Radiation Dose Reduction without Compromise to Image Quality by Alterations of Filtration and Focal Spot Size in Cerebral Angiography

Abstract

ObjectiveDifferent angiographic protocols may influence the radiation dose and image quality. In this study, we aimed to investigate the effects of filtration and focal spot size on radiation dose and image quality for diagnostic cerebral angiography using an in-vitro model and in-vivo patient groups.Materials and MethodsRadiation dose and image quality were analyzed by varying the filtration and focal spot size on digital subtraction angiography exposure protocols (1, inherent filtration + large focus; 2, inherent + small; 3, copper + large; 4, copper + small). For the in-vitro analysis, a phantom was used for comparison of radiation dose. For the in-vivo analysis, bilateral paired injections, and patient cohort groups were compared for radiation dose and image quality. Image quality analysis was performed in terms of contrast, sharpness, noise, and overall quality.ResultsIn the in-vitro analysis, the mean air kerma (AK) and dose area product (DAP)/frame were significantly lower with added copper filtration (protocols 3 and 4). In the in-vivo bilateral paired injections, AK and DAP/frame were significantly lower with filtration, without significant difference in image quality. The patient cohort groups with added filtration (protocols 3 and 4) showed significant reduction of total AK and DAP/patient without compromise to the image quality. Variations in focal spot size showed no significant differences in radiation dose and image quality.ConclusionAddition of filtration for angiographic exposure studies can result in significant total radiation dose reduction without loss of image quality. Focal spot size does not influence radiation dose and image quality. The routine angiographic protocol should be judiciously investigated and implemented.

Age of Data in Contemporary Research Articles Published in Representative General Radiology Journals

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The Benefits can be Achieved after the Shift from Transfemoral Access to Transradial Access in Cerebral Angiography

“…Given that the shift from TFA to TRA can promote the effectiveness of the procedure without reducing safety, support its widespread adoption. However, when compared with the findings from a previous study [17], in this study, the image quality grade was firstly used to evaluate the feasibility of TRA after the shift from TFA to TRA based on the complexity of aortic arch morphology. Also, previous studies showed the advantages of TRA in type III or bovine aortic arch in interventional procedures [5,18].…”

Low-Dose Fluoroscopy Protocol for Diagnostic Cerebral Angiography

“…Although several studies of low-dose protocols for digital subtraction angiography (DSA) and three-dimensional rotational angiography (3D-RA) in cerebral angiography have been conducted, there have been few studies of fluoroscopic protocols due to their relatively low proportion in total radiation dose and the difficulty in evaluating image quality. [4][5][6][7][8][9][10][11] In the case of cardiac intervention, where fluoroscopy plays a main role, various protocols have been investigated to achieve a reduction in fluoroscopic dose, including the effects of detector entrance dose (DED), frame rate, copper filter, peak kilovoltage (kVp), pulse width, focal spot size, and fluoroscopy time limitation. [12][13][14][15] Most of these studies have concluded that radiation dose could be reduced without complications or procedural delays.…”