Reducing operator radiation exposure during cardiac resynchronization therapy

Aims. To quantify the reduction in equivalent dose at operator's hand that can be achieved by placement of a radiation-absorbing drape (RADPAD) during long-lasting cardiac resynchronization therapy (CRT) procedures. Methods and results. This is a prospective observational study that included 22 consecutive patients with drug-refractory heart failure who underwent implantation of a CRT device. The cases were randomly assigned to Group A (11 cases), performed without RADPAD, and to Group B (11 cases), performed using RADPAD. Dose equivalent at the examiner's hand was measured as Hp(0.07) and as a time-adjusted Hp(0.07) rate (mGy/min) with a direct reading dosimeter. The mean fluoroscopy time was 20.8 ± 7.7 min and the mean dose area product (DAP) was 118.6 ± 45.3 Gy cm². No significant differences were found between body mass index, fluoroscopy time, and DAP between patients examined with or without RADPAD. The correlation between the fluoroscopy time and the DAP was high (R²=0.94, P < 0.001). Mean dose and dose rate measurement without the RADPAD at the finger and hand were Hp(0.07)=1.27 ± 0.47 mGy per procedure and Hp(0.07) rate = 0.057 ± 0.011 mGy/min, respectively. The dosage was reduced with the RADPAD to Hp(0.07) = 0.48 ± 0.20 (P < 0.05) and to Hp(0.07) rate =0.026 ± 0.008 (P < 0.001), respectively. Conclusion. A mean reduction of 54 in the equivalent dose rate to the operator's hand can be achieved with the use of RADPAD. The use of the RADPAD in CRT devices implantation will make unlikely the necessity of limiting the yearly number of implants for high volume operators. Published on behalf of the European Society of Cardiology.