Comprehensive assessment of patient image quality and radiation dose in latest generation cardiac x-ray equipment for percutaneous coronary interventions

Abstract

Abstract. This study aimed to determine whether a reduction in radiation dose was found for percutaneous coronary interventional (PCI) patients using a cardiac interventional x-ray system with state-of-the-art image enhancement and x-ray optimization, compared to the current generation x-ray system, and to determine the corresponding impact on clinical image quality. Patient procedure dose area product (DAP) and fluoroscopy duration of 131 PCI patient cases from each x-ray system were compared using a Wilcoxon test on median values. Significant reductions in patient dose (p ≪ 0.001) were found for the new system with no significant change in fluoroscopy duration (p ¼ 0.2); procedure DAP reduced by 64%, fluoroscopy DAP by 51%, and "cine" acquisition DAP by 76%. The image quality of 15 patient angiograms from each x-ray system (30 total) was scored by 75 clinical professionals on a continuous scale for the ability to determine the presence and severity of stenotic lesions; image quality scores were analyzed using a two-sample t -test. Image quality was reduced by 9% (p ≪ 0.01) for the new x-ray system. This demonstrates a substantial reduction in patient dose, from acquisition more than fluoroscopy imaging, with slightly reduced image quality, for the new x-ray system compared to the current generation system.

Image noise reduction technology allows significant reduction of radiation dosage in cardiac device implantation procedures

“…The impact of the new technology as compared to previous cath lab equipment has been tested in neuroangiology, electrophysiology, and coronary angiography and interventions as well as new structural heart disease interventions . A reduction of radiation dose of 34–66% has been demonstrated in these studies . Most of these studies had limited patient numbers and have not been randomized.…”

“…12,13,[20][21][22] A reduction of radiation dose of 34-66% has been demonstrated in these studies. 12,13,[20][21][22][23][24] Most of these studies had limited patient numbers and have not been randomized.…”

“…8,9,17 Phantom studies have been performed to evaluate the radiation exposure to the operator depending on applied protection aprons, applied views, position of the operator, and the DAP of the patient. 23 These studies have stressed the importance to reduce the DAP for the patient in order to reduce also the radiation exposure to the operator. 8 However to a conventional angiography system in PM and ICD implantation procedures and found a more than 69% reduction in radiation exposure.…”

Updating national diagnostic reference levels for interventional cardiology and methodological aspects

“…In the last few years, some manufacturers have developed hardware and software to reduce the dose delivered to patient in interventional practices and have obtained reductions of 50% in patient dose (or higher) while keeping an acceptable image quality [24][25][26][27][28]. While the differences in entrance air kerma per image vary in a factor of five, the differences in image quality scoring differ in a factor of nearly two.…”

An augmented reality system for image guidance of transcatheter procedures for structural heart disease

“…Transcatheter procedures are the predominant and increasingly favored treatment approach in a wide variety of structural heart disease, including atrial septal defect and patent foramen ovale closure, valvular repair/replacement, left atrial appendage closure and deployment of hemodynamic monitoring devices [1]. These procedures are typically performed under X-ray fluoroscopy since it is the most common imaging modality, provides real-time imaging, and can readily visualize radiopaque markers on transcatheter devices to help locate equipment position [2]. However, while one can identify the silhouette of the heart using fluoroscopy, the intracardiac structures are transparent, and therefore contrast agents, which transiently opacify the structure of interest, are used to visualize the relative position of the catheter to surrounding tissues.…”