03:36 PM Abstract No. 290 Phantom and in vivo comparison of radiation dose estimates and image quality between state-of-the-art interventional fluoroscopy systems

Abstract

To compare radiation dose estimates and image quality between state-of-the-art interventional fluoroscopy systems in phantom and clinical cases. Phantom study used acrylic sheets simulating different patient sizes to compare air kerma rates (AKRs) for different dose modes on Philips Allura-ClarityIQ and Siemens ArtisQ systems (4 systems). After IRB approval, cumulative air kerma (CAK) at the interventional reference point and kerma-area product (KAP) were extracted for cases performed over a 16-month period and compared by procedure type between the two types of systems. Next, CAK and KAP for patients with metastatic uveal melanoma receiving repeat chemo/immuno-embolization of the same liver lobe by the same physician on both types of systems were compared, accounting for differences in patient positioning, reference locations and digital acquisitions. For these cases, image quality was scored by 2 CAQ certified interventional radiologists using a five-point scale for 5 parameters. Interclass correlation coefficient (ICC) was computed and the scores were compared between the two types of systems. IBM’s SPSS Statistics was used for analysis (with Bonferroni corrections for multiple comparisons). Phantom study revealed a significant lower AKR (p<0.05) with Allura-ClarityIQ for acrylic thicknesses of 30-40cm. Clinical data contained 5113 cases; significant differences for CAK and KAP were seen in 9/16 and 3/16 procedure-types (p<0.05), respectively, with lower values for Allura-ClarityIQ systems. Subset analysis of 61 patients receiving identical treatment on both systems showed CAK and KAP were significantly lower for Allura-ClarityIQ systems (p<0.02; median for CAK lower by 44% and for KAP by 27%). Good reliability and absolute agreement was noted between readers for 5 parameters (ICC≥0.75). Image quality review scores were significantly higher for images obtained with Allura-ClarityIQ systems across all parameters (p<0.05; mean difference in scores between systems for each parameter ranging from 1.3 to 1.6). Allura-ClarityIQ systems utilized lower radiation dose and were associated with superior image quality compared with ArtisQ.