Comparison of a conventional and a flat-panel digital system in interventional cardiology procedures

The purpose of the study was to analyse the technical characteristics of a newly installed flat-panel fluoroscopy (FPF) system in an interventional cardiology (IC) department and compare it with an older conventional system. A patient survey was performed to investigate the radiation doses delivered by the X-ray systems. Finally, methods of technique optimization regarding the new digital system were investigated. Dose rates in all fluoroscopic and cine modes were measured and image quality assessed using a dedicated test tool. 200 patients were investigated, half using the conventional and half using the digital FPF system. Patient data collected were: sex, age, weight, height, dose-area product (DAP), fluoroscopy time (T) and total number of frames (F). Our results are: (1) Digital FPF system: high contrast resolution (HCR) is not affected by fluoroscopic mode, whereas low contrast resolution (LCR) is slightly decreased in the low mode. (2) The digital FPF system has 2.5 times better HCR than the conventional system, with 5 times lower dose in the fluoroscopy mode. (3) Median values of DAP, T and F, respectively, in coronary angiography (CA) are: 27.7 Gycm(2), 4.1 min and 876 for the digital and 39.3 Gycm(2), 5.3 min and 1600 for the conventional system. Median values for percutaneous transluminal coronary angioplasty (PTCA) are: 51.1 Gycm(2), 12.7 min and 1184 for the digital and 44.3 Gycm(2), 7.4 min and 1936 for the conventional system. Digital DAP in CA is reduced by 30%, suggesting that a dose reduction in the FPF system is possible. The results of the study concerning the FPF system lead to the conclusion that the lowest fluoroscopic mode and the lowest frame rate should be used in routine practice.