Noise reduction technology reduces radiation dose in chronic total occlusions percutaneous coronary intervention: a propensity score-matched analysis

  • Davide Maccagni
  • Susanna Benincasa
  • Barbara Bellini
  • Luciano Candilio
  • Enrico Poletti
  • Mauro Carlino
  • Antonio Colombo
  • Lorenzo Azzalini
Original Paper


Chronic total occlusions (CTO) percutaneous coronary intervention (PCI) is associated with high radiation dose. Our study aim was to evaluate the impact of the implementation of a noise reduction technology (NRT) on patient radiation dose during CTO PCI. A total of 187 CTO PCIs performed between February 2016 and May 2017 were analyzed according to the angiographic systems utilized: Standard (n = 60) versus NRT (n = 127). Propensity score matching (PSM) was performed to control for differences in baseline characteristics. Primary endpoints were Cumulative Air Kerma at Interventional Reference Point (AK at IRP), which correlates with patient’s tissue reactions; and Kerma Area Product (KAP), a surrogate measure of patient’s risk of stochastic radiation effects. An Efficiency Index (defined as fluoroscopy time/AK at IRP) was calculated for each procedure. Image quality was evaluated using a 5-grade Likert-like scale. After PSM, n = 55 pairs were identified. Baseline and angiographic characteristics were well matched between groups. Compared to the Standard system, NRT was associated with lower AK at IRP [2.38 (1.80–3.66) vs. 3.24 (2.04–5.09) Gy, p = 0.035], a trend towards reduction for KAP [161 (93–244) vs. 203 (136–363) Gycm2, p = 0.069], and a better Efficiency Index [16.75 (12.73–26.27) vs. 13.58 (9.92–17.63) min/Gy, p = 0.003]. Image quality was similar between the two groups (4.39 ± 0.53 Standard vs. 4.34 ± 0.47 NRT, p = 0.571). In conclusion, compared with a Standard system, the use of NRT in CTO PCI is associated with lower patient radiation dose and similar image quality.


Percutaneous coronary intervention Chronic total occlusions Radiation Noise reduction technology 


Compliance with ethical standards

Conflict of interest

The authors report no financial relationships or conflicts of interest regarding the content herein.

Ethical approval

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Supplementary material

10554_2018_1343_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 KB)


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Davide Maccagni
    • 1
    • 2
    • 5
  • Susanna Benincasa
    • 1
  • Barbara Bellini
    • 1
  • Luciano Candilio
    • 1
    • 3
  • Enrico Poletti
    • 4
  • Mauro Carlino
    • 1
  • Antonio Colombo
    • 1
  • Lorenzo Azzalini
    • 1
  1. 1.Cardio-Thoracic-Vascular DepartmentSan Raffaele HospitalMilanItaly
  2. 2.AITRI (Italian Association of Interventional Radiographers)MilanItaly
  3. 3.Cardiology DepartmentHammersmith Hospital Imperial CollegeLondonUK
  4. 4.Universita’ Vita-SaluteMilanItaly
  5. 5.Interventional CardiologySan Raffaele Scientific InstituteMilanItaly

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