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PubMed1980

Cardiac catheterization: dosimetry on patients.

Our study was made on 49 patients and we used capsules of lithium fluoride. The average fluoroscopy time was 32 min. and the average cinema film length was 76.5 metres. The relationship between the entry dose, the fluoroscopy time and the length of cinema film allowed us to calculate a fluoroscopy equivalent time (F.E.T) for each patient which was of 51 min. (32 min. + 76/4) as radiation dose of one minute fluoroscopy equal radiation dose of 4 metres of cinema film. The average heart dose was 0.70 X 10(-3) X FET (GY) or 70 mr/min. There was an absence of relation of the exit dosage to the diameter of the patient and a proportionality of the heart dose to the exit dose. Furthermore the maximum eye dose recorded was 200 mrads and the maximum gonadal dose was 350 mrads.

Adolescent↗
PubMed2006

Magnetic navigation in AV nodal re-entrant tachycardia study: early results of ablation with one- and three-magnet catheters.

AIMS: Steering soft, flexible catheters using an external magnetic field could have advantages for heart catheterization, especially for therapy of tachyarrhythmias. Our aims were to assess the feasibility of magnetic navigation to Koch's triangle and reliable ablation of atrioventricular nodal re-entry tachycardia (AVNRT) with a magnetic catheter. METHODS AND RESULTS: Consecutive patients with AVNRT were mapped and ablated with a magnetically enabled catheter (Helios I or II), with, respectively, one and three magnets at the tip. The catheter was remotely advanced with the Cardiodrive system and orientated with the Navigant control system. After initial positioning with the external magnets, adjustment was made in 5 degrees steps. Success rates, procedure, and fluoroscopy times were analysed, and compared with a local contemporary series of conventional AVNRT ablations. Magnetic navigation was feasible in all 20 patients. Targets were easily reached. Catheters remained stable in position during accelerated junctional rhythms. Ablation was successful in 18/20 procedures (90%). No significant complications occurred. Median patient fluoroscopy time was 12 min, median physician fluoroscopy time was 4 min. Fluoroscopy times tended to be shorter than that in the conventionally treated group. Procedure duration decreased significantly over time, median procedure time was similar to that in the conventional group. CONCLUSION: AVNRT can be successfully mapped and ablated using magnetic navigation. A learning curve was evident, unrelated to catheter type, but to increasing operator experience. Physician radiation times were one-third of patient times. No complications occurred. Procedure time is comparable with that of conventional ablation.

Cardiac Catheterization↗
PubMed2003

Radiation doses to patients from endoscopic retrograde cholangiopancreatography examinations and image quality considerations.

The purpose of this investigation was to measure the dose-area product (DAP) and the other relevant dosimetric quantities in diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Furthermore, the dependence of patient dose and image quality on the tube potential was investigated. A DAP meter was used for dose monitoring in seven diagnostic and 21 therapeutic ERCPs. For each ERCP the DAP meter readings, fluoroscopy time, number of radiographs and exposure data were recorded. From these data the fluoroscopy and radiography contributions to DAP, the entrance skin dose and the effective dose for each examination were estimated. For the investigation of the effect of tube potential on patient dose and image quality, a water phantom containing syringes filled with diluted contrast media was used. The average DAP was 13.7 Gy cm2 in diagnostic and 41.8 Gy cm2 in therapeutic ERCP whereas the average fluoroscopy times were 3.1 and 6.0 min respectively. DAP was strongly correlated to the fluoroscopy time. Measurements in the phantom showed that a good compromise between image quality and patient dose is obtained for tube potentials around 80 kV. Therapeutic ERCPs deliver on average higher doses to patients than diagnostic ERCPs. However, for a difficult diagnostic ERCP more patient exposure may be required than for a simple therapeutic ERCP.

Aged↗
PubMed2001

Paediatric dose reduction with the introduction of digital fluorography.

Fluoroscopy guided examinations in a paediatric X ray department were initially carried out on a unit that used a conventional screen-film combination for spot-films. A new fluoroscopy unit was installed with the facilities of digital fluorography and last image hold. Comparison of equipment performance showed that the dose per image for screen-film and digital fluorography was 3 microGy and 0.4 microGy, respectively. Although the screen-film had superior image quality, the department's radiologist confirmed that digital fluorography provided a diagnostic image. Patient dose measurements showed that introduction of the new unit caused doses to fall by an average of 70%, although fluoroscopy time had not changed significantly. The new unit produced 40% less air kerma during fluoroscopy. The remaining 30% reduction in dose was due to the introduction of digital fluorography and last image hold facilities. It is concluded that the use of digital fluorography can be an effective way of reducing paediatric dose.

