Comprehensive assessment of patient image quality and radiation dose in latest generation cardiac x-ray equipment for percutaneous coronary interventions

This study aimed to determine whether a reduction in radiation dose was found for percutaneous coronary interventional (PCI) patients using a new cardiac interventional X-ray system with state-of-the-art image enhancement and X-ray optimisation, compared to the current generation X-ray system, and to determine the corresponding impact on clinical image quality. Patient procedure dose area product (DAP) and fluoroscopy duration of 131 PCI patient cases from each X-ray system were compared using a Wilcoxon test on median values. Significant reductions in patient dose (p<<0.001) were found for the new system with no significant change in fluoroscopy duration (p=0.2); procedure DAP reduced by 64%, fluoroscopy DAP by 51% and “cine” acquisition DAP by 76%. The image quality of 15 patient angiograms from each X-ray system (30 total) was scored by 75 clinical professionals on a continuous scale for the ability to determine the presence and severity of stenotic lesions; image quality scores were analysed using a two-sample t-test. Image quality was reduced by 9% (p<<0.001) for the new X-ray system. This demonstrates a substantial reduction in patient dose, from acquisition more than fluoroscopy imaging, with slightly reduced image quality, for the new X-ray system compared to the current generation system.