Reducing patient radiation dosage during pediatric SVT ablations using an "aLARA" radiation reduction protocol in the modern fluoroscopic era

Laura A. Gellis, Scott R. Ceresnak, Gregory J. Gates, Lynn Nappo, Robert H. Pass

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background Ablation for supraventricular tachycardia (SVT) relies upon fluoroscopy (fluoro), which exposes the patient and staff to ionizing radiation. The objective of this work was to present a new "ALARA - As Low As Reasonably Achievable" protocol with alterations to fluoroscopic x-ray parameters to reduce dose without an electroanatomical (EAM) approach. Methods All patients <21 years of age undergoing ablation of SVT at our institution from June 2011 to April 2012 were included. EAM was not utilized in any case. An ALARA protocol of low frame rates (2 or 3 fps), low fluoro dose/frame (10-18 nGy/frame), and other techniques aimed at reducing use of fluoroscopy were employed. Demographics, procedural, and radiation data were analyzed. Results Forty-two patients underwent ablation and were studied. Median age was 14.1 years (range 4.8-21.1 years), weight was 51 kg (range 18.2-75 kg), and body surface area was 1.51 m2 (range 0.72- 1.94 m2). Seventeen (41%) had Wolff-Parkinson-White syndrome, 14 (33%) atrioventricular nodal reentrant tachycardia, and 11 (26%) concealed pathways. Median procedural time was 114 minutes (57-246 minutes). Median dose area product (DAP) for posterioanterior and lateral fluoroscopy was 343.2 uGym2 (range 38.2-3,172 uGym2); the median air Kerma product (K) was 45.4 mGy (range 6.7-567.5 mGy). DAP and K are lower than prior data from EAM and fluoroscopy techniques. The acute success rate was 95%; no procedural complications. Conclusions An ALARA protocol for ablation of SVT reduced radiation to below levels previously reported for combined EAM/fluoro approaches. Success rates were excellent with no complications and without the costs of EAM.

Original languageEnglish (US)
Pages (from-to)688-694
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume36
Issue number6
DOIs
StatePublished - Jun 2013

Fingerprint

Radiation Dosage
Supraventricular Tachycardia
Fluoroscopy
Radiation
Pediatrics
Atrioventricular Nodal Reentry Tachycardia
Wolff-Parkinson-White Syndrome
Body Surface Area
Ionizing Radiation
Air
X-Rays
Demography
Weights and Measures
Costs and Cost Analysis

Keywords

  • pediatrics
  • radiology
  • SVT

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Reducing patient radiation dosage during pediatric SVT ablations using an "aLARA" radiation reduction protocol in the modern fluoroscopic era. / Gellis, Laura A.; Ceresnak, Scott R.; Gates, Gregory J.; Nappo, Lynn; Pass, Robert H.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 36, No. 6, 06.2013, p. 688-694.

Research output: Contribution to journalArticle

@article{7db7dc740d3d4e6b98ffe9de1258689f,
title = "Reducing patient radiation dosage during pediatric SVT ablations using an {"}aLARA{"} radiation reduction protocol in the modern fluoroscopic era",
abstract = "Background Ablation for supraventricular tachycardia (SVT) relies upon fluoroscopy (fluoro), which exposes the patient and staff to ionizing radiation. The objective of this work was to present a new {"}ALARA - As Low As Reasonably Achievable{"} protocol with alterations to fluoroscopic x-ray parameters to reduce dose without an electroanatomical (EAM) approach. Methods All patients <21 years of age undergoing ablation of SVT at our institution from June 2011 to April 2012 were included. EAM was not utilized in any case. An ALARA protocol of low frame rates (2 or 3 fps), low fluoro dose/frame (10-18 nGy/frame), and other techniques aimed at reducing use of fluoroscopy were employed. Demographics, procedural, and radiation data were analyzed. Results Forty-two patients underwent ablation and were studied. Median age was 14.1 years (range 4.8-21.1 years), weight was 51 kg (range 18.2-75 kg), and body surface area was 1.51 m2 (range 0.72- 1.94 m2). Seventeen (41{\%}) had Wolff-Parkinson-White syndrome, 14 (33{\%}) atrioventricular nodal reentrant tachycardia, and 11 (26{\%}) concealed pathways. Median procedural time was 114 minutes (57-246 minutes). Median dose area product (DAP) for posterioanterior and lateral fluoroscopy was 343.2 uGym2 (range 38.2-3,172 uGym2); the median air Kerma product (K) was 45.4 mGy (range 6.7-567.5 mGy). DAP and K are lower than prior data from EAM and fluoroscopy techniques. The acute success rate was 95{\%}; no procedural complications. Conclusions An ALARA protocol for ablation of SVT reduced radiation to below levels previously reported for combined EAM/fluoro approaches. Success rates were excellent with no complications and without the costs of EAM.",
keywords = "pediatrics, radiology, SVT",
author = "Gellis, {Laura A.} and Ceresnak, {Scott R.} and Gates, {Gregory J.} and Lynn Nappo and Pass, {Robert H.}",
year = "2013",
month = "6",
doi = "10.1111/pace.12124",
language = "English (US)",
volume = "36",
pages = "688--694",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Reducing patient radiation dosage during pediatric SVT ablations using an "aLARA" radiation reduction protocol in the modern fluoroscopic era

AU - Gellis, Laura A.

