Comparison of radiation dose between different fluoroscopy systems in the modern catheterization laboratory: Results from bench testing using an anthropomorphic phantom

Background Variations in radiation dose between various X-ray systems have received limited study. Objective We examined the impact of X-ray system type on patient radiation dose during cardiac catheterization. Methods An anthropomorphic phantom was used in a series of standardized experiments that involved 15 sec of continuous cineangiography in 7 projections. Three to seven experiments were performed in four commonly used X-ray systems: Innova IGS (GE Healthcare), Integris Allura FD20 (Philips), Allura Clarity (Philips), and Artis one (Siemens). Phantom radiation dose was measured with a dedicated X-ray dosimetry system (Gafchromic radiology film and Film QA XR software, Ashland) that was precalibrated at 0, 1, 2, 3, and 4 Gray, and with the X-ray system built-in functions. Results Radiation dose was lowest with the Allura Clarity system [average film dose 4.2 ± 0.1 cGray, peak film dose 18.3 ± 1.6 cGray, Air Kerma (AK) dose 0.310 ± 0.002 Gray, Dose Area Product (DAP) dose 23.72 ± 0.84 Gray cm ² ], intermediate with the Integris Allura FD20 (average film dose 4.4 ± 1.1 cGray, peak film dose 29.4 ± 15.5 cGray, AK 0.482 ± 0.189 Gray, DAP 45.18 ± 21.90 Gray cm ² ), and highest with the Artis one system (average film dose 7.4 ± 0.8 cGray, peak film dose 66.9 ± 0.09 cGray, AK 0.746 ± 0.085 Gray, DAP 75.93 ± 9.11 Gray cm ² ) and the Innova IGS system (average film dose 7.2 ± 1.0 cGray, peak film dose 49.3 ± 28.9 cGray, AK 0.874 ± 0.340 Gray, DAP 92.28 ± 14.73 Gray cm ² ; P = 0.011 for average film dose, P = 0.019 for maximum film dose, P = 0.033 for AK, and P = 0.008 for DAP). Conclusions The X-ray system type has significant impact on patient radiation dose during cardiac catheterization.