Fundamental study of digital subtraction angiography using dose characteristic analysis of different protocols in lower limb arterial disease.

AbstractWe clarified the differences between the two pre-set protocols for iodine-digital subtraction angiography (ICM-DSA) and carbon dioxide (CO2)-DSA in terms of radiation exposure to patients and physicians when patients diagnosed with lower extremity artery disease (LEAD) undergo ICM-DSA or CO2-DSA, and identified factors that affect radiation exposure when patients undergo ICM-DSA or CO2-DSA. CO2-and ICM-DSA yielded 149 and 272 vessels in 21 and 49 patients, respectively. Multiple regression analyses revealed strong positive linear correlations between total air kerma (kinetic energy released per unit mass) at the patient entrance reference point (Ka,r), the total kerma area product (KAP), and the total number of acquisitions for ICM-DSA and CO2-DSA, respectively. Compared to Ka,r, there were significant differences in the tube potentials, KAP, and spectral shaping filters in both DSA procedures. The linear correlations between Ka,r and the number of ICM-DSA and CO2-DSA images varied among dose types, with strong linear correlations observed when Ka,r was classified into the above three groups. The X-ray conditions for each DSA image differed, with CO2-DSA using a significantly higher tube potential and different spectral shaping filters compared to ICM-DSA. When performing DSA for LEAD, an optimized protocol for each type of ontrast agent should be used.