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Impact of latest generation cardiac interventional X-ray equipment on patient image quality and radiation dose for trans-catheter aortic valve implantations
Gislason-Lee, Amber J. Keeble, C. Malkin, C.J. Egleston, D. Bexon, J. Kengyelics, S.M. Blackman, D. Davies, A.G.
Gislason-Lee, Amber J.
Keeble, C.
Malkin, C.J.
Egleston, D.
Bexon, J.
Kengyelics, S.M.
Blackman, D.
Davies, A.G.
Publication Date
2016
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© 2016 The authors. Published by the British Institute of Radiology. Reproduced in accordance with the publisher's self-archiving policy.
Peer-Reviewed
Yes
Open Access status
openAccess
Accepted for publication
2016-09-08
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Department
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Abstract
Objectives: This study aimed to determine the impact on radiation dose and image quality of a new cardiac interventional X-ray system for trans-catheter aortic valve implantation (TAVI) patients compared to the previously-used cardiac X-ray system.
Methods: Patient dose and image data were retrospectively collected from a Philips AlluraClarity (new) and Siemens Axion Artis (reference) X-ray system. Patient dose area product (DAP) and fluoroscopy duration of 41 patient cases from each X-ray system were compared using a Wilcoxon test. Ten patient aortograms from each X-ray system were scored by 32 observers on a continuous scale to assess the clinical image quality at the given phase of the TAVI procedure. Scores were dichotomised by acceptability and analysed using a Chi-squared test.
Results: Significant reductions in patient dose (p<<0.001) were found for the new system with no significant change in fluoroscopy duration (p=0.052); procedure DAP reduced by 55%, fluoroscopy DAP by 48% and “cine” acquisition DAP by 61%. There was no significant difference between image quality scores of the two X-ray systems (p=0.06).
Conclusions: The new cardiac X-ray system demonstrated a very significant reduction in patient dose with no loss of clinical image quality.
Advances in Knowledge: The huge growth of TAVI may impact on the radiation exposure of cardiac patients and particularly on operators including anaesthetists; cumulative exposure of interventional cardiologists performing high volume TAVI over 30-40 years may be harmful. The Phillips Clarity upgrade including improved image enhancement and optimised X-ray settings significantly reduced radiation without reducing clinically acceptable image quality.
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Published version
Citation
Gislason-Lee AJ, Keeble C, Malkin CJ et al (2016) Impact of latest generation cardiac interventional X-ray equipment on patient image quality and radiation dose for trans-catheter aortic valve implantations. The British Journal of Radiology. 89(1067): 20160269.
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Article