title: Significant dose reduction for pediatric digital subtraction angiography without impairing image quality: preclinical study in a piglet model.
abstract: OBJECTIVE
  The purpose of this study was to validate the hypothesis that image quality of digital subtraction angiography (DSA) in pediatrics is not impaired when using a low-dose acquisition protocol.
  
  
  METHODS
  Three piglets corresponding to common pediatric population sizes were used. DSA was performed in the aorta and renal, hepatic, and superior mesenteric arteries using both the commonly used reference standard and novel radiographic imaging noise reduction technologies to ensure pairwise radiation dose and image quality comparison. The air kerma per frame at the interventional reference point for each DSA acquisition was collected as a radiation dose measure, and image quality was evaluated by five interventional radiologists in a randomized blinded fashion using a 5-point scale.
  
  
  RESULTS
  The mean air kerma (± SD) at the interventional reference point with the novel x-ray imaging noise reduction technology was significantly lower (1.1 ± 0.8 mGy/frame) than with the reference technology (4.2 ± 3.0 mGy/frame, p = 0.005). However, image quality was statistically similar, with average scores of 3.2 ± 0.4 and 3.1 ± 0.5 for the novel and reference technologies, respectively (p = 0.934); interrater absolute agreement was 0.77.
  
  
  CONCLUSIONS
  The DSA radiation dose for pediatrics can be reduced by a factor of four with a novel x-ray imaging noise reduction technology without deterioration of image quality.
authors.affiliation: 1 Department of Radiology, Division of Pediatric Interventional Radiology, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH 45229.
authors.forename: John
authors.initials: J
authors.lastname: Racadio
authors.forename: Keith
authors.initials: K
authors.lastname: Strauss
authors.forename: Todd
authors.initials: T
authors.lastname: Abruzzo
authors.forename: Manish
authors.initials: M
authors.lastname: Patel
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Kukreja
authors.forename: Neil
authors.initials: N
authors.lastname: Johnson
authors.forename: Mark
authors.initials: M
authors.lastname: den Hartog
authors.forename: Bart
authors.initials: B
authors.lastname: Hoornaert
authors.forename: Rami
authors.initials: R
authors.lastname: Nachabe
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods*; D000818:Animals; D006801:Humans; D023421:Models, Animal; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013552:Swine
keywords: digital subtraction angiography (DSA); dose reduction; image quality; pediatrics