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Original research
Subjective and objective evaluation of image quality in biplane cerebral digital subtraction angiography following significant acquisition dose reduction in a clinical setting
  1. Amir R Honarmand1,
  2. Ali Shaibani1,2,3,
  3. Tamila Pashaee4,
  4. Furqan H Syed1,
  5. Michael C Hurley1,2,
  6. Christina L Sammet1,3,
  7. Matthew B Potts1,2,
  8. Babak S Jahromi1,2,
  9. Sameer A Ansari1,2,5
  1. 1Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Department Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  3. 3Department of Medical Imaging, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
  4. 4School of General Studies, Columbia University, New York, New York, USA
  5. 5Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  1. Correspondence to Dr S A Ansari, Departments of Radiology, Neurology, and Neurological Surgery, Northwestern University, Feinberg School of Medicine, 676 N St Clair, Suite 800, Chicago, IL 60611-2927, USA; s-ansari{at}


Objective Different technical and procedural methods have been introduced to develop low radiation dose protocols in neurointerventional examinations. We investigated the feasibility of minimizing radiation exposure dose by simply decreasing the detector dose during cerebral DSA and evaluated the comparative level of image quality using both subjective and objective methods.

Methods In a prospective study of patients undergoing diagnostic cerebral DSA, randomly selected vertebral arteries (VA) and/or internal carotid arteries and their contralateral equivalent arteries were injected. Detector dose of 3.6 and 1.2 μGy/frame were selected to acquire standard dose (SD) and low dose (LD) images, respectively. Subjective image quality assessment was performed by two neurointerventionalists using a 5 point scale. For objective image quality evaluation, circle of Willis vessels were categorized into conducting, primary, secondary, and side branch vessels. Two blinded observers performed arterial diameter measurements in each category. Only image series obtained from VA injections opacifying the identical posterior intracranial circulation were utilized for objective assessment.

Results No significant difference between SD and LD images was observed in subjective and objective image quality assessment in 22 image series obtained from 10 patients. Mean reference air kerma and kerma area product were significantly reduced by 61.28% and 61.24% in the LD protocol, respectively.

Conclusions Our study highlights the necessity for reconsidering radiation dose protocols in neurointerventional procedures, especially at the level of baseline factory settings.

  • Angiography

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  • Contributors ARH: design of the study, patient enrollment, data acquisition, data analysis/interpretation, manuscript preparation, and revising the draft critically for important intellectual content. AS and MCH: substantial contributions, data acquisition, data analysis/interpretation, and manuscript revision. TP, FHS, CLS, MBP, and BSJ: substantial contributions, data acquisition, and data analysis/interpretation. SAA: conception and design, data acquisition, data analysis/interpretation, manuscript preparation, revising the draft critically for important intellectual content, and final approval of the version to be published.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Northwestern University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data for our study are available according to institutional review board approved methods of the Northwestern University.