title: A new angiographic imaging platform reduces radiation exposure for patients with liver cancer treated with transarterial chemoembolization.
abstract: OBJECTIVE
  To quantify the reduction of radiation liver cancer patients are exposed to during transarterial chemoembolization (TACE), while maintaining diagnostic image quality, using a new C-arm imaging platform.
  
  
  METHODS
  In this prospective, HIPAA-compliant, IRB-approved, two-arm trial, 78 consecutive patients with primary or secondary liver cancer were treated with TACE on a C-arm imaging platform before and after an upgrade incorporating optimized acquisition parameters and advanced real-time image processing algorithms. Dose area product (DAP) and radiation time of each digital fluoroscopy (DF), digital subtraction angiography (DSA) and cone beam CT (CBCT) were recorded. DSA image quality was assessed by two blinded and independent readers on a four-rank scale.
  
  
  RESULTS
  Both cohorts showed no significant differences with regard to patient characteristics and tumour burden. The new system resulted in a statistically significant reduction of cumulative DAP of 66% compared to the old platform (median 132.9 vs. 395.8 Gy cm(2)). Individually, DAP of DF, DSA and CBCT decreased by 52%, 79% and 15% (p < 0.01, p < 0.01, p = 0.51), respectively. No statistically significant differences in DSA image quality were found between the two imaging platforms.
  
  
  CONCLUSIONS
  The new imaging platform significantly reduced radiation exposure for TACE procedures without increased radiation time or negative impact on DSA image quality.
  
  
  CONCLUSIONS
  • The new C-arm system allowed reduction of radiation exposure by two thirds • The procedure's course was not affected by the new platform • No decrease in DSA image quality was observed after the radiation reduction.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, 21287, USA.
authors.forename: Ruediger E
authors.initials: RE
authors.lastname: Schernthaner
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, 21287, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Duran
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, 21287, USA.
authors.forename: Julius
authors.initials: J
authors.lastname: Chapiro
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, 21287, USA.
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, 21287, USA. jfg@jhmi.edu.
authors.forename: Jean-François H
authors.initials: JF
authors.lastname: Geschwind
authors.affiliation: Ultrasound Imaging and and Interventions (UII), Philips Research North America, Briarcliff Manor, NY, USA.
authors.forename: MingDe
authors.initials: M
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015901:Angiography, Digital Subtraction / Q000379:methods; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D054893:Cone-Beam Computed Tomography / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000032:analysis
keywords: Cone-beam computed tomography; Interventional radiology; Liver neoplasms; Radiation dosage; Therapeutic chemoembolization