A Comparative Study of Patient Radiation Dose between Standard Angiogram and Road-Map Technique in Hemodialysis Patients During Fistuloplasty Using Digital Subtraction Angiography

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Abstract
Objective: To 1) compare the radiation dose received by patients undergoing hemodialysis vascular access angioplasty using Angiogram mode and Road-map mode, 2) evaluate patient radiation dose relative to the International Atomic Energy Agency (IAEA) trigger levels, and 3) identify technical factors influencing dose variation. Materials and Methods: This retrospective analytical study included 195 patients who underwent hemodialysis vascular access angioplasty at Songklanagarind Hospital between December 2019 and December 2021 (Road-map: 80 patients; Angiogram: 115 patients). Collected parameters included dose area product (DAP), reference point air kerma (Ka,r), kVp, mAs, fluoroscopy time, frame rate, and number of images. Data were analyzed using an independent t-test and a one-sample t-test. Results: Mean DAP and Ka,r in Road-map mode (0.92 Gy·cm² and 3.19 mGy) were significantly higher than Angiogram mode (0.55 Gy·cm² and 1.60 mGy) (p<0.001). Although Road-map mode utilized shorter fluoroscopy time, its fixed higher frame rate (15 fps vs. 2 fps) resulted in greater radiation exposure. Both techniques remained well below IAEA trigger levels. Conclusion: Angiogram mode offers an advantage in minimizing radiation dose, whereas Road-map mode may be preferred when rapid image guidance is required.

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