Adolescent↗
PubMed2006

Influence of patient thickness and operation modes on occupational and patient radiation doses in interventional cardiology.

Patient and staff dose values in an interventional cardiology laboratory for different operational modes and several patient thicknesses (from 16 to 28 cm, simulated using polymethylmethacrylate) are presented. When increasing patient thicknesses and depending on fluoroscopy and cine modes, occupational doses can increase >30 times the baseline level. Scatter dose rates at the cardiologist's position with no radiation protective tools ranged from 1 to 14 mSv h(-1) for fluoroscopy, and from 10 to 47 mSv h(-1) during cine acquisition. Patient entrance surface air kerma rates increased by nearly 3 and staff dose rates by up to 2.6 when fluoroscopy was moved from the low to the high mode, for a typical 20 cm thickness. The respective increase factors were 6 and 4.2 when patient thickness rose from 16 to 28 cm, and by 10 and 8.3, when comparing cine acquisition with the low fluoroscopy mode. The knowledge of typical dose rates for each X-ray system in use in catheterisation laboratories is essential in order to optimise protection of patients and staff.

Body Constitution↗
PubMed2006

Sonographic visualization and ultrasound-guided block of the third occipital nerve: prospective for a new method to diagnose C2-C3 zygapophysial joint pain.

BACKGROUND: Chronic neck pain after whiplash injury is caused by cervical zygapophysial joints in 50% of patients. Diagnostic blocks of nerves supplying the joints are performed using fluoroscopy. The authors' hypothesis was that the third occipital nerve can be visualized and blocked with use of an ultrasound-guided technique. METHODS: In 14 volunteers, the authors placed a needle ultrasound-guided to the third occipital nerve on both sides of the neck. They punctured caudal and perpendicular to the 14-MHz transducer. In 11 volunteers, 0.9 ml of either local anesthetic or normal saline was applied in a randomized, double-blind, crossover manner. Anesthesia was controlled in the corresponding skin area by pinprick and cold testing. The position of the needle was controlled by fluoroscopy. RESULTS: The third occipital nerve could be visualized in all subjects and showed a median diameter of 2.0 mm. Anesthesia was missing after local anesthetic in only one case. There was neither anesthesia nor hyposensitivity after any of the saline injections. The C2-C3 joint, in a transversal plane visualized as a convex density, was identified correctly by ultrasound in 27 of 28 cases, and 23 needles were placed correctly into the target zone. CONCLUSIONS: The third occipital nerve can be visualized and blocked with use of an ultrasound-guided technique. The needles were positioned accurately in 82% of cases as confirmed by fluoroscopy; the nerve was blocked in 90% of cases. Because ultrasound is the only available technique today to visualize this nerve, it seems to be a promising new method for block guidance instead of fluoroscopy.

Adult↗
PubMed2002

Assessment of patient effective radiation dose and associated radiogenic risk from extracorporeal shock-wave lithotripsy.

The aim of the present study was to calculate patient effective dose and associated radiogenic risk from fluoroscopy guided extracorporeal shock-wave lithotripsy procedures. Fluoroscopy required during extracorporeal shock-wave lithotripsy was classified in two types identified by beam orientation: antero-posterior and 30 degrees anterior-oblique projected exposures. Duration of each exposure was monitored in 124 patients undergoing extracorporeal shock-wave lithotripsy treatment for ureteral stones. The dose from a kidney-ureter-bladder radiograph and the dose per min of fluoroscopy along antero-posterior and anterior-oblique projections were measured at 13 organs/tissues using an anthropomorphic phantom and thermoluminescence dosimetry. A radio-opaque object was placed in the phantom to simulate an ureteral stone at the proximal and distal ureter. The total effective dose in male and female patients with proximal ureteral stones was 1.71 mSv and 1.82 mSv, respectively. The corresponding values for male and female patients with distal ureteral stones was 0.76 mSv and 1.62 mSv, respectively. In the United States, the theoretical sex-averaged radiogenic excess of fatal cancers was estimated to be 140 per million and 85 per million of patients treated for proximal and distal ureteral stone, respectively. The average radiogenic risk for genetic defect associated to treatments of proximal and distal ureteral stones was found to be 2.5 and 24.4 per million of births, respectively. The radiation risk from a typical fluoroscopy guided extracorporeal shock-wave lithotripsy treatment of ureteral stones is low. Presented data may be used to determine patient effective dose from extracorporeal shock-wave lithotripsy procedures performed in any laboratory.

