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Comparing Radiation Dose Between Commercially Available State-Of-The-Art Interventional Fluoroscopy Systems in Vitro and in Patients

L Trunz*, D Eschelman , J Dave , Thomas Jefferson University, Philadelphia, PA


(Tuesday, 7/31/2018) 1:15 PM - 1:45 PM

Room: Exhibit Hall | Forum 8

Purpose: To compare radiation dose between commercially available state-of-the-art interventional fluoroscopy systems in vitro and in patients.

Methods: System-reported air-kerma rates (AKR_system) for four interventional fluoroscopy rooms (Philips AlluraClarity and Allura with ClarityIQ upgrade, and Siemens Artis-Q with Pure and Clear) were verified using a solid-state sensor (AGMS-D, Radcal Corporation). In vitro analysis was performed using acrylic phantoms (30x30x0.5cm³) simulating three patient thicknesses (20-40cm) across available magnification levels for low and normal dose modes. AKR_system values were compared with similar phantom setup across the rooms for most-commonly used clinical protocol. IRB approval was obtained for retrospective clinical study. System-reported cumulative air kerma (CAK), kerma-area-product (KAP) and fluoroscopy time (FT) for cases performed over a 16-month period were extracted from GE Centricity RIS, and DoseMetrix (Primordial). Parameters for procedure codes with greater than 30 cases performed on each type of fluoroscopy system were compared. Statistical comparisons were performed with Bonferroni corrections for multiple comparisons.

Results: In vitro analysis showed statistically significant differences (p≤0.05) in AKR_system between the systems (25-45 mGy/min lower for Allura-Clarity systems) for 30 and 40 cm of simulated patient thicknesses and both dose modes; differences with 20 cm thickness were not significant (p≥0.07). Clinical dataset included 5,113 cases corresponding to 16 unique procedure codes. Non-parametric tests revealed that for 9 out of 16 procedure codes CAK was statistically significantly lower (p<0.05) for Allura-Clarity systems (median difference range: 34-61%), for 3 out of 16 procedures codes KAP was statistically significantly lower (p<0.05) for Allura systems (median difference range: 37-44%), and statistically significant difference in FT was observed only for 1 procedure code; other differences were not statistically significant.

Conclusion: Differences observed in radiation dose in vitro between the Allura-Clarity and Artis-Q systems were reflected in clinical cases; when the differences were significant, Allura-Clarity systems showed lower radiation dose utilization.

Funding Support, Disclosures, and Conflict of Interest: Jaydev K. Dave and David J. Eschelman received research grant from Philips Healthcare.


Fluoroscopy, Flat-panel Imagers, Dose


IM- X-ray: Fluoroscopy, digital angiography, and DSA

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