Novel X-Ray Imaging Technology Allows Substantial Patient Radiation Reduction without Image Quality Impairment in Repetitive Transarterial Chemoembolization for Hepatocellular Carcinoma.

Rationale and Objectives To assess patient radiation dose reduction and the image quality of a new X-ray imaging technology during repetitive transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Methods Fifty HCC patients (36 men; 57 ± 11 years) undergoing repetitive TACE were first randomly assigned to receive a TACE treatment on a reference X-ray system or a low-dose system with advanced real-time image processing. The alternate system was used for a repeated TACE (treatment interval, 0.5–6 months). Fluoroscopy time, number of digital subtraction angiography (DSA), air kerma (AK), and dose area product (DAP) were compared between the two systems and between the two repetitive TACE. Three interventional radiologists independently rated the image quality in blinded offline readings. Results Fluoroscopy time (8.7 ± 5.9 minutes vs. 8.7 ± 7.9 minutes, P  = .981), numbers of DSA runs (6 ± 4 vs. 6 ± 4, P  = .735), and exposure images (173 ± 86 vs. 168 ± 91, P  = .916) were equivalent between the two systems. No statistical difference in X-ray usage was found between repeated treatments. Compared to the reference system, the technology significantly reduced AK and DAP by 48.6% (0.17 ± 0.13 Gy vs. 0.41 ± 0.36 Gy, P 2 vs. 195.0 ± 155.5 Gy cm 2 , P Conclusions Patient radiation exposure can be substantially reduced by a factor of approximately two with the novel X-ray imaging technology while maintaining image quality.