Saba Assar, Mark Winkens, Kajo van der Marel, Roy van Pelt, Lindsay Johnson, Martijn S van Mourik, Ragui Ibrahim, Philippe L'Allier, Lim Soo Teik, Leah Raj, William Nicholson, Michael Collins, Ajay J Kirtane
These data suggest that the use of novel x-ray acquisition algorithms can improve image quality while maintaining or lowering radiation or iodine dose. The prospective evaluation of these algorithms within routine clinical practice is warranted in future clinical studies.
BACKGROUND: With advancements in percutaneous coronary intervention, clinicians face the challenge of balancing the need for high-quality imaging with the imperative to minimize radiation exposure and iodinated contrast use, particularly in complex procedures.
METHODS: We conducted a pilot study of 50 patients undergoing diagnostic coronary angiography in which each patient received 2 sequential angiograms, one using conventional image acquisition and processing protocols and the other acquired and processed using a novel algorithm, with a reduction in radiation, iodine content, or both. Angiographic runs were analyzed offline by 5 interventional cardiologists who independently reviewed the images, blinded to the image acquisition protocol. The study assessed image quality between the 2 acquisition protocols as well as interobserver variability to measure consistency in scoring among the evaluators.
RESULTS: The mean age of the patients was 63 ± 10 years (74% male). The mean body mass index was 27.8 ± 5.0 kg/m2, and 8 of 50 (16%) had a glomerular filtration rate <60 mL/min. When comparing 5-point image quality scores, the novel algorithm scored higher than the predicate comparator (on average, 1 point higher for the novel algorithm images over ClarityIQ images [P < .01]). In a blinded side-by-side comparison, the novel algorithm was preferred in 214 of 220 ratings and was found to be superior to the predicate comparator for both standard radiation and lower radiation cases. The interobserver correlation of preference between the protocols among the 5 readers ranged from 0.53 to 0.67, with an average of 0.61.
CONCLUSIONS: These data suggest that the use of novel x-ray acquisition algorithms can improve image quality while maintaining or lowering radiation or iodine dose. The prospective evaluation of these algorithms within routine clinical practice is warranted in future clinical studies.