Dose-Response Relationship, Radiation↗
PubMed1994

Reproducibility of digital subtraction fluoroscopic readings for coronary artery calcification.

RATIONALE AND OBJECTIVES: Digital subtraction fluoroscopy, an inexpensive screening test for coronary atherosclerosis, is highly sensitive in detecting coronary calcifications. However, no previous study has reported interobserver agreement for this test. METHODS: Six hundred and thirty-one subjects underwent digital subtraction fluoroscopy in the 60 degrees left anterior oblique projection. Images were acquired with pulsed fluoroscopy at 15 frames per second. An averaged mask was subtracted from successive images. These fluoroscopic images were stored on a digital disk and replayed in cine loop format. An observer, blinded to clinical information, read the fluoroscopic studies for the presence of calcium in the left main-left anterior descending artery, circumflex artery, and right coronary artery. The images were then stored on digital tape and reread by a second blinded observer. RESULTS: The percentages of interobserver agreement regarding the presence and absence of calcium in left main-left anterior descending, circumflex, and right coronary arteries, were 91.9%, 92.9%, and 92.2%, respectively. The overall kappa values, which are 0.85, 0.77, and 0.82 in left main-left anterior descending, circumflex, and right coronary arteries, respectively, show a highly significant level of agreement (P < .0001). CONCLUSION: Digital subtraction fluoroscopy is a reliable screening test for coronary calcifications.

Calcinosis↗
PubMed2000

Radiation exposure during fluoroscopically assisted pedicle screw insertion in the lumbar spine.

STUDY DESIGN: An experimental model to assess radiation exposure during lumbar pedicle screw insertion. OBJECTIVES: To measure skin (patient) and scatter (surgeon) doses of radiation during lumbar spine fluoroscopy to assess safety of the procedure for both the surgeon and patient and determine best practice. SUMMARY OF BACKGROUND DATA: Fluoroscopy assists with accuracy of pedicle screw placement, yet the optimal technique of C-arm use and risk to both patient and operating room staff from radiation exposure are unknown. METHODS: Entry- and scatter-dose recordings were made using a digital dosimeter while screening an anthropomorphic phantom prone on a radiolucent operating table. The source was positioned both superiorly and inferiorly with the height varied in the latter orientation to create a working space under the C-arm. The senior author's fluoroscopy records were reviewed in 140 consecutive cases. RESULTS: In a series of 140 patients who underwent pedicle screw fixation, the fluoroscopy time was 1.4 minutes per case or 0.33 minutes per screw. In the source-superior position, the effective dose received by the patient was approximately 2.3 mSv per case. In the source-inferior position with a working space of 300 mm, the effective dose was 6.8 mSv. Scatter dose to the surgeon was higher in the source-superior position but was still less than 10% of recommended limits for the hand, thyroid, and eyes. CONCLUSIONS: The source-superior position is the preferred position for pedicle screw screening if a working space is required. Patient exposure is minimized, and surgeon dose is well within current recommendations.

Bone Screws↗
PubMed2006

Accuracy of pedicle screw placement for upper and middle thoracic pathologies without coronal plane spinal deformity using conventional methods.

There is a growing interest in the implantation of pedicle screws into the middle and upper thoracic spine. However, usage of the technique is still under debate for these levels because the pedicles in these regions are small and exhibit a high degree of inter- and intraspecimen variability. Twenty-four consecutive patients treated for upper and middle thoracic pathologies by pedicle screw instrumentation under biplanar or uniplanar fluoroscopy were evaluated retrospectively. The rate of screw misplacement on postoperative computerized tomography and complications caused by misplaced screws were determined. In 24 cases, a total of 113 upper-middle thoracic pedicle screws were inserted. Fifty-one of them were inserted between T2 and T5 with guidance of biplanar fluoroscopy, and 62 were inserted between T6 and T8 with uniplanar fluoroscopy. The rate of misplacement was 20.3% for 113 screws (27.4% for T2 to T5 screws, and 14.5% for 62 T6 to T8 screws). Four screws were incorrectly inserted which could have clinical significance (3.5%), and 1 of them required revision. The difference between the upper and middle thoracic screws was not statistically significant (P=0.089). Screw insertion with laminectomy did not cause significant difference in both upper and middle thoracic regions. Only 2 complications were seen because of screw insertion. Pedicle screw insertion with guidance of fluoroscopy may be a reliable and safe method for upper and middle thoracic pathologies.

