Ultra-Low-Dose Noise-Free Technology to Reduce Radiation Exposure During Coronary Angiography.

Abstract

Background: Percutaneous coronary intervention (PCI) is a cornerstone treatment for coronary artery disease. As procedural volumes continue to rise, the associated radiation risk from angiography systems has drawn increasing concern. Thus, we developed a novel ultra-low-dose Noise-Free technology to optimize angiography systems. This study aims to investigate whether it effectively reduces radiation exposure in real-world coronary interventions.

Methods: A comparative study on a single-center, real-world, observational cohort. The primary end point was an intergroup comparison of procedural radiation exposure, including dose area product, air kerma, and dose rate, stratified by exposure mode (fluoroscopy or cine) and procedure type (diagnostic coronary angiography, single-vessel PCI, or chronic total occlusion PCI). The secondary end point included an expert semi-quantitative assessment and a quantitative contrast-to-noise ratio for image quality.

Results: A total of 380 procedures (102 coronary angiography, 78 single-vessel PCI, and 200 chronic total occlusion PCI) were performed in 380 patients using 4 different angiography systems. There was no significant difference in baseline patient characteristics, procedural time, or operator experience. In coronary angiography procedures, the ultra-low-dose technique demonstrated a total air kerma of 60.3 (38.5-74.1) mGy, total dose area product of 4.0 (2.9-5.2) Gy·cm², fluoroscopy dose rate of 7.9 (6.0-9.6) mGy/min, and cine dose rate of 51.7 (37.4-64.9) mGy/min, corresponding to 40% to 70%, 37% to 66%, 16% to 62%, and 25% to 79% reductions than others, respectively. Similar radiation reductions were observed for single-vessel PCI. For chronic total occlusion PCI, the corresponding percentages of radiation reduction in total air kerma, total dose area product, fluoroscopy dose rate, and cine dose rate were 59% to 73%, 54% to 69%, 22% to 64%, and 60% to 79%, respectively, relative to the other 3 systems. The semi-quantitative assessment and contrast-to-noise ratio analysis showed comparable image quality between the 4 systems.

Conclusions: The Noise-Free technique reduced radiation exposure across cumulative and rate metrics while preserving diagnostic image quality, with the greatest reduction observed in complex cases. These findings support its clinical utility for lowering radiation risk.