Comparison of patient dose in two-dimensional carotid arteriography and three-dimensional rotational angiography

It is known that interventional neuroradiology (IN) involves high radiation dose to both patients and staff even if performed by trained operators using modern fluoroscopic X-ray equipment and dose-reducing technology. Therefore, every new technology or imaging tool introduced, such as three-dimensional rotational angiography (3D RA), should be evaluated in terms of radiation dose. 3D RA requires a series with a large number of images in comparison with 2D angiography and it is sometimes considered a high-dose IN procedure. The literature is scarce on the 3D RA radiation dose and in particular there are no data on carotid arteriography (CA). The aim of this study was to investigate patient dose differences between 2D and 3D CA.

The study included 35 patients undergoing 2D CA in hospital 1 and 25 patients undergoing 3D CA in hospital 2. Patient technical data collection included information on the kerma area product (KAP), fluoroscopy time (T), total number of series (S), and total number of acquired images (F).

Median KAP was 112 Gy cm(2) and 41 Gy cm(2) for hospitals 1 and 2, respectively, median T was 8.2 min and 5.1 min, median S was 13 and 4, and median F was 247 and 242. Entrance surface air-kerma rate, as measured in "medium" fluoroscopy mode measured in 2D acquisition using a 20 cm phantom of polymethylmethacrylate, was 17.3 mGy/min for hospital 1 and 9.2 mGy/min for hospital 2.

3D CA allows a substantial reduction in patient radiation dose compared with 2D CA, while providing the necessary diagnostic information.