Radiation Dose Reduction Using a Novel Fluoroscopy System in Patients Undergoing Diagnostic Invasive Coronary Angiography

Background: Invasive coronary angiography (ICA) still causes a significant amount of radiation exposure for patients and operators. In February 2017, the Azurion system was introduced, a new-generation fluoroscopy image acquisition and processing system. Radiation exposure in patients undergoing ICA was assessed comparing the novel Azurion 7 F12 angiography system to its predecessor Allura Xper in a randomized manner. Methods: Radiation exposure was prospectively analyzed in 238 patients undergoing diagnostic ICA. Patients were randomly assigned to the novel Azurion system (119 patients) or its predecessor Allura Xper system (119 patients). In each patient, 8 predefined standard projections (5 left coronary artery, 3 right coronary artery) were performed. Image quality was quantified by grading of the images on the basis of a 5-point grading system. Results: Radiation dose area product was significantly lower in the Azurion group 109 (interquartile range [IQR 75-176] cGy cm(2)) compared with the Allura Xper group 208 [IQR 134-301] cGy cm(2) (P<0.001). Body mass index (26.6 [IQR 23.9-29.7] kg/m(2) vs. 26.2 [IQR 24.2-29.4] kg/m(2); P=0.607), body surface area (1.96 [IQR 1.81-2.11] m(2) vs. 1.90 [IQR 1.77-20.4] m(2); P=0.092), and procedure duration (1.5 [IQR 1.2-2.3] min vs. 1.6 [IQR 1.2-2.5] min; P=0.419) were similar in both groups. Images from the Azurion system were at least of equal quality compared with Allura Xper (image quality grade 4.82 +/- 0.45 vs. 4.75 +/- 0.52, P=0.43). Conclusion: Use of the novel Azurion 7 F12 angiography system resulted in a significant reduction of dose area product in patients undergoing diagnostic ICA by 56%.