Substantial radiation reduction in pediatric and adult congenital heart disease interventions with a novel X-ray imaging technology.

Background: Pediatric catheterization exposes patients to varying radiation doses. Concerns over the effects of X-ray radiation dose on the patient population have increased in recent years. This study aims at quantifying the patient radiation dose reduction after the introduction of an X-ray imaging technology using advanced real time image noise reduction algorithms and optimized acquisition chain for fluoroscopy and exposure in a pediatric and adult population with congenital heart disease.
Methods: Patient and radiation dose data was retrospectively collected (July 2012-February 2013) for 338 consecutive patients treated with a system using state of the art image processing and reference acquisition chain (referred as "reference system"). The same data was collected (March-October 2013) for 329 consecutive patients treated with the new imaging technology (Philips AlluraClarity, referred as "new system"). Patients were divided into three weight groups: A) below 10 kg, B) 10-40 kg, and C) over 40 kg. Radiation dose was quantified using dose area product (DAP), while procedure complexity using fluoroscopy time, procedure duration and volume of contrast medium.
Results: The new system provides significant patient dose reduction compared to the reference system. Median DAP values were reduced in group A) from 140.6 cGy·cm ² to 60.7 cGy·cm ² , in group B) from 700.0 cGy·cm ² to 202.2 cGy·cm ² and in group C) from 4490.4 cGy·cm ² to 1979.8 cGy·cm ² with reduction of 57%, 71% and 56% respectively (p < 0.0001 for all groups).
Conclusions: Despite no other changes in procedural approach, the novel X-ray imaging technology provided substantial radiation dose reduction of 56% or higher.