Impact of Angiography System Generation on Radiation Exposure in Peripheral, Abdominal, and Cerebral Angiography:...

To evaluate radiation exposure in peripheral, abdominal, and cerebral digital subtraction angiography (DSA) across three consecutive equipment generations and to identify technological potential for dose reduction.

In this retrospective single-center study, 450 patients were examined using three different platforms (150 per system): a conventional system (Allura Xper) and two subsequent generations featuring advanced noise reduction (Allura Clarity and Azurion). The patient cohort was equally distributed among head, abdomen, and lower limb regions. Primary endpoints included total dose-area product (DAP), fluoroscopic dose rate, dose per DSA frame, and the DAP per 3D rotational angiography (3D-RA) for the head. Subjective image quality was evaluated using a 5-point Likert scale.

Transitioning from the conventional system to the first generation with advanced image processing (Allura Clarity) resulted in a significant reduction in total DAP of 70% (abdomen), 65% (head), and 69% (lower limbs; each p<0.001). This effect was driven by a significant decrease in fluoroscopic dose rate (34-50%) and dose per DSA frame (68-74%). Transitioning to the latest system generation (Azurion) yielded a non-significant yet further reduction of 6-17%. Cerebral 3D-RA demonstrated stable dose requirements across all three generations (p=0.123). Subjective image quality improved significantly with the introduction of noise reduction algorithms (p<0.001), with no significant difference between the two most recent systems (p>0.05).

Advanced image processing algorithms are an effective tool for radiation dose reduction in angiography. However, a technological dose plateau appears to have been reached, as the current equipment generation has not shown further significant improvements in radiation dose requirements compared to its immediate predecessor. Dose requirements for 3D-RA do not, at present, benefit significantly from the advantages of modern image processing algorithms.

· State-of-the-art image processing markedly reduces radiation exposure.. · The largest effect was found with Allura Clarity.. · Azurion showed no additional significant dose reduction.. · DSA benefited more than fluoroscopy.. · 3D rotational angiography showed no significant difference in dose..

· Lisson CG, Breitruck J, Görich K et al. Impact of Angiography System Generation on Radiation Exposure in Peripheral, Abdominal, and Cerebral Angiography: Comparison Across Three Consecutive Generations. Rofo 2026; DOI 10.1055/a-2944-0126.