title: Therapeutic angiographic procedures: differences in dose area product between analog image intensifier and digital flat panel detector.
abstract: BACKGROUND
  Radiation exposure remains an unceasing concern in angiographic procedures. Modern angiography machines such as analog image intensifiers (AII) or the new flat panel detectors (FPD) aim at a further dose reduction.
  
  
  OBJECTIVE
  To present dose area products (DAP) in a broad spectrum of therapeutic angiographic procedures, comparing an AII to an FPD angiography system.
  
  
  METHODS
  A total of 999 peripheral therapeutic angiography procedures performed with an FPD (n = 562) and an AII system (n = 437) were evaluated. DAP, fluoroscopy time, and patients' body mass index (BMI) were recorded. Interventions were classified into five main groups: percutaneous transluminal angioplasty (PTA); PTA and stent placement; intra-arterial thrombolysis; embolization procedures; and specialized interventions.
  
  
  RESULTS
  DAP values in therapeutic angiographic procedures were significantly higher when performed with the FPD compared to the AII system. The increase of the FPD versus AII system was 100.1% for PTA, 39.9% for PTA and stent placement, 187% for intra-arterial thrombolysis, 31.3% for embolization procedures, and 361% for specialized interventions. These differences persisted after standardizing DAP values to the geometric mean fluoroscopy duration of each procedure. Fluoroscopy times were shorter in all interventions performed at the FPD as compared to the AII system. DAPs increased with higher BMI, but the DAP increase of both systems with elevated BMI was variable, depending on the individual intervention.
  
  
  CONCLUSIONS
  In therapeutic angiographic procedures, the FPD system required higher DAPs despite shorter fluoroscopy times as compared to an AII system. Better ergonomics and speediness of the FPD system may be advantageous in the emergency setting.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Universitätsklinik Heidelberg, Heidelberg, Germany daniel_spira@yahoo.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Spira
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kirchner
authors.affiliation: Institute of Clinical Epidemiology and Applied Biometry, Eberhard-Karls-University, Tübingen, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Blumenstock
authors.affiliation: Institute for Radiation Protection and Radionuclide Laboratory, Eberhard-Karls-University, Tübingen, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Herz
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Ketelsen
authors.affiliation: Department of Radiology and Nuclear Medicine, Franziskus Hospital, Bielefeld, Germany.
authors.forename: Jakub
authors.initials: J
authors.lastname: Wiskirchen
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wiesinger
mesh_terms: D000792:Angiography / Q000295:instrumentation*; D017130:Angioplasty; D015992:Body Mass Index; D004621:Embolization, Therapeutic; D005471:Fluoroscopy; D006801:Humans; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D011829:Radiation Dosage; D011835:Radiation Protection / Q000295:instrumentation; D011856:Radiographic Image Enhancement / Q000295:instrumentation*; D012189:Retrospective Studies; D015607:Stents; D015912:Thrombolytic Therapy; D014963:X-Ray Intensifying Screens
keywords: Therapeutic angiography; intervention; radiation exposure; technical aspects