Adolescent↗
PubMedDate not supplied

Trochanteric versus piriformis entry portal for the treatment of femoral shaft fractures.

OBJECTIVES: The purpose of this study was to compare results of femoral shaft fracture treatment with nailing through the greater trochanter to nailing through the piriformis fossa with nails specifically designed for each starting point. DESIGN: Prospective cohort study. SETTING: Four level 1 trauma centers. PATIENTS: One-hundred and eight patients treated by 1 of 4 surgeons for a femoral shaft or subtrochanteric fracture with antegrade nailing between January 2001 and April 2003 were included. Four patients who expired early in the postoperative period and 13 with insufficient follow-up were excluded from analysis. INTERVENTION: Patients were treated with either nailing through a greater trochanter starting point with the Trigen TAN nail (GT group) (n = 38) or through a piriformis fossa starting point with the Trigen FAN nail (PF group) (n = 53). OUTCOME MEASURES: Operative time, fluoroscopy time, fracture alignment, fracture healing, complications, and functional outcome based on the lower-extremity measure (LEM). RESULTS: Thirty-seven of the 38 fractures from the GT group and 52 of the 53 fractures from the PF group healed after the index procedure. One patient from the GT group had external rotation malalignment of 12 degrees. There were no other malalignments or iatrogenic fracture comminution. There were 2 infectious complications, 1 from each group. The average operative time was 75 minutes for piriformis insertion using the FAN nail and 62 minutes for trochanteric insertion using the TAN nail (P = 0.08). The average fluoroscopy time was 61% greater for the PF group (153 seconds) than for the GT group (95 seconds) (P < 0.05). These differences were magnified in patients who were obese (body mass index > 30) where the operative time was 30% greater (P < 0.05) and the fluoroscopy time was 73% higher in the PF group (P < 0.02). Patients from both groups had a similar initial decline and subsequent improvement in function over time (P > 0.05). CONCLUSIONS: A femoral nail specially designed for trochanteric insertion resulted in equally high union rates, equally low complication rates, and functional results similar to conventional antegrade femoral nailing through the piriformis fossa. The greater trochanter entry portal coupled with an appropriately designed nail represents a rational alternative for antegrade femoral nailing with the benefit of decreased fluoroscopy time and decreased operative time in patients who are obese.

Adolescent↗
PubMed2003

Electromagnetic field-based image-guided spine surgery part one: results of a cadaveric study evaluating lumbar pedicle screw placement.

STUDY DESIGN: Human cadaveric. OBJECTIVES: Compare the accuracy of electromagnetic field (EMF)-based image-guided lumbar pedicle screw insertion to conventional techniques using anatomic landmarks, and fluoroscopy. BACKGROUND: Image-guided surgical systems that aid in spinal instrumentation seek to minimize radiation exposure and improve accuracy. EMF tracking-based image-guidance was developed in the hopes of eliminating line-of-sight restrictions seen with other systems. MATERIALS AND METHODS: Sixteen fresh-frozen human cadavers were randomly allocated into three groups. Pedicle screws were inserted from L1 to L5 using only anatomic landmarks in group 1, fluoroscopy in group 2, and image-guidance in group 3. Insertion and total fluoroscopic time were recorded. Anatomic dissections were performed to assess screw placement. RESULTS: Accuracy was 83%, 78%, and 95% for groups 1, 2, and 3, respectively. However, image-guided pedicle screw placement resulted in a 5% critical perforation rate whereas anatomic and fluoroscopic placement resulted in a 15% and 22% critical perforation rate, respectively. The average degree of perforation was 1.5 mm with image guidance, and 3.8 mm with fluoroscopic guidance (P < 0.05). Fluoroscopy time and insertion time per screw were not improved using image guidance. CONCLUSIONS: Our study has shown that when EMF tracking was used for image-guided lumbar pedicle screw placement, accuracy was improved and the incidence and degree of cortical perforations that may place neurovascular structures at risk was also reduced. Current system requirements for set-up and image acquisition, however, do add time to the procedure, and when factored in, do not yet result in a decrease in the use of fluoroscopy or screw insertion time.

Analysis of Variance↗
PubMed2006

Radiation doses to patients from extracorporeal shock wave lithotripsy.

