Combining Optimized Image Processing With Dual Axis Rotational Angiography: Toward Low‐Dose Invasive Coronary Angiography

Abstract

Background Dual axis rotational coronary angiography ( DARCA ) reduces radiation exposure during coronary angiography on older x‐ray systems. The purpose of the current study is to quantify patient and staff radiation exposure using DARCA on a modality already equipped with dose‐reducing technology. Additionally, we assessed applicability of 1 dose area product to effective dose conversion factor for both DARCA and conventional coronary angiography ( CCA ) procedures. Methods and Results Twenty patients were examined using DARCA and were compared with 20 age‐, sex‐, and body mass index–matched patients selected from a prior study using CCA on the same x‐ray modality. All irradiation events are simulated using PCXMC ( STUK , Finland) to determine organ and effective doses. Moreover, for DARCA each frame is simulated. Staff dose is measured using active personal dosimeters (DoseAware, Philips Healthcare, The Netherlands). With DARCA , median cumulative dose area product is reduced by 57% (ie, 7.41 versus 17.19 Gy·cm 2 ). Effective dose conversion factors of CCA and DARCA are slightly different, yet this difference is not statistically significant. The occupational dose at physician's chest, leg, and collar level are reduced by 60%, 56%, and 16%, respectively, of which the first 2 reached statistical significance. Median effective dose is reduced from 4.75 mSv in CCA to 2.22 mSv in DARCA procedures, where the latter is further reduced to 1.79 mSv when excluding ventriculography. Conclusions During invasive coronary angiography, DARCA reduces radiation exposure even further toward low‐dose values on a system already equipped with advanced image processing and noise reduction algorithms. For both DARCA and CCA procedures, using 1 effective dose conversion factor of 0.30 mSv·Gy −1 ·cm −2 is feasible.

Quality and safety of coronary computed tomography angiography at academic and non-academic sites: insights from a large European registry (ESCR MR/CT Registry)

“…For instance, in the PROMISE trial, nuclear perfusion imaging had a median effective radiation dose of 12.6 mSv [17]. On the other hand, conventional diagnostic invasive coronary angiography requires approximately 4.75 mSv, with possible dose reduction down to 1.8 mSv, using novel methods such as dual-axis rotational angiography [19].…”

Fluoroscopically guided vascular and cardiac transcatheter procedures: a comparison of occupational and patient dose by anatomical region

“…The occupational eye dose was measured via the DoseAware dosimetry system (Philips Healthcare, Best, Netherlands). The DoseAware system consists of badges that are solid-state active personal dosimeters which log occupational radiation dose per second cumulatively [ 21 ]. DoseAware badges have been demonstrated to detect satisfactorily within varying pulse widths, tubevoltages and dose rates [ 22 , 23 ] and have a reported uncertainty of 5% [ 24 ].…”

A comparison of patient dose and occupational eye dose to the operator and nursing staff during transcatheter cardiac and endovascular procedures

“…DoseAware badges consist of a solid-state active personal dosimeter which log the dose per second cumulatively 36 . Occupational dosimeter measurements will have a degree of variability due to the effect of photon incident angles, energy range and pulsed-field characteristics 37 .…”