Practical Radiation Dose Using Modern and Aged Angiographic Equipment

Abstract

Background: Replacement of angiographic capital equipment is costly, particularly in resource-limited settings where aging platforms remain in clinical use. Advances in detector technology, image processing, and automated dose control have substantially reduced radiation exposure in modern systems, yet real-world generational comparisons remain limited.

Methods: This retrospective single-center study evaluated 363 neurointerventional procedures performed between September 2023 and February 2024 at The Queen’s Medical Center. Cases were completed on either a 17-year-old Philips Allura Xper FD10/10 (n=189) or a 1-year-old Siemens Artis Icono (n=174). Procedures were categorized as diagnostic angiography, embolization, or stroke intervention. Radiation exposure was assessed using system-reported cumulative air kerma. Medians and interquartile ranges were compared using Wilcoxon rank-sum testing.

Results: Across all procedures, median cumulative air kerma was significantly higher on the older system (1267 [902–1827] mGy) compared with the newer platform (410 [251–677] mGy; p<0.001), representing an approximately three-fold reduction following modernization. Diagnostic angiography demonstrated the largest relative decrease (1085 vs 280 mGy), followed by embolization (1847 vs 639 mGy) and stroke intervention (1382 vs 371 mGy) (all p<0.001). Clinically relevant thresholds were exceeded more frequently on the older system: 17.5% of cases surpassed 2 Gy versus 0.6% on the newer platform, while no procedures on the modern system exceeded 3 Gy.

Conclusions: Contemporary angiographic technology was associated with three- to four-fold reductions in radiation exposure across neurointerventional procedures, underscoring the substantial safety benefits of equipment modernization.

Keywords: Radiation dose, biplane angiography, air kerma, equipment modernization, patient safety.

Abbreviations: ALARA, as low as reasonably achievable; Gy, gray; mGy, milligray; IQR, interquartile range.