Prospective study to evaluate radiation dose and image quality in two-dimensional (2D) lower limb angiographic images acquired with a novel contrast-to-noise ratio (CNR)-driven exposure control protocol.
C J Q Yap, B J Kim, Z Resurreccion et al.
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In 30 seconds
This prospective randomised study compared a novel contrast-to-noise ratio-driven exposure protocol (OPTIQ) with a conventional dose protocol (CDP) in 40 lower limb angioplasty cases. OPTIQ was associated with lower patient radiation exposure: total dose-area product was 412.8 ± 318.2 vs 1,284.5 ± 841.2 μGym², and total air kerma was 19.9 ± 16.9 vs 55.0 ± 45.3 mGy. Subjective image-quality ratings did not differ significantly, and images from both protocols were considered diagnostically acceptable. Operator exposure was numerically lower with OPTIQ, but the difference was not statistically significant.
Key findings
- Total dose-area product was 412.8 ± 318.2 vs 1,284.5 ± 841.2 μGym² with OPTIQ and CDP, respectively (P<0.001).
- Total air kerma was 19.9 ± 16.9 vs 55.0 ± 45.3 mGy with OPTIQ and CDP, respectively (P<0.005).
- Subjective image-quality assessments showed no significant differences between protocols across measured parameters (P>0.05).
- Operator exposure was 0.138 ± 0.135 vs 0.362 ± 0.632 μSv/sec, a nonsignificant difference (P=0.288).
Why it matters
Lower limb angioplasty uses ionising radiation, with potential long-term risks to patients and operators. These findings suggest that a CNR-driven exposure protocol can substantially reduce patient dose while maintaining diagnostically acceptable subjective image quality. The operator-exposure result is less conclusive, so the study does not establish a significant occupational dose reduction.
What to keep in mind
The study included 40 cases, and image quality was assessed subjectively using Likert scales; operator exposure differences were not statistically significant.