title: Selective anti-scatter grid removal during coronary angiography and PCI: a simple and safe technique for radiation reduction.
abstract: Objectives The aim of this study was to quantify the radiation dose reduction during coronary angiography and percutaneous coronary intervention (PCI) through removal of the anti-scatter grid (ASG), and to assess its impact on image quality in adult patients with a low body mass index (BMI). Methods A phantom with different thicknesses of acrylic was used with a Westmead Test Object to simulate patient sizes and assess image quality. 129 low BMI patients underwent coronary angiography or PCI with or without the ASG in situ. Radiation dose was compared between both patient groups. Results With the same imaging system and a comparable patient population, ASG removal was associated with a 47% reduction in total dose-area product (DAP) (p < 0.001). Peak skin dose was reduced by 54% (p < 0.001). Operator scatter was reduced to a similar degree and was significantly reduced through removal of the ASG. Using an image quality phantom it was demonstrated that image quality remained satisfactory. Conclusions Removal of the ASG is a simple and effective method to significantly reduce radiation dose in coronary angiography and PCI. This was achieved while maintaining adequate diagnostic image quality. Selective removal of the ASG is likely to improve the radiation safety of cardiac angiography and interventions.
authors.affiliation: Department of Cardiology, St George Hospital, Kogarah, 2217, Sydney, Australia.
authors.forename: James R
authors.initials: JR
authors.lastname: Roy
authors.affiliation: Department of Cardiology, St George Hospital, Kogarah, 2217, Sydney, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Sun
authors.affiliation: Department of Cardiology, St George Hospital, Kogarah, 2217, Sydney, Australia.
authors.forename: Glenn
authors.initials: G
authors.lastname: Ison
authors.affiliation: Department of Cardiology, St George Hospital, Kogarah, 2217, Sydney, Australia.
authors.forename: Ananth M
authors.initials: AM
authors.lastname: Prasan
authors.affiliation: Department of Cardiology, St George Hospital, Kogarah, 2217, Sydney, Australia.
authors.forename: Tom
authors.initials: T
authors.lastname: Ford
authors.affiliation: Department of Cardiology, St George Hospital, Kogarah, 2217, Sydney, Australia.|Department of Medicine, University of New South Wales, 2031, Sydney, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hopkins
authors.affiliation: Department of Cardiology, St George Hospital, Kogarah, 2217, Sydney, Australia.
authors.forename: David R
authors.initials: DR
authors.lastname: Ramsay
authors.affiliation: Department of Cardiology, St George Hospital, Kogarah, 2217, Sydney, Australia. james.weaver@health.nsw.gov.au.|Department of Medicine, University of New South Wales, 2031, Sydney, Australia. james.weaver@health.nsw.gov.au.
authors.forename: James C
authors.initials: JC
authors.lastname: Weaver
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D017023:Coronary Angiography / Q000009:adverse effects / Q000295:instrumentation*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control*; D061214:Patient Safety; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D019047:Phantoms, Imaging; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control*; D015641:Radiography, Interventional / Q000009:adverse effects / Q000295:instrumentation*; D012307:Risk Factors; D012542:Scattering, Radiation; D015607:Stents