AU - Ceresnak, Scott R.

AU - Gates, Gregory J.

AU - Nappo, Lynn

AU - Pass, Robert H.

PY - 2013/6

Y1 - 2013/6

N2 - Background Ablation for supraventricular tachycardia (SVT) relies upon fluoroscopy (fluoro), which exposes the patient and staff to ionizing radiation. The objective of this work was to present a new "ALARA - As Low As Reasonably Achievable" protocol with alterations to fluoroscopic x-ray parameters to reduce dose without an electroanatomical (EAM) approach. Methods All patients <21 years of age undergoing ablation of SVT at our institution from June 2011 to April 2012 were included. EAM was not utilized in any case. An ALARA protocol of low frame rates (2 or 3 fps), low fluoro dose/frame (10-18 nGy/frame), and other techniques aimed at reducing use of fluoroscopy were employed. Demographics, procedural, and radiation data were analyzed. Results Forty-two patients underwent ablation and were studied. Median age was 14.1 years (range 4.8-21.1 years), weight was 51 kg (range 18.2-75 kg), and body surface area was 1.51 m2 (range 0.72- 1.94 m2). Seventeen (41%) had Wolff-Parkinson-White syndrome, 14 (33%) atrioventricular nodal reentrant tachycardia, and 11 (26%) concealed pathways. Median procedural time was 114 minutes (57-246 minutes). Median dose area product (DAP) for posterioanterior and lateral fluoroscopy was 343.2 uGym2 (range 38.2-3,172 uGym2); the median air Kerma product (K) was 45.4 mGy (range 6.7-567.5 mGy). DAP and K are lower than prior data from EAM and fluoroscopy techniques. The acute success rate was 95%; no procedural complications. Conclusions An ALARA protocol for ablation of SVT reduced radiation to below levels previously reported for combined EAM/fluoro approaches. Success rates were excellent with no complications and without the costs of EAM.

AB - Background Ablation for supraventricular tachycardia (SVT) relies upon fluoroscopy (fluoro), which exposes the patient and staff to ionizing radiation. The objective of this work was to present a new "ALARA - As Low As Reasonably Achievable" protocol with alterations to fluoroscopic x-ray parameters to reduce dose without an electroanatomical (EAM) approach. Methods All patients <21 years of age undergoing ablation of SVT at our institution from June 2011 to April 2012 were included. EAM was not utilized in any case. An ALARA protocol of low frame rates (2 or 3 fps), low fluoro dose/frame (10-18 nGy/frame), and other techniques aimed at reducing use of fluoroscopy were employed. Demographics, procedural, and radiation data were analyzed. Results Forty-two patients underwent ablation and were studied. Median age was 14.1 years (range 4.8-21.1 years), weight was 51 kg (range 18.2-75 kg), and body surface area was 1.51 m2 (range 0.72- 1.94 m2). Seventeen (41%) had Wolff-Parkinson-White syndrome, 14 (33%) atrioventricular nodal reentrant tachycardia, and 11 (26%) concealed pathways. Median procedural time was 114 minutes (57-246 minutes). Median dose area product (DAP) for posterioanterior and lateral fluoroscopy was 343.2 uGym2 (range 38.2-3,172 uGym2); the median air Kerma product (K) was 45.4 mGy (range 6.7-567.5 mGy). DAP and K are lower than prior data from EAM and fluoroscopy techniques. The acute success rate was 95%; no procedural complications. Conclusions An ALARA protocol for ablation of SVT reduced radiation to below levels previously reported for combined EAM/fluoro approaches. Success rates were excellent with no complications and without the costs of EAM.

KW - pediatrics

KW - radiology

KW - SVT

UR - http://www.scopus.com/inward/record.url?scp=84878565896&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878565896&partnerID=8YFLogxK

U2 - 10.1111/pace.12124

DO - 10.1111/pace.12124

M3 - Article

C2 - 23510152

AN - SCOPUS:84878565896

VL - 36

SP - 688

EP - 694

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

IS - 6

ER -