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Contributo para o estabelecimento de níveis de referência de diagnóstico em eletrofisiologia de intervenção: estudo de um centro em Portugal
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Abstract(s)
A maioria dos procedimentos eletrofisiologia de intervenção necessitam de fluoroscopia expondo à radiação ionizante todos os intervenientes. O recurso a níveis de referência de diagnóstico (NRD) pode ser uma ferramenta profícua para promover a otimização de dose. O principal objetivo deste estudo consistiu em investigar as doses de exposição, determinando os NRD. Realizou-se um estudo institucional, transversal e retrospetivo, através da revisão dos procedimentos de estudos eletrofisiológicos de diagnóstico e/ou tratamento e de implantação de dispositivos cardíacos, realizados entre 23 de maio de 2018 e 19 de fevereiro de 2020. Os procedimentos foram distribuídos em grupos de acordo com a sua complexidade e aferidos os seus NRD para os descritores de dose Cumulative air kerma (CK, mGy) e Air kerma area product (PKA, mGy.cm2).
Este estudo incluiu 516 procedimentos. Os NRD determinados foram: estudo eletrofisiológico de diagnóstico (12mGy e 3,5Gy.cm2); estudo eletrofisiológico com ablação em cavidades cardíacas direitas (62mGy e 20Gy.cm2); ou em cavidades cardíacas esquerdas (87,5mGy e 32Gy.cm2); ablação por fibrilhação auricular (103mGy e 34Gy.cm2); implantação de cardioversor-desfibrilhador ou pacemaker com um eletrocateter de fixação passiva (7mGy e 2,5Gy.cm2), ou ativa (10mGy e 3Gy.cm2), e com dois eletrocateteres de fixação passiva (9mGy e 3Gy.cm2), ou ativa (15mGy e 4,5Gy.cm2), ou um ativo e um passivo (12mGy e 4Gy.cm2); implantação de dispositivo de ressincronização cardíaca (158,5mGy e 35Gy.cm2) ou upgrade (98mGy e 36Gy.cm2). Os procedimentos mais complexos foram os que apresentaram os NRD mais elevados.
Verificou-se que a maioria dos NRD determinados se situa abaixo dos valores publicados na literatura.
Most interventional electrophysiology procedures require fluoroscopy therefore exposing all intervening parties to ionizing radiation. The use of diagnostic reference levels (DRLs) can be a useful tool to promote dose optimization. The main objective of this study was to investigate the exposure doses, determining the DRLs. An institutional study, cross-sectional and retrospective was carried out, through the review of electrophysiological diagnostic and/or treatment study procedures and the implantation of cardiac devices, performed between May 23, 2018 and February 19, 2020. The procedures were distributed in groups according to their complexity and determined their diagnostic reference levels for the dose descriptors Cumulative air kerma (CK, mGy) and Air kerma area product (PKA, mGy.cm2). This study included 516 procedures. The determined DRLs were: electrophysiological diagnostic study (12mGy and 3,5Gy.cm2); electrophysiological study with ablation in right heart cavities (62mGy and 20Gy.cm2); electrophysiological study with ablation in left heart cavities (87,5mGy and 32Gy.cm2); atrial fibrillation ablation (103mGy and 34Gy.cm2); implantation of a cardioverter-defibrillator or pacemaker with a passive fixation lead (7mGy and 2,5Gy.cm2) or active (10mGy and 3Gy.cm2) and with two passive fixation leads (9mGy and 3Gy.cm2), or active (15mGy and 4,5Gy.cm2), or an active and one passive (12mGy and 4Gy.cm2); implantation of a cardiac resynchronization device (158,5mGy and 38Gy.cm2) or upgrade (98mGy and 36Gy.cm2). The most complex procedures were those with the highest DRLs. It was determined that most of the DRLs found are below the values published in the literature.
Most interventional electrophysiology procedures require fluoroscopy therefore exposing all intervening parties to ionizing radiation. The use of diagnostic reference levels (DRLs) can be a useful tool to promote dose optimization. The main objective of this study was to investigate the exposure doses, determining the DRLs. An institutional study, cross-sectional and retrospective was carried out, through the review of electrophysiological diagnostic and/or treatment study procedures and the implantation of cardiac devices, performed between May 23, 2018 and February 19, 2020. The procedures were distributed in groups according to their complexity and determined their diagnostic reference levels for the dose descriptors Cumulative air kerma (CK, mGy) and Air kerma area product (PKA, mGy.cm2). This study included 516 procedures. The determined DRLs were: electrophysiological diagnostic study (12mGy and 3,5Gy.cm2); electrophysiological study with ablation in right heart cavities (62mGy and 20Gy.cm2); electrophysiological study with ablation in left heart cavities (87,5mGy and 32Gy.cm2); atrial fibrillation ablation (103mGy and 34Gy.cm2); implantation of a cardioverter-defibrillator or pacemaker with a passive fixation lead (7mGy and 2,5Gy.cm2) or active (10mGy and 3Gy.cm2) and with two passive fixation leads (9mGy and 3Gy.cm2), or active (15mGy and 4,5Gy.cm2), or an active and one passive (12mGy and 4Gy.cm2); implantation of a cardiac resynchronization device (158,5mGy and 38Gy.cm2) or upgrade (98mGy and 36Gy.cm2). The most complex procedures were those with the highest DRLs. It was determined that most of the DRLs found are below the values published in the literature.
Description
Keywords
Eletrofisiologia de intervenção NRD Proteção radiológica Interventional electrophysiology DRLs Radiological protection
Citation
Publisher
NUCLIRAD - Núcleo de Desenvolvimento dos Técnicos de Radiologia