Obesity Is a Major Determinant of Radiation Dose in Patients Undergoing Pulmonary Vein Isolation for Atrial Fibrillation
Joris Ector, MD*,*,
Octavian Dragusin, MSc ,
Bert Adriaenssens, MD*,
Wim Huybrechts, MD*,
Rik Willems, MD, PhD*,
Hugo Ector, MD, PhD* and
Hein Heidbüchel, MD, PhD*
* Cardiology
Radiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
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Figure 1 Patient Radiation Dose Versus Fluoroscopy Time and BMI
Scatter plots showing the relationship between patient radiation dose and total fluoroscopy time (A) and body mass index (BMI) (B). There is a significantly stronger correlation between BMI and radiation dose than between fluoroscopy time and radiation dose. DAP = dose-area product; PDiff(R1-R2) = p value for difference between correlation coefficients; R1,2 = correlation coefficients.
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Figure 2 DAP Values According to BMI
Dose area product values (in Gy·cm2) according to BMI, expressed both for total PVI procedure and per hour of fluoroscopy. Bars and numbers represent mean DAP values, whiskers represent 95% confidence intervals. PVI = pulmonary vein isolation; other abbreviations as in Figure 1.
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Figure 3 Effective Dose Values According to BMI
Effective dose (in mSv) according to BMI for total PVI procedure (A) and per hour of fluoroscopy (B), as calculated with the PCXMC software, dose conversion coefficients, and WinODS software. Bars and numbers represent mean effective dose, whiskers represent 95% confidence intervals. *Significantly higher effective doses estimated with National Radiological Protection Board (NRPB) conversion coefficients versus PCXMC calculations occur in patient groups with body mass index (BMI) >25 kg/m2. PVI = pulmonary vein isolation.
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Figure 4 Relationship Between Effective Dose Values Calculated With 3 Different Methods
Scatter plots illustrating the relationship between effective doses calculated with (A) PCXMC and NRPB conversion coefficients and (B) PCXMC and WinODS software for each patient. (A) Although both methods give similar results in normal-weight patients, PCXMC generates lower effective dose estimates than conversion coefficient estimates in overweight and especially obese patients. (B) Excellent agreement between effective dose calculations with PCXMC and WinODS for male patients, regardless of BMI. For female patients, WinODS calculations result in higher effective dose estimates. Abbreviations as in Figure 3.
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