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Abstract
Introduction Interventional neuroradiology provides increasingly safe and minimally invasive treatment options for neurovascular diseases, but the growing use of diagnostic and complicated fluoroscopy-guided procedures has led to heightened concerns over ionizing radiation exposure to patients and staff. AlluraClarity (Philips Healthcare) is a new commercially available angiographic imaging platform that addresses these concerns by employing novel algorithm- and hardware adjustments that allow for dose reduction while preserving image quality. In this study we report a comparison between AlluraClarity and its predecessor platform (Allura Xper) in a retrospective case review to assess the achieved reduction in mean radiation dose for various neurointerventional procedures.
Materials and methods This review was conducted under an IRB-approved data registry. Cumulative dose area product (DAP) and total fluoroscopy time were collected for cases imaged on the Allura Xper (n = 659) and AlluraClarity (n = 329) platforms. Cases were stratified into 8 procedure categories: AVM embolization, carotid stenting, aneurysm coil embolization, diagnostic angiography, flow diverter implantation, stent coiling, thrombectomy, and other (see Table 1). Linear models were fitted to assess the effects of platform by procedure type on both cumulative DAP and total fluoroscopy time.
Number of cases and relative reductions achieved by AlluraClarity
Results Linear modeling showed that the AlluraClarity platform is associated with a significant (p < 0.05) reduction in radiation dose across almost all procedures. Table lists the dose reduction achieved per procedure (see Figure 1 for means and confidence intervals). An average of 48% reduction in cumulative DAP was observed across procedures. Only for the small number of AVM-treatments the lower cumulative DAP associated with AlluraClarity failed to reach significance (p = 0.0632). Overall, fluoroscopy time was not associated with platform (see Table 1), although there was a significant difference for diagnostic procedures (p < 0.0001; Allura Xper = 10.64 min, CI 95% = [10.12,11.15]; AlluraClarity = 12.30 min, CI 95% = [11.53,13.07]).
Conclusion The introduction of the AlluraClarity imaging platform was associated with a significant reduction in radiation dose exposure for diagnostic and treatment procedures as compared to Allura Xper. While on average the cumulative DAP was reduced by 48%, this did not lead to an overall increase in total fluoroscopy time. Future work will incorporate the impact on staff dose and operator behavior in complex cases where patient exposure becomes a limiting factor.
Disclosures K. van der Marel: None. S. Vedantham: None. I. van der Bom: 5; C; Philips Healthcare. M. Howk: None. T. Narain: None. M. Gounis: 1; C; Philips Healthcare, eV3/Covidien, NIH, Silk Road, Stryker Neurovascular. 2; C; Stryker Neurovascular, Codman Neurovascular. A. Puri: None. A. Wakhloo: 1; C; Philips Healthcare, NIH. 2; C; Stryker Neurovascular.