Impact of a contrast-to-noise ratio driven and material specific exposure control on image quality and radiation exposure in angiography.

Conventional detector-dose driven exposure controls (DEC) do not consider the contrasting material of interest in angiography. Considering the latter when choosing the acquisition parameters should allow for optimization of x-ray quality and consecutively lead to a substantial reduction of radiation exposure. Therefore, the impact of a material-specific, contrast-to-noise ratio (CNR) driven exposure control (CEC) compared to DEC on radiation exposure was investigated. A 3D-printed phantom containing iron, tantalum, and platinum foils and cavities, filled with iodine, barium, and gas (carbon dioxide), was developed to measure the CNR. This phantom was placed within a stack of polymethylmethacrylate and aluminum plates simulating a patient equivalent thickness (PET) of 2.5-40 cm. Fluoroscopy and digital radiography (DR) were conducted applying either CEC or three, regular DEC protocols with parameter settings used in abdominal interventions. CEC protocols where chosen to achieve material-specific CNR values similar to those of DEC. Incident air kerma at the reference point(K), using either CEC or DEC, was assessed and possible K reduction for similar CNR was estimated. We show that CEC provided similar CNR as DEC at the same or lower K. When imaging barium, iron, and iodine K was substantially reduced below a PET of 20 cm and between 25 cm and 30 cm for fluoroscopy and Dr When imaging platinum and tantalum using fluoroscopy and DR and gas using DR, the K reduction was substantially higher. We estimate the K reduction for these materials between 15% and 84% for fluoroscopy and DR between 15% and 93% depending on the PET. The results of this study demonstrate a high potential for skin dose reduction in abdominal radiology when using a material-specific CEC compared to DEC. This effect is substantial in imaging materials with higher energy K-edges, which is beneficial, for example, in long-lasting embolization procedures with tantalum-based embolization material in young patients with arterio-venous malformations.