Managing image quality and patient dose in the angiography suite: do you really need that image quality?

Angiographic equipment used for intervention has evolved dramatically over the last 20 years. As a result, attainable image quality has improved significantly. Since image quality and radiation dose are intricately related, the potential patient dose has risen as well. Image quality must therefore be managed in a manner that meets the needs of the procedure with the most beneficial limitation of radiation delivery. This article reviews the basic tenets of minimizing patient dose in the angiography suite. In addition, it investigates technical parameters that can be manipulated, allowing the operator to achieve the image quality needed to successfully complete the task with the least dose delivered to the patient. While a detailed description of each manufacturer's operating instructions is beyond the scope of this article, general principles are reviewed so that operators can understand the questions and issues involved. The hope is that this will facilitate the adaptation of these principles, which can then be applied to any machine. The responsibility is then on the operators to become facile with their own technical environment, so the maximum benefit/risk ratio can be afforded patients.