Neurointerventions on two generations of angiography systems: Recent systems reduce radiation exposure by half

Fluoroscopically-guided neurointervention may be associated with prolonged procedure time and substantial radiation exposure to the patient and staff. This study sought to examine technological features affecting the potential radiation exposure reduction of new angiography systems, compared to older systems, for neurointerventional procedures.

Consecutive neurointerventional patients (2020-2022) were retrospectively analyzed. The air kerma at the reference point (K_a,r) and kerma-area product (KAP) were compared between Artis icono and Artis zee (Siemens) using statistical analyses (two-tailed t tests), where P < 0.05 is considered significant. X-ray tube potential and copper filtration were examined. Tests with an anthropomorphic phantom (Sun Nuclear) on Artis icono were conducted and entrance skin exposure and x-ray spectral half value layer were measured. Effective spectral filtration was characterized by x-ray spectral modeling.

The number of procedures was 1158 [median (range) age, 59 (7-95) years] on Artis zee and 1087 [60 (1-95) years] on Artis icono, without significant difference in age (p = 0.059) between cohorts. K_a,r was 925.4 (890.6-960.1) mGy [mean (95 % CI)] and KAP was 119.8 (115-124.5) Gy∙cm² on Artis zee. The measures were 48-50 % lower on Artis icono, 440.5 (411.7-469.4) mGy (K_a,r) and 59.5 (55.4-63.6) Gy∙cm² (KAP); while the difference in fluoroscopic time between the two generations of angiography systems was insignificant (p = 0.55).

The newer angiography system, with updated hardware and software, was found to result in half the radiation exposure compared to older technology of the same manufacturer, even though fluoroscopic time was similar.