title: Comparison of radiation dose between different fluoroscopy systems in the modern catheterization laboratory: Results from bench testing using an anthropomorphic phantom.
abstract: BACKGROUND
  Variations in radiation dose between various X-ray systems have received limited study.
  
  
  OBJECTIVE
  We examined the impact of X-ray system type on patient radiation dose during cardiac catheterization.
  
  
  METHODS
  An anthropomorphic phantom was used in a series of standardized experiments that involved 15 sec of continuous cineangiography in 7 projections. Three to seven experiments were performed in four commonly used X-ray systems: Innova IGS (GE Healthcare), Integris Allura FD20 (Philips), Allura Clarity (Philips), and Artis one (Siemens). Phantom radiation dose was measured with a dedicated X-ray dosimetry system (Gafchromic radiology film and Film QA XR software, Ashland) that was precalibrated at 0, 1, 2, 3, and 4 Gray, and with the X-ray system built-in functions.
  
  
  RESULTS
  Radiation dose was lowest with the Allura Clarity system [average film dose 4.2±0.1 cGray, peak film dose 18.3±1.6 cGray, Air Kerma (AK) dose 0.310±0.002 Gray, Dose Area Product (DAP) dose 23.72±0.84 Gray*cm2], intermediate with the Integris Allura FD20 (average film dose 4.4±1.1 cGray, peak film dose 29.4±15.5 cGray, AK 0.482±0.189 Gray, DAP 45.18±21.90 Gray*cm2), and highest with the Artis one system (average film dose 7.4±0.8 cGray, peak film dose 66.9±0.09 cGray, AK 0.746±0.085 Gray, DAP 75.93±9.11 Gray*cm2) and the Innova IGS system (average film dose 7.2±1.0 cGray, peak film dose 49.3±28.9 cGray, AK 0.874±0.340 Gray, DAP 92.28±14.73 Gray*cm2; P=0.011 for average film dose, P=0.019 for maximum film dose, P=0.033 for AK, and P=0.008 for DAP).
  
  
  CONCLUSIONS
  The X-ray system type has significant impact on patient radiation dose during cardiac catheterization.
authors.affiliation: Division of Cardiovascular Diseases, VA North Texas Health Care System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Georgios
authors.initials: G
authors.lastname: Christopoulos
authors.affiliation: Division of Cardiovascular Diseases, VA North Texas Health Care System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Georgios E
authors.initials: GE
authors.lastname: Christakopoulos
authors.affiliation: Division of Cardiovascular Diseases, VA North Texas Health Care System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: Division of Cardiovascular Diseases, VA North Texas Health Care System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Ronald
authors.initials: R
authors.lastname: Layne
authors.affiliation: Division of Cardiovascular Diseases, VA North Texas Health Care System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Grabarkewitz
authors.affiliation: Division of Cardiovascular Diseases, VA North Texas Health Care System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Donald
authors.initials: D
authors.lastname: Haagen
authors.affiliation: Division of Cardiovascular Diseases, University of Oklahoma, Norman, Oklahoma.
authors.forename: Faisal
authors.initials: F
authors.lastname: Latif
authors.affiliation: Division of Cardiovascular Diseases, University of Oklahoma, Norman, Oklahoma.
authors.forename: Mazen
authors.initials: M
authors.lastname: Abu-Fadel
authors.affiliation: Division of Cardiovascular Diseases, VA North Texas Health Care System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Division of Cardiovascular Diseases, VA North Texas Health Care System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002932:Cineangiography / Q000009:adverse effects / Q000295:instrumentation*; D017023:Coronary Angiography / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D005471:Fluoroscopy; D008422:Materials Testing; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects; D015641:Radiography, Interventional / Q000009:adverse effects / Q000295:instrumentation*; D013997:Time Factors
keywords: cardiac catheterization; quality improvement; radiation