The Impact of Novel X-Ray Systems and X-Ray System Optimization on Patient Radiation Dose Administered During Cardiac Catheterization.

The effect of x-ray system optimization on patient radiation dose has received limited study. We analyzed patient radiation dose in 1786 cardiac catheterization procedures (diagnostic coronary angiography and/or percutaneous coronary intervention [PCI]) performed at a single tertiary-care center before and after x-ray system optimization. After optimization, cineangiography dose-area product (DAP) dose was lower in the overall group of patients who underwent diagnostic angiography and/or PCI (1347 μGy•m² [IQR, 645-2345 μGy•m²] vs 1658 μGy•m² [IQR, 640- 2757 μGy•m²]; P=.03), as well as in the diagnostic angiography group (1795 μGy•m² [IQR, 1140-2994 μGy•m²] vs 2356 μGy•m² [IQR, 311-3576 μGy•m²]; P<.01) and PCI group (2152 μGy•m² [IQR, 1338-3477 μGy•m²] vs 2562 μGy•m² [IQR, 1681-3859 μGy•m²]; P=.02). Cineangiography DAP per exposure was also lower in the overall group (143 μGy•m² [IQR, 91-212 μGy•m²] vs 164 μGy•m² [IQR, 106-233 μGy•m²] per exposure; P<.01) and in the diagnostic angiography group (158 μGy•m² [IQR, 102-225 μGy•m²] vs 184 μGy•m² [IQR, 125-271 μGy•m²] per exposure; P<.01). After optimization, cineangiography air kerma (AK) dose (319 mGy [IQR, 197-531 mGy] vs 421 mGy [IQR, 241-600 mGy]; P=.01) and cineangiography AK per exposure (20.7 mGy [IQR, 12.9-29.0 mGy] vs 23.6 mGy [IQR, 14.1-32.9 mGy] per exposure; P=.03) were also lower in the PCI group. There was no significant change in fluoroscopy AK dose after optimization (20.7 mGy [IQR, 12.7-30.1 mGy] vs 20.4 mGy [IQR, 12.8-31.3 mGy] per minute; P=.71) and fluoroscopy DAP dose (156 μGy•m² [IQR, 101-242 μGy•m²] vs 156 μGy•m² [IQR, 102-236 μGy•m²] per minute; P=.91). X-ray system optimization was associated with lower cineangiography DAP, but similar fluoroscopy radiation dose.