Decadal Changes in Institutional Diagnostic Reference Levels for X-Ray Angiography: A Retrospective Comparative Study

Angiography is a key imaging modality for the diagnosis and treatment of vascular diseases, and the growing sophistication of interventional procedures has heightened the need for radiation dose optimization. Diagnostic Reference Levels (DRLs) are widely used to monitor patient exposure and to support optimization in accordance with the ALARA principle. This study compared radiation dose metrics from a newly installed angiographic system at Attikon University Hospital with those obtained from the institution's previous system and with values reported in the published literature. Radiation dose and procedural parameters were retrospectively collected for digital cerebral subtraction angiography (DSA), embolization, nephrostomy, vertebroplasty, transjugular intrahepatic portosystemic shunt (TIPS), chemoembolization, and injection procedures. Dose area product (DAP), fluoroscopy-related DAP, patient entrance dose indicators, and fluoroscopy time were analyzed. Median DAP values ranged from 5.72 to 349.60 Gy·cm² depending on the procedure. Compared with data acquired approximately a decade earlier, DAP values increased by an average of 96.4%, whereas fluoroscopy times remained largely unchanged. Despite this increase, dose levels were generally lower than those reported in the international literature. Median DAP values ranged from 5.72 to 349.60 Gy·cm² depending on the procedure. Compared with data acquired approximately a decade earlier, DAP values increased by an average of 96.4%, whereas fluoroscopy times remained largely unchanged. Although these differences may reflect the combined influence of technological developments, evolving procedural complexity, operator-related factors, and changes in clinical practice over time, these variables were not directly assessed in the present retrospective study. Nevertheless, the updated institutional Diagnostic Reference Levels provide a valuable benchmark for radiation dose optimization, quality assurance, and future multicenter studies aimed at supporting national DRL establishment.