Digital zoom is a useful, simple, and cost-effective method of reducing radiation exposure in percutaneous coronary intervention.

Reducing radiation exposure is a very important issue in interventional cardiology techniques such as percutaneous coronary intervention. Although novel techniques to reduce radiation exposure are valuable, we should also reconsider older techniques. Digital zoom has been available in Japan from 2005. Digital zoom enlarges an 8-inch field of view (FOV) by 1.2 times, allowing visualization of a 6.7-inch FOV without FOV switching. We identified 2101 suitable cases of percutaneous intervention (PCI) and divided them into two groups according to the use of digital zoom; 1195 patients were included in the digital zoom group and 906 patients in the conventional group. We collected data regarding the reference air kerma (RAK) and dose-area product (DAP). We calculated RAK and DAP per minute fluoroscope time (RAK/min, DAP/min, respectively). There were intergroup differences in RAK, DAP, RAK/min, and DAP/min (digital zoom group vs conventional group; RAK, 1590 mGy [990-2410] vs 1850 [1220-2720], p < 0.01, RAK/min; 54.7 mGy/min [38.5-73.2] vs 71.2 [51.5-93.0], p < 0.01; DAP, 16,000 cGy × cm2 [10,300-24,400] vs 20,700 [13,400-29,500], p < 0.001; DAP/min, 557 cGy × cm2/min [392-737] vs 782 [571-1010], p < 0.01, respectively). Because of baseline differences between the two groups, we performed propensity score matching. Even after score matching, there were intergroup differences in DAP, DAP/min, RAK, and RAK/min. Furthermore, the least squares method showed that digital zoom is a significant predictor of RAK (ß = 0.14, p < 0.01) and DAP (ß = 0.20, p < 0.01). Digital zoom is an older cost-effective technique that can significantly reduce radiation exposure in PCI.

Neonatal magnification radiography using standard-focus x-ray tubes.

Radiographic examination of the chests of premature newborn infants is complicated by the small size and poor object contrast of the structures to be evaluated. Magnification radiography can improve image quality significantly in this situation. Unfortunately, high-quality magnification radiography requires dedicated microfocus equipment that is not available in most neonatal intensive care units. The use of standard-focus x-ray tubes (up to 1 mm focal spot size) for moderate magnification radiography (1.5 times) by using the anode side of the x-ray field of the standard mobile x-ray unit is proposed. In addition to the cost advantage of using existing standard mobile x-ray equipment, the high tube current allows for short exposure times and long target-film distances. This reduces most motion unsharpness and allows for a large air gap that results in improved image contrast. Although focal spot size at the anode side of the field is smaller in only one dimension, the magnification radiographs are superior to those obtained using the central part of the x-ray beam and superior to standard contact radiographs using the same equipment. Improvement in image quality is due primarily to decreased noise and improved contrast in the magnified image.