Novel X-ray image noise reduction technology reduces patient radiation dose while maintaining image quality in coronary angiography.

T. ten Cate,M. Mauti,M.J. de Boer,H. Suryapranata,C. Camaro,N. Reifart,H. Gehlmann,M. van Wely

doi:10.1007/s12471-015-0742-1

T. ten Cate, M. Mauti + Show 6 more

Open Access

https://doi.org/10.1007/s12471-015-0742-1

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Abstract

AimsThe consequences of high radiation dose for patient and staff demand constant improvements in X-ray dose reduction technology. This study assessed non-inferiority of image quality and quantified patient dose reduction in interventional cardiology for an anatomy-specific optimised cine acquisition chain combined with advanced real-time image noise reduction algorithms referred to as ‘study cine’, compared with conventional angiography.MethodsFifty patients underwent two coronary angiographic acquisitions: one with advanced image processing and optimised exposure system settings to enable dose reduction (study cine) and one with standard image processing and exposure settings (reference cine). The image sets of 39 patients (18 females, 21 males) were rated by six experienced independent reviewers, blinded to the patient and image characteristics. The image pairs were randomly presented. Overall 85 % of the study cine images were rated as better or equal quality compared with the reference cine (95 % CI 0.81–0.90). The median dose area product per frame decreased from 55 to 26 mGy.cm2/frame (53 % reduction, p < 0.001).ConclusionThis study demonstrates that the novel X-ray imaging technology provides non-inferior image quality compared with conventional angiographic systems for interventional cardiology with a 53 % patient dose reduction.

Highlights

Prolonged X-ray guided procedures are associated with a risk of deterministic and stochastic injury [1, 2]
This study demonstrates that the novel X-ray imaging technology provides non-inferior image quality compared with conventional angiographic systems for interventional cardiology with a 53 % patient dose reduction
The study was designed to assess noninferiority of image quality and to quantify patient dose reduction between a cine acquisition run acquired with the standard image processing and exposure settings compared with a cine acquisition run acquired with the advanced image processing and optimised exposure system settings to enable dose reduction

Summary

Introduction

Prolonged X-ray guided procedures are associated with a risk of deterministic and stochastic injury [1, 2]. The number of percutaneous coronary interventions (PCI) has remained relatively stable in recent years, the complexity of coronary interventions has increased. One contributor to prolonged procedures is PCI of chronic total occlusions, which has become increasingly successful [3,4,5]. Prolonged procedures result in higher radiation doses [6,7,8], especially in obese patients, in whom higher radiation is often necessary to obtain adequate diagnostic images [9, 10]. In accordance with the ALARA (As Low As Reasonable Achievable) principle, the best ratio between image quality and radiation dose should be determined. Dose awareness and recent developments in noise reduction algorithms have created new opportunities for dose reduction without compromising image quality [11,12,13]

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