title: Novel X-Ray Imaging Technology Allows Substantial Patient Radiation Reduction without Image Quality Impairment in Repetitive Transarterial Chemoembolization for Hepatocellular Carcinoma.
abstract: OBJECTIVE
  To assess patient radiation dose reduction and the image quality of a new X-ray imaging technology during repetitive transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).
  
  
  METHODS
  Fifty HCC patients (36 men; 57 ± 11 years) undergoing repetitive TACE were first randomly assigned to receive a TACE treatment on a reference X-ray system or a low-dose system with advanced real-time image processing. The alternate system was used for a repeated TACE (treatment interval, 0.5-6 months). Fluoroscopy time, number of digital subtraction angiography (DSA), air kerma (AK), and dose area product (DAP) were compared between the two systems and between the two repetitive TACE. Three interventional radiologists independently rated the image quality in blinded offline readings.
  
  
  RESULTS
  Fluoroscopy time (8.7 ± 5.9 minutes vs. 8.7 ± 7.9 minutes, P = .981), numbers of DSA runs (6 ± 4 vs. 6 ± 4, P = .735), and exposure images (173 ± 86 vs. 168 ± 91, P = .916) were equivalent between the two systems. No statistical difference in X-ray usage was found between repeated treatments. Compared to the reference system, the technology significantly reduced AK and DAP by 48.6% (0.17 ± 0.13 Gy vs. 0.41 ± 0.36 Gy, P < .0001) and 50.3% (77.3 ± 55.2 Gy cm(2) vs. 195.0 ± 155.5 Gy cm(2), P < .0001), respectively. Image quality was rated comparable between the new system and the reference, with average scores of 3.9 ± 0.3 versus 4.4 ± 0.3 in fluoroscopy and 4.5 ± 0.2 versus 4.3 ± 0.3 in DSA.
  
  
  CONCLUSIONS
  Patient radiation exposure can be substantially reduced by a factor of approximately two with the novel X-ray imaging technology while maintaining image quality.
authors.affiliation: Department of Interventional Radiology, the Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Molecular Imaging Research Center of Harbin Medical University, 1 Yinhang Street, Nangang District, Harbin, Heilongjiang, 150001, China.
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Wen
authors.affiliation: Image Guided Therapy Systems, Philips Healthcare Australia, SA, Australia.
authors.forename: Xianxian
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Department of Interventional Radiology, the Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Molecular Imaging Research Center of Harbin Medical University, 1 Yinhang Street, Nangang District, Harbin, Heilongjiang, 150001, China.
authors.forename: Renfei
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Interventional Radiology, the Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Molecular Imaging Research Center of Harbin Medical University, 1 Yinhang Street, Nangang District, Harbin, Heilongjiang, 150001, China.
authors.forename: Junya
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Interventional Radiology, the Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Molecular Imaging Research Center of Harbin Medical University, 1 Yinhang Street, Nangang District, Harbin, Heilongjiang, 150001, China.
authors.forename: Po
authors.initials: P
authors.lastname: Yang
authors.affiliation: Department of Interventional Radiology, the Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Molecular Imaging Research Center of Harbin Medical University, 1 Yinhang Street, Nangang District, Harbin, Heilongjiang, 150001, China. Electronic address: shenbzh@vip.sina.com.
authors.forename: Baozhong
authors.initials: B
authors.lastname: Shen
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement
keywords: Angiography; hepatocellular carcinoma; patient radiation; radiation reduction; transarterial chemoembolization