title: Radiation dose reduction during transjugular intrahepatic portosystemic shunt implantation using a new imaging technology.
abstract: OBJECTIVE
  To compare patient radiation dose in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) implantation before and after an imaging-processing technology upgrade.
  
  
  METHODS
  In our retrospective single-center-study, cumulative air kerma (AK), cumulative dose area product (DAP), total fluoroscopy time and contrast agent were collected from an age- and BMI-matched collective of 108 patients undergoing TIPS implantation. 54 procedures were performed before and 54 after the technology upgrade. Mean values were calculated and compared using two-tailed t-tests. Two blinded, independent readers assessed DSA image quality using a four-rank likert scale and the Wilcoxcon test.
  
  
  RESULTS
  The new technology demonstrated a significant reduction of 57% of mean DAP (402.8 vs. 173.3Gycm2, p<0.001) and a significant reduction of 58% of mean AK (1.7 vs. 0.7Gy, p<0.001) compared to the precursor technology. Time of fluoroscopy (26.4 vs. 27.8min, p=0.45) and amount of contrast agent (109.4 vs. 114.9ml, p=0.62) did not differ significantly between the two groups. The DSA image quality of the new technology was not inferior (2.66 vs. 2.77, p=0.56).
  
  
  CONCLUSIONS
  In our study the new imaging technology halved radiation dose in patients undergoing TIPS maintaining sufficient image quality without a significant increase in radiation time or contrast consumption.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: c.spink@uke.de.
authors.forename: C
authors.initials: C
authors.lastname: Spink
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Avanesov
authors.affiliation: Philips Healthcare, Hamburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Schmidt
authors.affiliation: Philips Research, Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Grass
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Schoen
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Adam
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Bannas
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Koops
mesh_terms: D005260:Female; D005471:Fluoroscopy / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D011829:Radiation Dosage; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Image-processing technology; Interventional radiology; Liver; Radiation dosage; Transjugular intrahepatic portosystemic shunt (TIPS)