Radiation dose reduction during transjugular intrahepatic portosystemic shunt implantation using a new imaging technology

Abstract

Objective: To compare patient radiation dose in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) implantation before and after an imaging-processing technology upgrade.

Methods: In our retrospective single-center-study, cumulative air kerma (AK), cumulative dose area product (DAP), total fluoroscopy time and contrast agent were collected from an age- and BMI-matched collective of 108 patients undergoing TIPS implantation. 54 procedures were performed before and 54 after the technology upgrade. Mean values were calculated and compared using two-tailed t-tests. Two blinded, independent readers assessed DSA image quality using a four-rank likert scale and the Wilcoxcon test.

Results: The new technology demonstrated a significant reduction of 57% of mean DAP (402.8 vs. 173.3Gycm², p<0.001) and a significant reduction of 58% of mean AK (1.7 vs. 0.7Gy, p<0.001) compared to the precursor technology. Time of fluoroscopy (26.4 vs. 27.8min, p=0.45) and amount of contrast agent (109.4 vs. 114.9ml, p=0.62) did not differ significantly between the two groups. The DSA image quality of the new technology was not inferior (2.66 vs. 2.77, p=0.56).

Conclusions: In our study the new imaging technology halved radiation dose in patients undergoing TIPS maintaining sufficient image quality without a significant increase in radiation time or contrast consumption.

Keywords: Image-processing technology; Interventional radiology; Liver; Radiation dosage; Transjugular intrahepatic portosystemic shunt (TIPS).