Radiation dose reduction capabilities of a new C-arm system with optimized hard- and software

• Published in: European journal of radiology 2021-01, Vol.134, p.109367, Article 109367
• Main Authors: Javor, Domagoj, Moyses, Johanna, Loewe, Christian, Schernthaner, Ruediger E.
• Format: Article
• Language: English
• Subjects: Angiography, Digital Subtraction; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic; Drug Tapering; Fluoroscopy; Humans; Interventional Radiology; Liver Neoplasms; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - therapy; Prospective Studies; Radiation Dosage; Radiation Exposure; Radiation Protection; Radiography, Interventional; Software; Therapeutic Chemoembolization
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2020.109367

[Display omitted] •The new angiography unit allowed a 72% reduction of radiation exposure.•The procedure’s course was not affected by the new platform.•No decrease in DSA image quality was observed due to radiation reduction. To assess the radiation dose reduction capabilities and the image quality of a new C-arm system in comparison to a standard C-arm system. Prospective, randomized, IRB approved two-arm trial design. 49 consecutive patients with primary or secondary liver cancer were treated with transarterial chemoembolization (TACE) on two different angiography units. 28 patients were treated on a conventional angiography unit B, 21 patients on unit A which provides improved hardware and optimized image processing algorithms. Dose area product (DAP) and fluoroscopy time were recorded. DSA image quality of all procedures was assessed on a four-rank-scale by two independent and blinded readers. Both cohorts showed no significant differences with regard to patient characteristics, tumor burden and fluoroscopy time. The new system resulted in a statistically significant reduction of cumulative DAP of 72% compared to the old platform (median 76 vs. 269 Gy*cm2). Individually, Fluoro-DAP and DSA-DAP decreased by 48% and 77% (p = 0.012 and p < 0.01), respectively. No statistically significant differences in DSA image quality were found between the two imaging platforms. The new C-arm system significantly reduced radiation exposure for TACE procedures without increased radiation time or negative impact on DSA image quality. The combination of optimized hardware and software yields the highest radiation dose reduction and is of utmost importance for patients and interventionalists.