title: Impact of New-generation Hybrid Imaging Technology on Radiation Dose during Percutaneous Coronary Interventions and Trans-femoral Aortic Valve Implantations: A comparison with conventional flat-plate angiography.
abstract: BACKGROUND
  Technological advancements in newer-generation catheterisation laboratories may reduce patient and occupational radiation exposure.
  
  
  METHODS
  We compared fluoroscopy time and dose-area product (DAP) between a Philips Allura X-PER FD20 and Siemens Artis Zeego Hybrid systems for 47 single-vessel percutaneous coronary interventions (PCI) and 35 transcatheter aortic valve implantations (21 Corevalve, 14 Edwards Sapien TAVI) using the FD20, versus 30 PCI and 28 TAVI (15 Corevalve, 13 Sapien) with the Zeego over a 24-month period.
  
  
  RESULTS
  Multivariate analysis revealed that, adjusting for patient weight and fluoroscopy time, DAP (median, interquartile range) was 26% lower for PCI with the Zeego than the FD20 [55.6 (27.0-91.5) vs 77.6 (51.2-129.1) Gy.cm(2), P=0.03)] and using tomographic imaging with the Zeego did not increase DAP for TAVI procedures [98.1 (65.9-136.6) vs 112.4 (64.9-156.2) Gy.cm(2) (P=NS). Although fluoroscopy times were longer for TAVI procedures than PCI with both systems (23.5-24.4 vs 7.3-9.2mins, p<0.0001), there was a significant difference in DAP between PCI and combined TAVI with the Zeego (55.6 vs 112.4Gy.cm(2), P<0.006) but not with the FD20 (77.6 vs 98.1Gy.cm(2), P=NS).
  
  
  CONCLUSIONS
  Specific dose-reducing features of the new-generation system reduced DAP more for PCI than TAVI, as valve replacement procedures use additional cine-acquisition not necessary for PCI.
authors.affiliation: Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: John E
authors.initials: JE
authors.lastname: Boland
authors.affiliation: Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.
authors.forename: Louis W
authors.initials: LW
authors.lastname: Wang
authors.affiliation: Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Love
authors.affiliation: Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: Marino
authors.initials: M
authors.lastname: Christofi
authors.affiliation: Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia. Electronic address: dmuller@stvincents.com.au.
authors.forename: David W M
authors.initials: DW
authors.lastname: Muller
mesh_terms: D000368:Aged; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011829:Radiation Dosage; D013997:Time Factors; D014056:Tomography, X-Ray / Q000295:instrumentation* / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
keywords: Cardiac catheterisation; Coronary angiography; Percutaneous coronary intervention; Radiation; Structural heart intervention; Transcatheter aortic valve replacement