Decreasing radiation doses in digital subtraction angiographies consecutively performed by trainees

Digital subtraction angiography (DSA) performed by trainees may be related to increased radiation exposure. This study was aimed to investigate and quantify this learning effect, with fluoroscopy time and dose-area product (DAP) as parameters. We collected procedure data of the first to the fortieth cerebral DSA consecutively performed by 13 trainees in a training centre. DAP, procedure time, fluoroscopy time, number of cine-frames of the first 20 DSA procedures performed by these trainees were compared with that of the second 20 procedures. There was no significant difference concerning the procedure time between the first and the second 20 procedures (56.3 ± 29.5 vs 51.5 ± 20.2 min, p = 0.113). Numbers of cine-frames were very similar between the first and the second 20 procedures (750.7 ± 290.3 vs 744.5 ± 188.7, p = 0.830). Fluoroscopy time of the first 20 procedures was significantly longer than that of the second 20 procedures (17.8 ± 15.4 vs 12.6 ± 9.0, p = 0.001). DAP of the first 20 procedures was significantly higher than that of the second 20 procedures (6.4 ± 4.9 vs 3.8 ± 1.8, p < 0.001). DAP was correlated significantly with the performer's experience (R = -0.288, p < 0.001). There exists a learning effect of radiation exposure during cerebral DSA procedures performed by trainees. The learning effect is significant during the first 20 procedures, and becomes insignificant after 20 procedures. Insufficient catheter skills in novice trainees may be one reason for this effect.