra factor 2 reduction for the operator. Large differences were observed between fluoroscopy systems used for catheter abl ation in the Netherlands. Depending on patient body mass and fluoroscopy sy stem, patient skin dose varied between 0.2 and 8.4 Gy/hour. Proper measures may allow for a significant reduction of patient and operator radiation ex posure in catheter ablation procedures. The large influence of body mass an d equipment on patient's skin dose requires a more direct monitoring of ski n dose than total fluoroscopy time.