Impact of latest generation cardiac interventional X-ray equipment on patient image quality and radiation dose for trans-catheter aortic valve implantations.
OBJECTIVE
This study aimed to determine the impact on radiation dose and image quality of a new cardiac interventional X-ray system for trans-catheter aortic valve implantation (TAVI) patients compared to the previously-used cardiac X-ray system.


METHODS
Patient dose and image data were retrospectively collected from a Philips AlluraClarity (new) and Siemens Axion Artis (reference) X-ray system. Patient dose area product (DAP) and fluoroscopy duration of 41 patient cases from each X-ray system were compared using a Wilcoxon test. Ten patient aortograms from each X-ray system were scored by 32 observers on a continuous scale to assess the clinical image quality at the given phase of the TAVI procedure. Scores were dichotomised by acceptability and analysed using a Chi-squared test.


RESULTS
Significant reductions in patient dose (p << 0.001) were found for the new system with no significant change in fluoroscopy duration (p = 0.052); procedure DAP reduced by 55%, fluoroscopy DAP by 48% and "cine" acquisition DAP by 61%. There was no significant difference between image quality scores of the two X-ray systems (p = 0.06).


CONCLUSIONS
The new cardiac X-ray system demonstrated a very significant reduction in patient dose with no loss of clinical image quality. Advances in Knowledge: The huge growth of TAVI may impact on the radiation exposure of cardiac patients and particularly on operators including anaesthetists; cumulative exposure of interventional cardiologists performing high volume TAVI over 30-40 years may be harmful. The Phillips Clarity upgrade including improved image enhancement and optimised X-ray settings significantly reduced radiation without reducing clinically acceptable image quality.
1 Division of Biomedical Imaging, University of Leeds, Leeds, UK.
Amber J
AJ
Gislason-Lee
2 Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
Claire
C
Keeble
3 Department of Cardiology, Leeds General Infirmary, Leeds, UK.
Christoper J
CJ
Malkin
1 Division of Biomedical Imaging, University of Leeds, Leeds, UK.
Daniel
D
Egleston
1 Division of Biomedical Imaging, University of Leeds, Leeds, UK.
Josephine
J
Bexon
1 Division of Biomedical Imaging, University of Leeds, Leeds, UK.
Stephen M
SM
Kengyelics
3 Department of Cardiology, Leeds General Infirmary, Leeds, UK.
Daniel
D
Blackman
1 Division of Biomedical Imaging, University of Leeds, Leeds, UK.
Andrew G
AG
Davies
D005471:Fluoroscopy; D006801:Humans; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000295:instrumentation*; D013902:Radiography, Thoracic / Q000295:instrumentation*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement