AHA: Protocol reduces children's rad exposure during EP procedures
A protocol that uses continuous real-time radiation monitoring, low-dose imaging programs and requires physician awareness of radiation dose significantly reduced radiation exposure during electrophysiology (EP) procedures in children, according to research presented at the annual meeting of the American Heart Association's Scientific Sessions earlier this month in Chicago.

Akash R. Patel, MD, an EP fellow at the Children's Hospital of Philadelphia, and colleagues looked at boys and girls at an average age of 14.5 years who underwent EP procedures to diagnose and treat arrhythmias.

"Radiation exposure in pediatric electrophysiology procedures is not insignificant," said Patel. "We compared the radiation exposure of 70 children who had undergone the procedures before we began the protocol to that of 61 children who had the procedures after we instituted the protocol."

The new protocol uses a low-dose fluoroscopy setting and continuous real-time monitoring of radiation exposure. When the radiation dose registers at certain levels, the physician is notified so that he or she can adjust the fluoroscopy cameras to minimize exposure.

The researchers found significantly reduced radiation exposure among children whose procedures were performed using the new protocol, including:
  • 22 percent reduction in the time that the x-ray machine was on;
  • 52 percent reduction in the dose of x-ray entering the skin, which helps to prevent skin injury; and
  • 51 percent reduction in median effective dose, which correlates with the lifetime increased risk of cancer from radiation exposure.

"While we did not measure what these lower doses mean in the long run, we presume, for example, that reducing the effective dose will decrease the child's lifetime increased cancer risk from radiation exposure," Patel said.

"The public should be aware of radiation exposure from electrophysiology procedures, and physicians and hospitals should be vigilant in implementing protocols aimed at reducing radiation exposure from these procedures. This is especially important in children to minimize their risk of radiation-induced cancer because they should live for many decades after their procedures."