Introduction: Adverse effects of increased use of cerebral Digital subtraction angiography (DSA) are the resulting radiation-induced skin reactions and increased risk of malignancy. This study aimed to identify a method for reducing radiation exposure during routine cerebral DSA.
Methods: A retrospective review of the 138 consecutive adult patients undergoing DSA with biplane angiography system (Artis Zee, Siemens, Germany) from September 2015 to February 2016 was performed. At January 2016, the ‘dose parameter’ resetting was done by manufacturing programmer from 2.4µGy to 1.2µGy. The pre-dose parameter reduction (Group 1) and post-dose parameter reduction (Group 2) groups were established. Angiograms and procedure examination protocols were reviewed according to patient age, gender, and diagnosis while angiography techniques were reviewed on the basis of following radiation dose parameters: fluoroscopy time, reference point air kerma (Ka,r; in mGy), and kerma area product (PKA; in µGym2).
Results: The Mean Ka,r values in Group 1 and 2 were 1841.5 mGy and 1274.8 mGy, respectively. The mean PKA values in Group 1 and 2 were 23212.5 µGym2 and 14854.0 µGym2, respectively. Ka,r and PKA values were significantly decreased in Group 2, compared with Group 1 (p<0.001). Among individual factors, young age is a determining factor of reduced fluoroscopy time (p<0.001), Ka,r (p=0.047), and PKA (p=0.022).
Conclusions: Increased awareness of radiation risks, as well as the establishment of strategies to reduce radiation dose, resulted in decreased radiation doses for DSA. The use of appropriate examinations and low-dose parameters in fluoroscopy contributed significantly to the radiation dose reductions.
Patient Care: The use of low dose parameter of fluoroscopy and appropriate examinations contributed significantly to the reduced radiation doses, especially in old age and aneurysm treatment.
Learning Objectives: Despite the development of non-invasive neuroimaging techniques, cerebral digital subtraction angiography (DSA) remains the most useful method for evaluation and treatment of many cerebrovascular diseases. Unfortunately, DSA involves the inevitable risk of exposing both patient and medical team to radiation.