The aim of this study was to determine the radiation doses to patients during extracorporeal shock wave lithotripsy (ESWL) and compare them with the available bibliographical data. In this method localization of the renal stones is attained by the use of fluoroscopy, and thus ESWL is included among those medical practices associated with patient radiation exposure. The entrance surface dose was measured using 3-4 thermoluminescent dosimeters positioned on the patients' backs at the entrance surfaces of the two x-ray beams for 50 ESWL procedures. Fluoroscopy time and number of spot films were also recorded. The average entrance surface dose at the patient's side with the renal stone was estimated to be 76.5 mGy for the oblique x-ray beam and 44.5 mGy for the PA x-ray beam. The mean fluoroscopy time was 204 s while 4 spot films were acquired on average. The mean effective dose (E) was estimated as 1.63 mSv per patient. The mean entrance surface dose values recorded in this study are comparable to but smaller than the values reported in the literature for ESWL, while the mean fluoroscopy time is within the range of values reported by other authors. On the other hand, the estimated E value is relatively higher compared to the corresponding values given in the literature based on patient measurements. However, it is comparable to recent published data acquired using extended measurements in an anthropomorphic phantom.

Adult↗
PubMed2006

Skin entrance radiation dose in an interventional radiology procedure.

Monitoring of skin entrance radiation exposure in lengthy interventional procedures has been recommended because of the potential for skin injury. Fluoroscopy duration and dose-area product (DAP) are readily available real-time measurements. It would be of interest to study the correlation of these parameters and skin entrance radiation. Twenty neurological interventional procedures performed through the aortic arch were monitored. Two pieces of GafChromic XR Type R film were placed between the patient and the examination table. An observer recorded the fluoroscopy duration and DAP for each phase of the procedure. Each film was scanned post-procedure in RBG mode, and then the image was analyzed for peak skin entrance radiation dose (in air kerma). All DAP values were corrected according to a calibration with an ion chamber. With the DAP values for the respective phases of a procedure, the effective dose in a Reference Man was calculated. For these twenty cases, the means and standard deviations were 17.2+/-6.4 min for x ray on-time, 256+/-65 Gy cm (-2) for DAP, 94+/-34 cGy for peak skin entrance dose in air kerma, and 19.2+/-5.0 mSv for effective dose, respectively. The peak skin entrance dose was correlated to fluoroscopy duration, DAP, and effective dose with the r(2)-values of 0.48, 0.46, and 0.09, respectively. The correlation with DAP or fluoroscopy duration was not sufficiently strong to infer skin entrance dose from either of these parameters. Therefore, skin entrance dose should be determined directly.

Film Dosimetry↗
PubMed2004

Evaluation of magnetic navigation in an in vitro model of uterine artery embolization.

PURPOSE: To compare steering of a novel magnetic guide wire with a standard 0.014-inch guide wire within a vascular phantom. MATERIALS AND METHODS: The magnetic guiding system (MGS) was composed of two permanent magnets on each long side of the fluoroscopy table generating a 0.1-T magnetic field, and a C-arm angiography system. The magnetic field was created according to vectors drawn onto two radiographic projections. Consequently, the tip of the intravascular guide wire containing a permanent magnet was deflected parallel to the magnetic field. Ninety-six catheterizations were performed in water-filled polyvinyl chloride tubes imitating the arterial tree of a female pelvis. This vascular phantom resembled a total of 12 uterine arteries with three different calibers (inner diameters: 1.1 mm, 1.7 mm, and 4.2 mm). Fluoroscopy and procedure times were measured to compare magnetic-assisted and conventional catheterization. RESULTS: Catheterization to every predefined target was successful for all attempts with both guiding techniques. The fluoroscopy time during magnetic navigation was significantly shorter in vessels of all three sizes compared with conventional navigation (means of 19.6 sec, 5.9 sec, and 4.8 sec vs. 48.8 sec, 49.8 sec, and 32.7 sec for small, medium, and large vessels, respectively; P < .05). Procedure times with use of the magnetic guide wire (149.6 sec, 52.1 sec, and 39.9 sec) were not significantly different than those with conventional navigation (60.4 sec, 68.6 sec, and 47.7 sec). CONCLUSIONS: The MGS enables exact endovascular navigation with shorter fluoroscopy time in an in vitro model. The MGS may offer opportunities to reduce x-ray exposure to patients and staff.

Catheterization↗
PubMed2004

Computer-assisted versus conventional surgery for insertion of 96 cannulated iliosacral screws in patients with postpartum pelvic pain.

