Describe the dose management methods/techniques used
Prior to dye injection, “fluoroscopy save,” option was used to acquire images, after which the output was reversed to get the DSA image. This method was applied to phrenic artery angiography (which requires many hand injection angiography procedures) and upper/lower extremity procedures (PTA, stent insertion, diagnosis since these images can be acquired even with low dose radiation). The results showed no issues with treatment or clinical outcome of patients, but high BMI patients were excluded for phrenic artery angiography due to low quality images.
Explain the results and conclusions reached
On average, the surface dose was managed from 4122.67μGy to 857μGy, the neighboring dose from 117μGy to 23.67μGy. Independent t-test was completed through SPSS (version 18; PASW statistics), with the analysis showing significant difference (p<0.001).
Discuss the case outcome(s), future implications, etc.
Compared to the DSA, DSFS allows image acquisition with reduced radiation dose, and a higher frame rate useful for capturing branching of the vessels. However, the image quality can vary, and thus the method is limited to certain locations in the body as well as the body type; thus the method is useful for parts of the body with thin layers of fat, or specific anatomy such as upper/lower extremities. Furthermore, SMART MASK can be used in conjunction with DSFS, but is currently not recommendable because the images display the vessels and device too dark. If this problem can be remedied, further reduction in radiation would be possible without compromise of patients’ health.