Impact of New X-ray Angiography Technology in Reducing Periprocedural Coronary Angiography Radiation: Real World Comparison Between A New Generation and an Older Angiography System.

Background

Radiation safety is the biggest operator concern while performing coronary angiograpy in the cathlab. Minimizing radiation exposure both for the operator and the patient is considered to be one of the primary priorities in the modern cathlab. Dose reduction technology is currently present in all new generation x-ray angiography machines.

Methods

In our hospital we built a new cathlab and installed the new generation x-ray angiography system. In the old cathlab we have and older, (10y old) x-ray angiography system. There were same doctors operating and same supportive staff present at the procedure.

The starting dose protocol on the old system was 15fps Cardiac Low dose for cine and 15fps Xlow for fluoro, while on the new system 3,75fps Cardiac Ultra Low dose for fluoro and 7,5fps Cardiac Ultra Low dose for cine. The contrast media used on old machine was iodixanol 652mg/mL and on new machine iomeprol 816,5 mg/mL.

Satisfactory image quality was the main goal at the procedure. 913 patients underwent coronary angiography and PCI – 458 on the old system and 455 on the new system. The patients were grouped according to the used X-ray system (old/new). Dose area product (DAP; mGy/cm2), cumulative dose (CUD; mGy) and fluoroscopy time (min) values were recorded. To account for the differences in fluoroscopy time since both diagnostic and intervention procedures were included in the study, DAP and CUD values were normalized by dividing them by the corresponding fluoroscopy times and the DAP/min and CUD/min values for the old and new system groups were later analyzed.

Results

The mean DAP/min and CUD/min values were 3.42 Gy*cm2/min and 29.13 mGy/min respectively for the new system group, and 14.33 Gy*cm2/min and 172.35 mGy/min respectively for the old system group. The mean difference of DAP/min and CUD/min mean values was 10.91 Gy*cm2/min and 143.22 mGy/min respectively, which represents a 76% reduction in DAP/min and an 83% reduction in CUD/min mean values for the new system group in comparison with the old one. The difference was statistically significant with a p-value of 0.000 for both DAP/min and CUD/min.

Conclusions

New generation angiography systems clearly impact our radiation safety in a positive way by significantly lowering radiation exposure.