Emerging Technology in Radiation Safety and Image Quality

**Spoiler Alert** – There is available technology that dramatically reduces radiation exposure without compromising image quality or changing existing workflow.

Radiation exposure during interventional procedures in catheterization laboratories (“cath labs”) is a known risk. What are the costs of reducing that risk – additional workflow, increased concerns of ergonomics, lower image quality? What role can technology have in reducing that exposure, that risk? And does that technology already exist? And if it did, what would that mean to you, your staff, and your patients?

Most cath labs focus on what they already know with respect to radiation safety. They have “quality” initiatives that start by making sure the image source (SID, or Source to Image Distance) is as close to the patient as possible. Everyone does this and it makes good sense. The closer the SID is to the patient, the lower the risk of scatter radiation to the physician and staff. This is good practice…for the physician and staff. It does nothing to limit the radiation exposure to the patient. More on that later.

Another initiative is the use of shields, either fixed to the table or movable around the lab and patient. These shields are lead and block radiation. They help protect the physician and staff but often require added time and effort to set them up or to move them as needed. Again, they do nothing for the patient.

Additional initiatives to reduce radiation exposure are more problematic. These include limiting the field of view (FOV) with shutters and setting X-ray systems to low-dose radiation – as low as possible. While effective in reducing radiation exposure, these practices also reduce image quality. And, as most interventional physicians know, image quality is the most important thing.

Along the same lines of reducing radiation dose (and image quality) is the common practice of using lower frame rates and exposure rates. Both reduce exposure, but also dramatically impact image quality.

Radiation safety and radiation exposure are important not only to the physician but to the staff and patients as well. As procedures become more and more advanced – becoming longer and requiring more fluoro (more radiation) – how can hospitals and physicians minimize the radiation exposure to everyone in the room – to the physician, to staff, and to the patient?

All manufacturers of interventional systems utilize various proprietary programs that reduce the amount of radiation and exposure during cases. These typically amount to computer algorithms and, in some form, limit exposure with the previously mentioned methods of limiting the FOV and/or lowering frame rates. But, again, the problem of relying on these programs alone for radiation safety is that they significantly reduce image quality and, therefore, risk the best-case outcome.

Current interventional cardiology procedures are performed with systems that use a FOV, without regard to the physician’s actual ROI. This exposes the patient to more radiation and the physician and staff to additional scatter radiation.

There is a better solution. Technology already exists that dramatically reduces radiation exposure without lowering image quality. In 2022, Omega Medical Imaging introduced the Soteria.AI. This revolutionary system uses AI technology to automatically control the region of interest (ROI). This is something totally different. Different than the claims of other systems and provides proven radiation reduction.

Unlike the collimation of other manufacturers, Omega’s AI technology uses dynamic collimation that reduces radiation exposure to the full FOV but still provides that imagery for orientation. Instead of getting a smaller FOV in an effort to reduce dose, Omega provides a full FOV with reduced radiation while providing superior image quality in the ROI in one seamless image. The process is hands-free and doesn’t disrupt existing workflow. That’s next-level radiation safety.

What makes the Omega System unique, what makes it truly different, is the ultra-fast secondary collimation that blocks – not just filters but blocks – the radiation to the peripheral (FOV) anatomy outside of the ROI and exposes it to a dramatically reduced rate of radiation. Advanced control systems and image processing opens the primary collimator at a set rate to take a full FOV image that is then integrated with the dynamic ROI image. The FOV image provides a “road map” of the peripheral anatomy for the physician while the ROI image provides the exceptional image quality the interventionalist needs.

The advantages are obvious – the patient is subjected to dramatically reduced radiation exposure which also reduces scatter radiation to physicians and staff.

Physicians expose their bodies to radiation without much thought about the length of their careers and how much radiation they will subject themselves to. Increased cataracts, brain tumors, various cancers, and even orthopedic issues due to heavy lead protection are just some of the risks interventional physicians face over their careers. It’s easy to think of radiation protection during one case, but harder to do so for a long career.

In a study conducted by Maria Grazia Andreassi, Ph.D., and reported in Medical News Today, healthcare professionals working in cath labs experienced 6.3 times greater risk for cataracts, 2.8 times greater risk for skin lesions, and 7.1 times greater risk for orthopedic problems when compared to those who did not. As expected, the radiation exposure was highest for interventional cardiologists and electrophysiologists, but the risk is high for staff as well.

In a comparative study, Omega proved a significant dose reduction is achieved when using an AI image-guided ROI system compared to a non-AI system. Radiation is reduced in all modes of acquisition (fluoro and cine) at varying frame rates. Radiation reduction in cine more was up to ~75% for staff and ~71% for patients. In fluoro mode, radiation reduction was ~61% for staff and ~51% for patients.

Physicians, like many in healthcare, hear about new technologies – like those from Omega – but aren’t always innovative enough and willing to accept new technology and new standards of care. Omega provides something unique – protection for everyone in the room. By reducing the total radiation dose, Omega establishes a new modality of radiation protection and image quality.

Physicians and healthcare professionals are always looking for potential solutions, for ways to provide better, safer care. Physicians need to protect themselves while doing what’s best for their patients. But these two goals can coexist. They already do with the Omega Soteria.AI.

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