title: Impact of new X-ray technology on patient dose in pacemaker and implantable cardioverter defibrillator (ICD) implantations.
abstract: OBJECTIVE
  New X-ray technology providing new image processing techniques may reduce radiation exposure. The aim of this study was to quantify this radiation exposure reduction for patients during pacemaker and implantable cardioverter defibrillator (ICD) implantation.
  
  
  METHODS
  In this retrospective study, 1185 consecutive patients who had undergone de novo pacemaker or ICD implantation during a 2-year period were included. All implantations in the first year were performed using the reference technology (Allura Xper), whereas in the second year, the new X-ray technology (AlluraClarity) was used. Radiation exposure, expressed as the dose area product (DAP), was compared between the two time periods to determine the radiation exposure reduction for pacemaker and ICD implantations without cardiac resynchronization therapy (CRT) and with CRT. Procedure duration and contrast volume were used as measures to compare complexity and image quality.
  
  
  RESULTS
  The study population consisted of 591 patients who had undergone an implantation using the reference technology, and 594 patients with the new X-ray technology. The two groups did not differ in age, gender, or body mass index. The DAP decreased with 69 % from 16.4 ± 18.5 to 5.2 ± 6.6 Gy cm2for the non-CRT implantations (p < 0.001). The DAP decreased with 75 % from 72.1 ± 60.0 to 17.8 ± 17.4 Gy cm2for the CRT implantations (p < 0.001). Nevertheless, procedure duration and contrast volume did not differ when using the new technology (p = 0.09 and p = 0.20, respectively).
  
  
  CONCLUSIONS
  Introduction of new X-ray technology resulted in a radiation exposure reduction of more than 69 % for patients during pacemaker and ICD implantation while image quality was unaffected.
authors: Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands. jorisvdijk@gmail.com.|MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. jorisvdijk@gmail.com.
authors: Joris D
authors: JD
authors: van Dijk
authors: Department of Cardiology, Isala Hospital, Zwolle, The Netherlands.
authors: Jan Paul
authors: JP
authors: Ottervanger
authors: Department of Cardiology, Isala Hospital, Zwolle, The Netherlands.
authors: Peter Paul H M
authors: PP
authors: Delnoy
authors: Department of Medical Physics, Isala Hospital, Zwolle, The Netherlands.
authors: Martine C M
authors: MC
authors: Lagerweij
authors: Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
authors: Siert
authors: S
authors: Knollema
authors: MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
authors: Cornelis H
authors: CH
authors: Slump
authors: Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
authors: Pieter L
authors: PL
authors: Jager
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D019919:Prosthesis Implantation / Q000379:methods / Q000706:statistics & numerical data; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000032:analysis / Q000517:prevention & control / Q000706:statistics & numerical data*; D011835:Radiation Protection / Q000379:methods / Q000706:statistics & numerical data; D015641:Radiography, Interventional / Q000295:instrumentation* / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Dose reduction; Imaging; Implantable cardioverter defibrillator (ICD); Pacemaker; Radiation dose