血管撮影装置からの x 線(閾値)に起因するペースメーカー...
TRANSCRIPT
- 9-
秋葉・中村・中谷・吉川:血管撮影装置からの X 線(閾値)に起因するペースメーカー誤作動
X
3 DDD
2
2
, , ,
, alert period 1
0.41 0.57mGy/0.01sec X-ray
1
1958
“
”
implantable cardioverter-defibrillator : ICD
40
QOL
1
electromagnetic interference : EMI
2005
X CT
2,3
1125001 X CT
3)
1,4 10)
X ICD
2
X
1,4 10)
血管撮影装置からの X線(閾値)に起因するペースメーカー誤作動
(平成 21年 10月 8日 受付)
秋葉 憲彦 1), 中村 修 2), 中谷 儀一郎 2), 吉川 宏起 3)
1) 国立病院機構 東京医療センター放射線科2) 日本医療科学大学 保健医療学部3) 駒澤大学 医療健康科学部
- 10-
駒澤大学医療健康科学部紀要 第 7号(2010)
C-MOS
X 53
3
DAR-3000 ST.
JUDE. MEDECAL AFFIRMITY DR S/N 328983
S/N 423536, S/N 454458 3
source to surface distance: SSD
70cm
,
entrance surface dose: ESD
UNIDOS Type-App. Nr.10005-50268, TN 30001-2462
0.6cc Fig. 1
DDD , blanking period, noise
sampling period alert period
60ppm pacing Heart simulator
70ppm inhibition
.
event histogram heart rate
histogram, percent of total time
3
76kV, 250mA, 0.01sec,
7.5FPS/sec, 10sec , 130kV, 500mA
0.1s, 7.5FPS/sec, 5sec X
A-P P-A
(pacing )
inhibition
Fig. 1 Geometric Figure of ESD using Chamber.
Pacemaker
B e d
SSD
I . I
Phantom
X-ray tube
- 11-
秋葉・中村・中谷・吉川:血管撮影装置からの X 線(閾値)に起因するペースメーカー誤作動
r
3.1
X
60sec
mA, kV
(mGy/60sec) ,
,
3.2 Sensitivity
A-P sensitivity
0.5 2.5mV
160 200 250 320 400 500mA
60 120kV 1kV
sensitivity
sensitivity
3.3
A-P 60 120kV
0.04sec 7.5 FPS 5sec
sensitivity SSD50cm
1 2
X 1
160 200 250 320 400
Measurement ResultsStandard Exposure 76kV, 250mA, 0.01sec, 7.5frame / sec,10 sec
Pacing A:A pacing, V:V pacing
1.0 Sec Inhibition P:P wave, R:R wave
1.0 Sec
Fig. 2 Mesurement Results of Standard Exposure 76 kV, 250 mA, 0.01 sec, 7.5 frame/sec, 10 sec
No influence is found during pacing time and inhibitory time on ICPs at the standard and maximum exposure conditions(anterior
posterior exposure direction). Left arrow indicates the starting time of X-ray exposure, and the right arrow indicates the ending time.
- 12-
駒澤大学医療健康科学部紀要 第 7号(2010)
500mA 60kV 1kV
1
0.04 0.08 0.1sec
2 FPS
FPS 1 1FPS
1 /sec 7.5FPS 7.5 /sec X
FPS 1 3 5 7.5 FPS
FPS
4
Fig. 2 76kV, 250mA, 0.01sec,
7.5FPS/sec, 10sec
1.0sec X
X
A V
X
P
R PM
3
, A-P, P-A
, P-A
,
, ,
Fig. 3 130kV, 500mA 0.1s, 7.5FPS/sec,
5sec
X , V R ,
A-V P-V X
,
4.2 Sec
Measurement Results Maximum Exposure 120kV, 500mA, 0.1sec, 7.5frame / sec,5.0 sec
Pacing A:A pacing, V:V pacing, P:P wave, R:R wave
Fig. 3 Mesurement Results of Maximum Exposure at the Pacing Period 120 kV, 500 mA, 0.1 sec, 7.5 frame/sec, 5 sec
The figure shows the pacing map at the maximum exposure condition A P exposure direction . The marker shows that R takes
the place of V and P-V changes to A-V soon after. Over sensing of the ICP is started by receiving the noises other than its basic
event and the pacing function is interrupted. The interruption period continues for 4.2 seconds.
- 13-
秋葉・中村・中谷・吉川:血管撮影装置からの X 線(閾値)に起因するペースメーカー誤作動
4.2 Sec
4.2sec 181.5mGy X
1)
2
Fig. 4 ,
X , R ,P-R A-V
,
5.2sec 182.4mGy
X 0.2sec
X 11
2
Measurement Results Maximum Exposure 120kV, 500mA, 0.1sec, 7.5frame / sec,5.0 sec
Pacing A:A pacing, V:V pacing, P:P wave, R:R wave 5.2Sec
Fig. Mesurement Results of Maximum Exposure at the Inhibitory Period 120 kV, 500 mA, 0.1
sec, 7.5 frame/sec, 5 sec
The marker shows that R to appear and then P-R changes to A-V at the maximum exposure condition A-P
exposure direction . The interruption time is 5.2 seconds. It is indicated that the pacing from atrium to ventricle
occurs in spite of inhibitory period.
Sensitivity
Fig.5 Exposure Conditions Introduced Over Sensing of ICPs with Different Sensitivities (kV mA
- 14-
駒澤大学医療健康科学部紀要 第 7号(2010)
4.1
4
182.4mGy/5sec 60sec
kV mA
182.4mGy/60sec
.
