title: Patient Radiation Dose Reduction during Transarterial Chemoembolization Using a Novel X-Ray Imaging Platform.
abstract: OBJECTIVE
  To evaluate radiation dose reduction in patients undergoing transarterial chemoembolization with the use of a new image acquisition and processing platform.
  
  
  METHODS
  Radiation-dose data were obtained from 176 consecutive chemoembolization procedures in 135 patients performed in a single angiography suite. From January 2013 through October 2013, 85 procedures were performed by using our institution's standard fluoroscopic settings. After upgrading the x-ray fluoroscopy system with an image acquisition and processing platform designed to reduce image noise and reduce skin entrance dose, 91 chemoembolization procedures were performed from November 2013 through December 2014. Cumulative dose-area product (CDAP), cumulative air kerma (CAK), and total fluoroscopy time were recorded for each procedure. Image quality was assessed by three interventional radiologists blinded to the x-ray acquisition platform used.
  
  
  RESULTS
  Patient radiation dose indicators were significantly lower for chemoembolization procedures performed with the novel imaging platform. Mean CDAP decreased from 3,033.2 dGy·cm(2) (range, 600.3-9,404.1 dGy·cm(2)) to 1,640.1 dGy·cm(2) (range, 278.6-6,779.9 dGy·cm(2); 45.9% reduction; P < .00001). Mean CAK decreased from 1,445.4 mGy (range, 303.6-5,233.7 mGy) to 971.7 mGy (range, 144.2-3,512.0 mGy; 32.8% reduction; P < .0001). A 20.3% increase in mean total fluoroscopy time was noted after upgrading the imaging platform, but blinded analysis of the image quality revealed no significant degradation.
  
  
  CONCLUSIONS
  Although a small increase in fluoroscopy time was observed, a significant reduction in patient radiation dose was achieved by using the optimized imaging platform, without image quality degradation.
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143. Electronic address: ryan.kohlbrenner@ucsf.edu.
authors.forename: Ryan
authors.initials: R
authors.lastname: Kohlbrenner
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143.
authors.forename: K Pallav
authors.initials: KP
authors.lastname: Kolli
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Taylor
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143.
authors.forename: Maureen P
authors.initials: MP
authors.lastname: Kohi
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fidelman
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: LaBerge
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kerlan
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143.
authors.forename: Vishal K
authors.initials: VK
authors.lastname: Agarwal
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143.
authors.forename: Evan D
authors.initials: ED
authors.lastname: Lehrman
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143.
authors.forename: Sujal
authors.initials: S
authors.lastname: Nanavati
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143.
authors.forename: David E
authors.initials: DE
authors.lastname: Avrin
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143.
authors.forename: Robert
authors.initials: R
authors.lastname: Gould
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000295:instrumentation*; D016461:Chemoembolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D011835:Radiation Protection / Q000295:instrumentation*; D015641:Radiography, Interventional / Q000295:instrumentation*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult