title: Evaluation of a noise reduction imaging technology in iliac digital subtraction angiography: noninferior clinical image quality with lower patient and scatter dose.
abstract: OBJECTIVE
  To determine whether equivalent-quality images can be obtained from digital subtraction angiography (DSA) of the iliac artery after implementation of a novel imaging technology that reduces patient and scatter x-ray dose.
  
  
  METHODS
  Imaging using two randomly ordered DSA runs was performed in 51 adults scheduled for iliac artery angiography or intervention or both. One DSA run used standard acquisition chain and image processing algorithms (referred to as " reference DSA"), and the other DSA run used dose-reduction and real-time advanced image noise reduction technology (referred to as "study DSA"). The quality of each pair of runs, consecutively performed without changes in working projection or injection parameters, was independently rated by five radiologists blinded to the imaging technology used. Patient radiation dose was evaluated using air kerma and dose area product, and scatter dose was evaluated using three dosimeters (DoseAware, Philips Healthcare, Best, The Netherlands), located at fixed positions.
  
  
  RESULTS
  Comparable image pairs were available in 48 patients. There were 44 patients undergoing treatment involving the common (n = 33) or external (n = 29) iliac arteries. Study DSA images were rated as equal to or better than reference DSA images for 96% of comparisons, with an average overall agreement among raters of 0.93 (95% confidence interval, 0.65-0.96). Mean patient radiation dose (n = 48) and scatter dose rate for the three dosimeters (n = 50) was 83% ± 5 and 69% ± 10 lower, respectively, using the study technology (P < .001).
  
  
  CONCLUSIONS
  Iliac artery DSA performed using a dose-reduction and real-time advanced image noise reduction technology results in image quality that is noninferior to conventional DSA but with significantly lower patient and scatter radiation exposure (P < .001).
authors.affiliation: Department of Interventional Radiology, St. Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands.. Electronic address: m.van.strijen@antoniusziekenhuis.nl.
authors.forename: Marco J
authors.initials: MJ
authors.lastname: van Strijen
authors.affiliation: Philips Healthcare, Best, The Netherlands.
authors.forename: Thijs
authors.initials: T
authors.lastname: Grünhagen
authors.affiliation: Philips Healthcare, Best, The Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: Mauti
authors.affiliation: Department of Radiology, Marienhospital, Stuttgart, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Zähringer
authors.affiliation: Sheffield Vascular Institute, Northern General Hospital, Sheffield.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Gaines
authors.affiliation: Department of Radiology, Hull Royal Infirmary, Hull.
authors.forename: Graham J
authors.initials: GJ
authors.lastname: Robinson
authors.affiliation: Department of Radiology, Broomfield Hospital, Chelmsford, United Kingdom.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Railton
authors.affiliation: Department of Radiology, Hagaziekenhuis, Den Haag, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: van Overhagen
authors.affiliation: Department of Medical Physics, St. Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Habraken
authors.affiliation: Department of Interventional Radiology, St. Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands.
authors.forename: Marc
authors.initials: M
authors.lastname: van Leersum
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging*; D008297:Male; D011829:Radiation Dosage; D012542:Scattering, Radiation