Hoffmann Rainer, Langenbrink Lukas, Reimann Doris, Kastrati Mirlind, Becker Michael, Piatkowski Michal, Michaelsen Jochen
Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany.
Department of Cardiology, Medical Clinic I, University Clinic Aachen, Aachen, Germany.
Pacing Clin Electrophysiol. 2017 Dec;40(12):1374-1379. doi: 10.1111/pace.13222. Epub 2017 Nov 19.
Novel x-ray systems with real-time image noise reduction technology (INRT) to reduce radiation dose during fluoroscopy and cine acquisition have become available. This study evaluated the reduction of radiation dose in device implantation with INRT.
Radiation dose data from 132 consecutive new device implantation procedures (102 pacemaker [PM] or implantable cardioverter defibrillator [ICD] and 30 cardiac resynchronization therapy [CRT] devices) performed between January 2015 and December 2015 on an angiography system with INRT (Allura ClarityIQ) were collected. For comparison, radiation dose data from 147 consecutive device implantation procedures (121 PM/ICDs and 26 CRT devices) performed between June 2013 and September 2014 on a C-arm system with continuous and pulsed fluoroscopy option (4 frames/second) were evaluated. Total dose area product (DAP), fluoroscopy DAP, and cine DAP were evaluated.
Patient age, gender and body weight, procedure, and fluoroscopy times were similar between systems. In PM/ICD cases, DAP of INRT and C-arm system was similar (423 ± 381 cGycm vs 417 ± 517 cGycm) due to pulsed fluoroscopy with the C-arm system (78% of time) and sparse use of cine. In CRT procedures requiring higher image quality (82% use of continuous fluoroscopy with C-arm system), DAP of INRT was significantly lower (1,544 ± 834 cGycm vs 7,252 ± 6,431 cGycm, P < 0.001) due to less fluoroscopy DAP (1,414 ± 757 cGycm vs 5,854 ± 6,767 cGycm) and less cine DAP (130 ± 106 cGycm vs 1,399 ± 1,342 cGycm). Considering all procedures, total DAP was reduced by 60% using INRT.
Novel INRT results in a substantial lowering of radiation dose in device implantation, in particular, in complex CRT implantation procedures requiring high image quality.
具有实时图像降噪技术（INRT）的新型X射线系统已可用于在荧光透视和电影采集期间降低辐射剂量。本研究评估了在设备植入过程中使用INRT降低辐射剂量的情况。
收集了2015年1月至2015年12月期间在具有INRT的血管造影系统（Allura ClarityIQ）上进行的132例连续新设备植入手术（102例起搏器[PM]或植入式心脏复律除颤器[ICD]以及30例心脏再同步治疗[CRT]设备）的辐射剂量数据。为作比较，评估了2013年6月至2014年9月期间在具有连续和脉冲荧光透视选项（每秒4帧）的C形臂系统上进行的147例连续设备植入手术（121例PM/ICD和26例CRT设备）的辐射剂量数据。评估了总剂量面积乘积（DAP）、荧光透视DAP和电影DAP。
两个系统之间患者的年龄、性别和体重、手术以及荧光透视时间相似。在PM/ICD病例中，由于C形臂系统采用脉冲荧光透视（78%的时间）且电影使用较少，INRT和C形臂系统的DAP相似（423±381 cGycm对417±517 cGycm）。在需要更高图像质量的CRT手术中（C形臂系统82%使用连续荧光透视），由于荧光透视DAP较低（1414±757 cGycm对5854±6767 cGycm）和电影DAP较低（130±106 cGycm对1399±1342 cGycm），INRT的DAP显著更低（1544±834 cGycm对7252±6431 cGycm，P<0.001）。考虑所有手术，使用INRT可使总DAP降低60%。
新型INRT可大幅降低设备植入过程中的辐射剂量，尤其是在需要高图像质量的复杂CRT植入手术中。
