Significant Dose Reduction for Pediatric Digital Subtraction Angiography Without Impairing Image Quality: Preclinical Study in a Piglet Model

OBJECTIVE. The purpose of this study was to validate the hypothesis that image quality of digital subtraction angiography (DSA) in pediatrics is not impaired when using a low-dose acquisition protocol. MATERIALS AND METHODS. Three piglets corresponding to common pediatric population sizes were used. DSA was performed in the aorta and renal, hepatic, and superior mesenteric arteries using both the commonly used reference standard and novel radiographic imaging noise reduction technologies to ensure pairwise radiation dose and image quality comparison. The air kerma per frame at the interventional reference point for each DSA acquisition was collected as a radiation dose measure, and image quality was evaluated by five interventional radiologists in a randomized blinded fashion using a 5-point scale. RESULTS. The mean air kerma (+/- SD) at the interventional reference point with the novel x-ray imaging noise reduction technology was significantly lower (1.1 +/- 0.8 mGy/frame) than with the reference technology (4.2 +/- 3.0 mGy/frame, p = 0.005). However, image quality was statistically similar, with average scores of 3.2 +/- 0.4 and 3.1 +/- 0.5 for the novel and reference technologies, respectively (p = 0.934); interrater absolute agreement was 0.77. CONCLUSION. The DSA radiation dose for pediatrics can be reduced by a factor of four with a novel x-ray imaging noise reduction technology without deterioration of image quality.