Comparative effectiveness of digital variance and subtraction angiography in lower limb angiography: A Monte Carlo modelling approach

Abstract

Objective: By modelling patient exposures of interventional procedures, this study compares the reduction of radiation detriment between Digital Variance Angiography (DVA) and Digital Subtraction Angiography (DSA).

Methods: The paper presents a retrospective risk assessment using an in-house developed tool on 107 patient exposures from a clinical trial of DVA used to diagnose peripheral arterial disease (PAD). DICOM exposure parameters were used to initiate the PENELOPE (PENetration and Energy LOss of Positrons and Electrons) Monte Carlo simulation, radiation quality and quantity, and irradiation geometry. The effective dose and the lifetime attributable risk (LAR) for cancer incidence and mortality are calculated based on the International Commission on Radiation Protection's (ICRP) 103 recommendations and the Committee on the Biological Effects of Ionising Radiations' latest (BEIR VII) report, respectively.

Results: The study found that procedures conducted using DVA significantly reduce the radiation exposure of patients, compared to DSA. The collective effective dose for the DVA group was 58% lower than that for the DSA group. Correspondingly, the LAR of different organs showed a substantial decrease for cancer incidence (25-75%) and mortality (51-84%).

Conclusion: DVA demonstrates a considerable reduction in physical dosimetric quantities and consequently effective dose and cancer risk, suggesting its potential as a safer alternative to DSA in interventional radiology. The use of DVA supports the optimisation of patient radiation protection and aligns with the principles of ALARA (as low as reasonably achievable).

Keywords: Cancer risk; Digital Subtraction Angiography; Digital Variance Angiography; Monte Carlo simulation; Radiation dose.