title: Digital subtraction angiography during transjugular intrahepatic portosystemic shunt creation or revision: data on radiation exposure and image quality obtained using a standard and a low-dose acquisition protocol in a flat-panel detector-based system.
abstract: OBJECTIVE
  To determine whether the use of a low-dose acquisition protocol (LDP) in digital subtraction angiography during transjugular intrahepatic portosystemic shunt (TIPS) creation/revision results in significant reduction of patient radiation exposure and adequate image quality, as compared to a default reference standard-dose acquisition protocol (SDP).
  
  
  METHODS
  Two angiographic runs were performed during TIPS creation/revision: the first following catheterization of the portal venous system and the second after stent deployment/angioplasty. Constant field of view, object to image-detector distance, and source to image-receptor distance were maintained in each patient during the two angiographic runs. 17 consecutive adult patients who underwent TIPS creation (n = 11) or TIPS revision (n = 6) from December 2013 to March 2014 were considered eligible for this single centre prospective study. In each patient, the LDP and the SDP were used in a random order for the two runs, with each patient serving as his/her own control. The dose-area product (DAP) was calculated for each image and compared. Image quality was graded by two interventional radiologists other than the operator.
  
  
  RESULTS
  In all runs acquired with the LDP, image quality was considered adequate for a successful procedural outcome. The DAP per image of the LDP was numerically inferior as compared to the DAP per image of the SDP in all patients. The mean reduction in DAP per image was 75.24% ± 5.7% (p < 0. 001).
  
  
  CONCLUSIONS
  Radiation exposure during TIPS creation/revision was significantly reduced by selecting a LDP in our flat-panel detector-based system, while maintaining adequate image quality.
authors.affiliation: Diagnostic and Therapeutic Services Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy, rmiraglia@ismett.edu.
authors.forename: Roberto
authors.initials: R
authors.lastname: Miraglia
authors.forename: Luigi
authors.initials: L
authors.lastname: Maruzzelli
authors.forename: Kelvin
authors.initials: K
authors.lastname: Cortis
authors.forename: Corrado
authors.initials: C
authors.lastname: Tafaro
authors.forename: Roberta
authors.initials: R
authors.lastname: Gerasia
authors.forename: Carmelo
authors.initials: C
authors.lastname: Parisi
authors.forename: Angelo
authors.initials: A
authors.lastname: Luca
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D002985:Clinical Protocols; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D019047:Phantoms, Imaging; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011446:Prospective Studies; D011829:Radiation Dosage; D015642:Radiology, Interventional; D012086:Reoperation