4.2 Sensitivity
Fig. 5 sensitivity
Sensitivity 0.5, 1.0,
1.5,2.0 ,
Sensitivity2.5
sensitivity
sensitivity
sensitivity
Fig. 6 Exposure Conditions Introduced Over Sensing of ICPs(kV mA
Fig. 7 Threshold of X-ray Dose Rate Introduced Oversensing of ICPs mGy/0.01sec
- 15-
秋葉・中村・中谷・吉川:血管撮影装置からの X 線(閾値)に起因するペースメーカー誤作動
5sec
5sec
3sec
5.2sec
1.0 Second
Fig. 8 Oversensing of ICPs at Different FPS frame per second
- 16-
駒澤大学医療健康科学部紀要 第 7号(2010)
4.3
4.2
FPS
1
Fig. 6 0.04 0.08 0.1sec
500mA,58kV
400 A 64kV 320mA 67kV 250mA 74kV
200mA 80kV 160mA 86kV
kV
, Fig.
6 Fig. 7
mGy/0.01sec
80msec 250mA 80kV 0.41mGy/0.01sec
40msec 400mA,64kV
0.52mGy/0.01sec 0.11mGy/0.01sec
2 FPS
Fig. 8 FPS
FPS 1 3 5 7.5 FPS
FPS X , A-V
P-V X
FPS
11) 2
1FPS 0.96sec
blanking period , sampling period
0.125sec1) Fig. 8 alert period
FPS
Fig. 9 Exposure Conditions kV mA and Dose Rate mGy/0.01sec Introduced Oversensing of ICPs at
Different FPS.
- 17-
秋葉・中村・中谷・吉川:血管撮影装置からの X 線(閾値)に起因するペースメーカー誤作動
Fig. 9 FPS
FPS
Fig
7
mGy/0.01sec 1FPS 0.57
0.69mGy/0.01sec 3FPS 0.46 0.57mGy/0.01sec
5FPS 0.46 0.56mGy/0.01sec 7.5FPS 0.43
0.52mGy/0.01sec 1FPS
5
IC C-Metal-Oxide-Semiconductor(
C-MOS C-MOS
X
X PN
PN
X
1,4 10)
CT 360
X
7)
X X
Fig. 4 5sec 5.2sec
X
0.04 0.08 0.1sec
Fig. 7 FPS 1 3 5
7.5 FPS
Fig. 9
FPS
X
FPS
60ppm
0.01sec 0.99sec
X
1FPS
0.57 0.69mGy/0.01sec FPS
msec 0.41
0.57mGy/0.01sec
1FPS FPS 3 5 7.5 FPS
X C-MOS
6
X
P-A
X
A-P X
3
11) 2
- 18-
駒澤大学医療健康科学部紀要 第 7号(2010)
FPS
sec
1sec X
0.41 0.69mGy/0.01sec
X 1 alert period
1 60ppm 1sec
1sec
1,4 10
X kV mA
C-MOS 1
X
X
X 5sec 3
7.
1
2007 11-19
2
X CT 3
2005(http://www.medtronic.co.jp).
3 X CT
1125001
2005 11.25.
4
X
2008 64 3 335-341
5
X
2008 64 7 795-804
6
X 2008 64 7
805-813
7
15(1),32-35, (2007)
8 Blamires NG,Myatt J. X-ray effects on pacemaker type
circuits. Pacing Clin Electrophysiol 1982;5(2):151-155.
9 Yamaji S, Imai S, Saito F. Does high-power computed
tomography scanning equipment affect the operation of
pacemakers? Circ J 2006;70(2):190-197.
10 Lewis M. Radiation dose issues in multi-slice CT s
ccaning. Impact technology up dateno.3,2005.(http://www.i
mpactscan.org/).
11
(http://www.soumu.go.jp/s-news/2002/020702_3_1.html).
- 19-
秋葉・中村・中谷・吉川:血管撮影装置からの X 線(閾値)に起因するペースメーカー誤作動
Malfunction of the implantable cardiac pacemakers influenced by X-ray irradiation of over the threshold from the angiography equipment
Norihiko Akiba* Osamu Nakamura** Giichiro Nakaya** Kohki Yoshikawa ***
* Department of Radiology , National Hospital Organization Tokyo Medical Center
** Faculty of Health Science , Nihon Institute of Medical Science
*** Graduate Division of Health Sciences , Komazawa University
Abstract
This study performed experimental studies of the X-ray influence on implantable cardiac pacemakers (ICPs) from the angiography
equipment. Three ICPSs pacing in DDD mode were used exerimentalily in the angiographic study. Those ICPs were irradiated under
two exposure levels; one was the standard dose and the other was the maximum dose of the angiography equipment. The results showed
that the influence of irradiation on the ICPs was that of level 2 as classified by a research report from the Ministry of Internal Affairs and
Communications only when the maximum dose level was irradiated. In the following study, the conditions inducing over sensing of
ICPs in the angiography equipment were searched. In this study the influences of ICPs by the tube voltage, tube current, exposure time,
exposure period of X-ray by the angiography equipment were evaluated. The results showed that the over sensing of the ICPs were
determined mainly by the tube voltage and tube current. Interruptions were happened by lower tube voltage at the higher tube current
exposure and by the higher tube voltage at the lower tube current exposure. In conclusions, over sensing of the ICPs could be caused
regardless exposure time and exposure period when the only one pulse of X-ray over the threshold of 0.41 0.57mGy /0.01sec was
exposed in the alert period between the pacing events or sensing events.
Keywords:
over sensing, pacemaker, irradiation dose, alert period, exposure time exposure period