Analysis of Radiation Doses and Dose Reduction Strategies During Cerebral Digital Subtraction Angiography

World Neurosurg. 2017 Apr:100:216-223. doi: 10.1016/j.wneu.2017.01.004. Epub 2017 Jan 12.


Objective: Adverse effects of increased use of cerebral digital subtraction angiography (DSA) include 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 138 consecutive adult patients who underwent DSA with a biplane angiography system (Artis Zee, Siemens, Germany) from September 2015 to February 2016 was performed. In January 2016, the dose parameter was reset by the manufacturer from 2.4 μGy to 1.2 μGy. Predose (group 1) and postdose parameter reduction (group 2) groups were established. Angiograms and procedure examination protocols were reviewed according to patient age, gender, and diagnosis and angiography techniques were reviewed on the basis of the 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 groups 1 and 2 were 1841.5 mGy and 1274.8 mGy, respectively. The mean PKA values in groups 1 and 2 were 23212.5 μGym2 and 14854.0 μGym2, respectively. Ka,r and PKA values were significantly lower in group 2 compared with group 1 (P < 0.001). Among individual factors, young age was a determining factor for 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, led to lower radiation doses for DSA. The use of appropriate examinations and low-dose parameters in fluoroscopy contributed significantly to the radiation dose reductions.

Keywords: Aneurysm; Cerebral angiography; Digital subtraction angiography; Fluoroscopy; Radiation dosage.

MeSH terms

  • Adult
  • Aged
  • Angiography, Digital Subtraction / statistics & numerical data*
  • Cerebral Angiography / statistics & numerical data*
  • Cerebrovascular Disorders / diagnostic imaging*
  • Cerebrovascular Disorders / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Radiation Dosage
  • Radiation Exposure / prevention & control*
  • Radiation Exposure / statistics & numerical data
  • Radiation Monitoring / statistics & numerical data
  • Radiation Protection / methods
  • Radiation Protection / statistics & numerical data*
  • Reproducibility of Results
  • Republic of Korea / epidemiology
  • Retrospective Studies
  • Sensitivity and Specificity