Selective anti-scatter grid removal during coronary angiography and PCI: a simple and safe technique for radiation reduction

Abstract

Objectives The aim of this study was to quantify the radiation dose reduction during coronary angiography and percutaneous coronary intervention (PCI) through removal of the anti-scatter grid (ASG), and to assess its impact on image quality in adult patients with a low body mass index (BMI). Methods A phantom with different thicknesses of acrylic was used with a Westmead Test Object to simulate patient sizes and assess image quality. 129 low BMI patients underwent coronary angiography or PCI with or without the ASG in situ. Radiation dose was compared between both patient groups. Results With the same imaging system and a comparable patient population, ASG removal was associated with a 47% reduction in total dose-area product (DAP) (p < 0.001). Peak skin dose was reduced by 54% (p < 0.001). Operator scatter was reduced to a similar degree and was significantly reduced through removal of the ASG. Using an image quality phantom it was demonstrated that image quality remained satisfactory. Conclusions Removal of the ASG is a simple and effective method to significantly reduce radiation dose in coronary angiography and PCI. This was achieved while maintaining adequate diagnostic image quality. Selective removal of the ASG is likely to improve the radiation safety of cardiac angiography and interventions.

Reliability of radiographic measurements for hip dysplasia using a reduced radiation technique

“…Roy et al . [26] reported a 47% reduction in radiation dose to the patient as well as reduced scatter to the operator with removal of the grid during coronary angiography. In pediatric cardiac catheterization, Gould et al .…”

“…Other fields of medicine have investigated the use of grid removal as a means of reducing patient radiation. Roy et al [26] reported a 47% reduction in radiation dose to the patient as well as reduced scatter to the operator with removal of the grid during coronary angiography. In pediatric cardiac catheterization, Gould et al [27] reported a 30% decrease in DNA double-strand breakages with grid removal.…”

Cardiovascular imaging 2017 in the International Journal of Cardiovascular Imaging

“…They found reductions in radiation doses of about 50% with very little effect on image quality. They suggest a larger clinical study to assess procedural outcomes [5].…”

Technical evaluation of a prototype ratio 29:1 grid for adult patient cardiovascular angiography imaging conditions

“…However, this perspective is not exclusive and may depend on pediatric patient size (Onnasch et al 2004, Gislason et al 2010, Ubeda et al 2013, Chamberlain et al 2019. Others have also investigated the use of non-grid or air gap techniques to mitigate scatter for adult patient fluoroscopic and angiographic imaging (Gray and Swee 1982, Partridge et al 2006, Cortis et al 2014, Smith et al 2016, Roy et al 2017. Simply removing the grid results in reduced patient radiation dose due to the combination of automatic dose rate control circuit and lack of x-ray beam attenuation by the grid.…”