BACKGROUND: The purpose of this study was to assess the value of fluoroscopy-based computer-assisted surgery (CAS) for the insertion of iliosacral screws. The results of CAS were compared with the results of a conventionally operated prospective control group. Endpoints of this study were fluoroscopy time, guide wire insertion time, operation time and complication rate. METHODS: The study group consisted of 24 patients with postpartum pelvic pain syndrome. All patients were treated with a stabilization of the pelvic ring by means of an anterior plate fixation and autologous tricortical bone graft as well as two iliosacral screws bilaterally. Consequently, the results of 48 versus 48 iliosacral screw fixations could be evaluated. Conventionally operated patients were turned from the supine to the prone position intraoperatively, whereas CAS operated patients were operated in the supine position. One surgeon performed all operations. RESULTS: The fluoroscopy time in the CAS group was 0.7 minutes versus 1.8 minutes in the conventionally treated group (p < 0.01). The mean insertion time for four guide wires was 20.2 minutes in the CAS versus 19.4 minutes in the conventionally operated group (p = 0.6). The mean operation time in the CAS group was 97 minutes; 116 minutes in the conventional group (p = 0.03). In the CAS group one patient had pain and a sensory deficit of S2 postoperatively. The Fisher's exact test showed no difference in complication rate between the two groups (p = 0.26). CONCLUSIONS: The fluoroscopy time is decreased with a factor 2.5 using CAS. Guide wire insertion time was similar in both groups. The reduction in operation time using CAS was due to fact that patients were operated in the supine position during the whole procedure. This study shows that CAS is a save technique for insertion of iliosacral screws.

Adult↗
PubMed1998

Radiation use in the orthopaedic theatre: a prospective audit.

BACKGROUND: There is concern about the exposure of orthopaedic surgeons to radiation. The aim of this study was to monitor radiation use in theatre to improve practice and to attempt to quantify the radiation dose the orthopaedic surgeon may have received. METHODS: A 6-month prospective audit of all procedures performed in the orthopaedic theatre that used fluoroscopy or radiographs was undertaken An anthropomorphic phantom was used to measure scatter and direct-skin doses. Screening times were recorded in a subsequent 6-month post at a tertiary trauma centre. RESULTS: Fluoroscopy or radiographs were used in 378 procedures. Fluoroscopy was used in 260 procedures with a screening time of 124 min at an average of 0.48 min per procedure. Lead aprons were worn in 99% of cases and thyroid guards in 32%. All dosimeter badges were negative. The surgeon's hand was caught in the fluoroscopy beam in 15% of procedures. The phantom recordings ranged from 13 to 210 microGy for skin dose and 0.17-0.87 microGy for scatter dose. The calculated hand exposure was less than 5% of recommended levels. In the trauma post 210 min of screening was used potentially increasing the hand exposure to one-third of recommended limits. If a printer was used to record the image, 58% of intra-operative radiographs would have been avoided. CONCLUSIONS: Hand exposure to radiation is the limiting factor in orthopaedics. The extremity limit will only be exceeded if the hands are regularly caught in the beam. Dose-reduction gloves should be considered for high-risk procedures. A printer can reduce the need for intraoperative plain radiographs.

Body Burden↗
PubMed2005

Radiation doses to patients and cardiologists from permanent cardiac pacemaker implantation procedures.

BACKGROUND: The purpose of this study was to determine the patient and cardiologist doses during the implantation of permanent cardiac pacemakers under fluoroscopic control. METHODS: For 55 procedures concerning three different types of pacemakers (DDD, VDD, and VVI), the dose-area product (DAP) meter readings and fluoroscopy times were recorded. From these data, the dose to the operating cardiologist was estimated. RESULTS: The median values of DAP and fluoroscopy time for all the procedures monitored were 11.4 Gycm(2) and 6.6 minute, respectively. For the 22 DDD, 21 VDD, and 12 VVI pacemakers implanted, the respective DAP median values were 14.7, 9.9, and 7.3 Gycm(2) and the respective median fluoroscopy times were 8.4, 5, and 2.9 minutes. The median doses to the hands, chest, eyes, and legs of the cardiologist conducting the manipulations were estimated to 0.21, 0.06, 0.03, and 0.11 mGy, respectively, per procedure. CONCLUSIONS: Compared to the existing literature, the median DAP value of this study is almost identical to the 11.2 Gycm(2) reported from a sample of 627 patients in 17 different x-ray rooms, whereas the fluoroscopy times are within the range of values reported by other authors. Concerning the cardiologist exposure, the estimated values indicate that the implantation of pacemakers is a procedure that does not involve a severe risk, especially if it is taken into account that lead aprons and collars are routinely used.

Analysis of Variance↗