Does a novel X-ray imaging technology provide a substantial radiation dose reduction for patients in trans-catheter aortic valve implantation procedures?

Purpose: Modern interventional X-ray equipment employs image processing to permit reduction in radiation whilst retaining sufficient image quality. The aim of this study was to investigate whether our recently-installed system (AlluraClarity, Philips Healthcare) which contains advanced real-time image noise reduction algorithms and anatomy-specific X-ray optimization (beam filtering, grid switch, pulse width, spot size, detector and image processing engine), affected patient procedure dose and overall procedure duration in routine trans-catheter aortic valve implantation (TAVI) procedures. Methods: Patient dose for 42 TAVI patients from the AlluraClarity cardiac catheterisation lab and from a reference system (Axiom Artis, Siemens Healthcare) in the same cardiology department was recorded. Median values from the two X-ray systems were compared using the Wilcoxon statistical test. Results: Total patient procedure dose medians were 4016 and 7088 cGy cm2 from the AlluraClarity and reference systems respectively. AlluraClarity median patient doses were 3405 cGy cm2 and 783.5 cGy cm2 from fluoroscopy and digital image acquisition respectively. Reference median patient doses were 4928 cGy cm2 and 2511 cGy cm2 from fluoroscopy and digital image acquisition respectively. All differences in patient dose were significant at the 5% level. Median total fluoroscopy times [min:sec] were 19:57 and 20:20 for the AlluraClarity and reference systems respectively. Conclusion: The AlluraClarity cardiac catheterisation lab had 43% lower total patient procedure dose for TAVI patients than the reference lab; fluoroscopy and digital image acquisition doses were 31% and 69% lower respectively. In terms of total fluoroscopy time, there was no statistically significant difference between the two labs.