Impact of new X-ray technology reducing patient and staff doses in interventional cardiology.

Objectives: The radiology industry has been developing advanced X-ray systems which now deliver high-quality imaging while reducing radiation exposure. In this study, we analyse the impact of the new X-ray systems on patient and occupational radiation doses, compared with the previous ones (from the same manufacturer).

Methods: A dose management system (DMS) was employed to analyse large datasets from interventional cardiology procedures to assess the radiation protection improvements. Interventionists wear electronic active dosimeters wirelessly linked to the DMS to record personal occupational doses.Our analysis was conducted at four levels for the old and new X-ray systems: Patient doses, using the Kerma Area Product (KAP); Scatter radiation measured by the reference (ambient) dosimeter located on the C-arm; Occupational doses using over-apron personal electronic dosimeters, and updating local Diagnostic Reference Levels (DRLs) for the most frequent procedures.

Results: This methodology enables the evaluation of the new technology's impact at different levels: patient dose values (Level 1), scatter radiation measured by the ambient dosimeters (Level 2), occupational doses for interventionists (Level 3), and updated local DRLs (Level 4).

Conclusions: Based on an analysis of 5,002 interventional cardiology procedures, the new X-ray systems demonstrated a substantial reduction in radiation doses (median values): Patient doses (KAP values) decreased by 56-67%. Scatter radiation (ambient dose) decreased by 52-68%. Occupational doses: Interventionists' doses decreased by 33%. The updated local DRLs (median values) for CA and PTCA with the new X-ray systems are 17 Gy·cm2 and 50 Gy·cm2 representing reductions of 62% and 52%, respectively.

Advances in knowledge: The implementation of advanced X-ray technology has significantly reduced patient and occupational radiation exposure, all without compromising diagnostic accuracy. The effects on local diagnostic reference levels and the reduction in occupational doses should be regularly assessed to ensure that appropriate optimization actions are maintained.