Substantial radiation reduction in pediatric and adult congenital heart disease interventions with a novel X-ray imaging technology

Abstract

BackgroundPediatric catheterization exposes patients to varying radiation doses. Concerns over the effects of X-ray radiation dose on the patient population have increased in recent years. This study aims at quantifying the patient radiation dose reduction after the introduction of an X-ray imaging technology using advanced real time image noise reduction algorithms and optimized acquisition chain for fluoroscopy and exposure in a pediatric and adult population with congenital heart disease.MethodsPatient and radiation dose data was retrospectively collected (July 2012–February 2013) for 338 consecutive patients treated with a system using state of the art image processing and reference acquisition chain (referred as “reference system”). The same data was collected (March–October 2013) for 329 consecutive patients treated with the new imaging technology (Philips AlluraClarity, referred as “new system”). Patients were divided into three weight groups: A) below 10 kg, B) 10–40 kg, and C) over 40 kg. Radiation dose was quantified using dose area product (DAP), while procedure complexity using fluoroscopy time, procedure duration and volume of contrast medium.ResultsThe new system provides significant patient dose reduction compared to the reference system. Median DAP values were reduced in group A) from 140.6 cGy·cm2 to 60.7 cGy·cm2, in group B) from 700.0 cGy·cm2 to 202.2 cGy·cm2 and in group C) from 4490.4 cGy·cm2 to 1979.8 cGy·cm2 with reduction of 57%, 71% and 56% respectively (p < 0.0001 for all groups).ConclusionsDespite no other changes in procedural approach, the novel X-ray imaging technology provided substantial radiation dose reduction of 56% or higher.

Estimating radiation exposure during paediatric cardiac catheterisation: a potential for radiation reduction with air gap technique

“…1 Given the association of cumulative radiation exposure to cancer risk, there has been a push to reduce radiation exposure in the catheterisation lab to "as low as reasonably achievable" through the study of novel imaging techniques, education in position statements from national organisations, and quality improvement benchmarks from national databases. 3,[11][12][13][14][15] AGT is a radiation reduction imaging technique originally described in adults undergoing coronary artery imaging. 4 Although AGT has been studied in the paediatric population, previous studies have evaluated this technique in conjunction with other radiation reducing interventions and/or have not evaluated differential effects in larger versus smaller children.…”

“…The results reported were obtained on an older Phillips fluoroscopy system, while newer systems demonstrate significantly reduced radiation. 13 One would expect similar relative reduction trends in newer systems, given that the underlying mechanisms of radiation reduction would be the same regardless of the system used. We also made no attempt to manipulate beam parameters to optimise imaging specifically for AGT, instead relying on the system's automatic exposure control to adjust the imaging parameters.…”

A Radiation Dose Reduction Technology to Improve Patient Safety During Cardiac Catheterization Interventions

“…This dose reduction technology has already been shown to reduce radiation dose in neuroradiology patients, 8,9 electrophysiology patients, 10 in digital subtraction angiography preclinical studies, 11 and for pediatric and congenital heart disease patients. 12 The work described here evaluates the degree of dose reduction from using this new technology installed in a dedicated cardiac catheterization laboratory (Allura Xper FD20/10, Philips Healthcare, Best, the Netherlands) for diagnostic CA and PCI procedures, compared to dose received by patients in a standard cardiac catheterization laboratory (Allura Xper FD20, Philips Healthcare, Best, the Netherlands) that does not have this technology available. To the best of our knowledge, this is the first evaluation of this technology for PCI (interventional) and CA (diagnostic) patients in an interventional cardiology setting in North America.…”

Reduced Patient Radiation Exposure during Neurodiagnostic and Interventional X-Ray Angiography with a New Imaging Platform

“…Procedural dose reductions and the noninferiority of image quality by using IP DRT have been described for iliac 9,10 and coronary angiography in adults 8,[11][12][13] and in children. 13 For neuroangiographic procedures, a randomized, blinded review of consecutive DSA runs with dose-reduction technology targeting one-fourth of the standard radiation dose showed the ability to maintain diagnostic image quality.…”

“…Procedural dose reductions and the noninferiority of image quality by using IP DRT have been described for iliac 9,10 and coronary angiography in adults 8,[11][12][13] and in children. 13 For neuroangiographic procedures, a randomized, blinded review of consecutive DSA runs with dose-reduction technology targeting one-fourth of the standard radiation dose showed the ability to maintain diagnostic image quality. 7 A larger European study in 614 patients provided further evidence of significant reductions in total dose-area products of 62% and 65% for diagnostic and interventional procedures, respectively, while not significantly affecting fluoroscopy time, procedure duration, and the number of acquired images.…”