Amir Reza Honarmand MD, Presenter: Nothing to Disclose

Ali Shaibani MD, Abstract Co-Author: Nothing to Disclose

Michael Charles Hurley MBBCh, Abstract Co-Author: Nothing to Disclose

Christina Louise Sammet PhD, Abstract Co-Author: Nothing to Disclose

Sameer A. Ansari MD, PhD, Abstract Co-Author: Shareholder, RaPID Medical Technologies, LLC

We aimed to investigate the feasibility of reducing the radiation exposure dose in diagnostic cerebral DSA examinations while preserving the overall image quality for diagnostic purposes.

Following IRB approval, a prospective study was performed on patients undergoing diagnostic cerebral DSA using biplane flat detector angiography unit. DSA images were acquired using a predefined manufacturer standard program by selecting detector dose of 3.6 μGy/frame (mean typical tube voltage (TTV): 80.6 kVP, mean tube current (TC): 230.6 mA, using focal spot size (FS) of 0.6 and inherent filtration) and reduced detector dose of 1.2 μGy/frame (mean TTV: 73.6 kVP, mean TC: 153.5 mA, using FS of 0.3 with additional 0.1/0.2 copper filter) dose protocols for each patient. Using identical contrast agent, contrast injection rate, and fluoroscopy time, randomly selected internal carotid or vertebral arteries and their contralateral equivalent arteries were injected to obtain standard radiation dose and low radiation dose AP and lateral DSA images, respectively.  Image quality assessment was performed independently by two neurointerventionalists. A 5 point scale was used for qualitative evaluation of arterial, capillary, and venous phases of DSA images respectively. The total score was defined as the overall diagnostic value. Paired sample t-test and Wilcoxon's signed rank test compared the kerma-area product (KAP) and scores assigned to image quality parameters, respectively. P value <0.05 was considered statistically significant.

Twenty-three DSA image series were obtained from nine patients (8M/1F, mean age: 65.9) undergoing diagnostic DSA. Mean KAP was significantly reduced by 60% or 2.5 fold (1408.90 ± 419.18 μGy/m2 versus 557.08 ± 214.56 μGy/m2, P <0.0001). No significant difference was observed between image quality scores assigned by the observers while assessing arterial (observer 1(O1): P=1.0; observer 2 (O2): P=0.24), capillary (O1: P=0.54; O2: P=0.3), venous (O1: P=0.14; O2: P=0.7) phases, and overall diagnostic value (O1: P=0.34; O2: P=0.8).

Radiation exposure dose can be reduced significantly without compromising image quality for diagnostic purposes in cerebral DSA studies.

Significant reduction of radiation exposure dose is feasible while maintaining image quality for diagnostic and therapeutic purposes in intracranial endovascular procedures.

Honarmand, A, Shaibani, A, Hurley, M, Sammet, C, Ansari, S, Significant Acquisition Dose Reduction Maintains Diagnostic Quality of Biplane Cerebral Digital Subtraction Angiography.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018447.html