title: Subjective and objective evaluation of image quality in biplane cerebral digital subtraction angiography following significant acquisition dose reduction in a clinical setting.
abstract: 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.
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Amir R
authors.identifier: http://orcid.org/0000-0002-7491-381X
authors.initials: AR
authors.lastname: Honarmand
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Department Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Department of Medical Imaging, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Shaibani
authors.affiliation: School of General Studies, Columbia University, New York, New York, USA.
authors.forename: Tamila
authors.identifier: http://orcid.org/0000-0001-5179-8380
authors.initials: T
authors.lastname: Pashaee
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Furqan H
authors.initials: FH
authors.lastname: Syed
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Department Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Hurley
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Department of Medical Imaging, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Sammet
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Department Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Potts
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Department Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Babak S
authors.initials: BS
authors.lastname: Jahromi
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Department Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Ansari
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods / Q000592:standards*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control / Q000592:standards*; D016037:Single-Blind Method; D014711:Vertebral Artery / Q000000981:diagnostic imaging*
keywords: Angiography