Evaluation of Neuroangiography Settings and Protective Shielding on Radiation Exposure to Patient and Interventionist: A Comparative Dosimetric Study

BACKGROUND: Neuroendovascular procedures expose surgeons and patients to significant radiation, increasing long-term health risks. Despite the known effects of imaging parameters on radiation exposure, the relative impacts of different imaging and shielding strategies have been less studied. We aimed to assess the effects of digital subtraction angiography parameter modifications on operator and patient radiation doses. METHODS: Using a phantom skull in a neuroendovascular suite, radiation was measured under varying digital subtraction angiography settings, including image intensifier distance, collimation, magnification, frame rate, and protective shielding. Operator exposure was recorded using a dosimeter, and patient dose was obtained from the angiography system. Each configuration was tested in 3 independent trials. One-way ANOVA was used to determine statistical significance. RESULTS: Lowering the frame rate (5.2-fold) and moving the image intensifier closer to the patient (3.5-fold) significantly reduced operator exposure ( P <0.0001). Double shielding reduced operator dose 10-fold ( P <0.0001). Patient dose was minimized by reducing magnification (9.3-fold; P <0.0001), lowering the frame rate (2.4-fold; P <0.0001), and decreasing image intensifier distance (1.7-fold; P <0.0001). Collimation decreased operator dose but slightly increased patient skin dose. Optimal parameter combinations maintained operator exposure well below recommended safety limits while minimizing patient dose. CONCLUSIONS: Low frame rates, close image intensifier positioning, minimal magnification, and double shielding substantially reduce radiation risk for both operators and patients. These evidence-based configurations provide a practical framework for safer neuroendovascular procedures.