Angio-CT does not increase patient radiation exposure compared to conventional cone-beam CT for intra-arterial liver
Charlotte Schneider1,2, Han Keijzers3,4, Erik Jan Rijkhorst3
1Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Objectives:
To evaluate patient radiation dose during intra-arterial liver procedures using Computed Tomography angiography (angio-CT) compared with C-arm Cone-Beam CT (CBCT).
Material And Methods:
This retrospective study included bland embolization and radioembolization mapping procedures performed between November 2021 and December 2024 using dual-phase angio-CT or single-phase CBCT on a hybrid angiography suite. Effective dose was calculated by converting dose-area and dose-length product using conversion factors. Fluoroscopy-only (2D), CBCT/angio-CT (3D) effective dose and total effective dose were compared using the Mann-Whitney U-test. Bootstrap resampling and permutation testing with Monte Carlo error propagation were applied to assess the robustness of 3D and total effective dose comparisons.
Results:
Ninety-two procedures were included: 48 in the CBCT group and 44 in the angio-CT group. The 2D effective dose was comparable. The 3D effective dose was 4.1-fold lower in the angio-CT group (median 9.85 [IQR: 5.37-22.6 mSv] vs 39.9 mSv [IQR: 21.2-69.6 mSv], p < 0.001), resulting in 1.6-fold reduction in total effective dose for procedures performed by angio-CT (median 34.6 [IQR: 23.7-54.3 mSv] vs 55.9 mSv [IQR: 37.6-103 mSv], p < 0.001). After dose conversion uncertainty correction, corrected p-values were < 0.001 for 3D effective dose and 0.053 for the total dose.
Conclusion:
Hybrid angiography suites incorporating angio-CT significantly reduced 3D effective dose compared to single-phase CBCT imaging. However, the total effective dose did not remain significant after uncertainty correction. Therefore, the use of angiography suites incorporating dual-phase angio-CT does not appear to change patient radiation exposure during intra-arterial liver procedures.
Key Points:
Question What is the effect of integrating angio-CT into hybrid angiography suites on patient radiation exposure? Findings Dual-phase angio-CT integration into intra-arterial liver therapy workflows does not increase overall procedural radiation exposure and is associated with a decreased 3D effective dose. Clinical relevance Angio-CT offers several clinical advantages, and existing literature demonstrates improved image quality compared with CBCT. This study shows that dual-phase angio-CT does not increase patient radiation exposure compared to single-phase CBCT, supporting its use when available.
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