Quantitative Digital Subtraction Angiography Measurement of Arterial Velocity at Low Radiation Dose Rates

Quantitative digital subtraction angiography (qDSA) has been proposed to quantify blood velocity for monitoring treatment progress during blood flow altering interventions. The method requires high frame rate imaging [~ 30 frame per second (fps)] to capture temporal dynamics. This work investigates performance of qDSA in low radiation dose acquisitions to facilitate clinical translation.

Velocity quantification accuracy was evaluated at five radiation dose rates in vitro and in vivo. Angiographic technique ranged from 30 fps digital subtraction angiography ( \(29.3 \pm 1.7\;{\text{mGy}}/{\text{s}}\) $29.3\pm 1.7\text{mGy}/\text{s}$ at the interventional reference point) down to a 30 fps protocol at 23% higher radiation dose per frame than fluoroscopy ( \(1.1 \pm 0.2\;{\text{mGy}}/{\text{s}}\) $1.1\pm 0.2\text{mGy}/\text{s}$ ). The in vitro setup consisted of a 3D-printed model of a swine hepatic arterial tree connected to a pulsatile displacement pump. Five different flow rates (3.5–8.8 mL/s) were investigated in vitro. Angiography-based fluid velocity measurements were compared across dose rates using ANOVA and Bland–Altman analysis. The experiment was then repeated in a swine study (n = 4).

Radiation dose rate reductions for the lowest dose protocol were 99% and 96% for the phantom and swine study, respectively. No significant difference was found between angiography-based velocity measurements at different dose rates in vitro or in vivo. Bland–Altman analysis found little bias for all lower-dose protocols (range: [− 0.1, 0.1] cm/s), with the widest limits of agreement ([− 3.3, 3.5] cm/s) occurring at the lowest dose protocol.

This study demonstrates the feasibility of quantitative blood velocity measurements from angiographic images acquired at reduced radiation dose rates.