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J. Imaging
Volume 12
Issue 7
10.3390/jimaging12070333
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Article

Decadal Changes in Institutional Diagnostic Reference Levels for X-Ray Angiography: A Retrospective Comparative Study

by
Ioannis Antonakos
1,*,
Emmanouil Annousis
2,
Tatiana Roko
1,
Antonia Alexiadou
1,
Maria Dmitropoulou
1,
Dimitris Filippiadis
2,
Stavros Spiliopoulos
2,
Konstantinos Palialexis
2,
Athanasios Giannakis
2,
Niki Parmenidou
2 and
Efstathios Efstathopoulos
2
1
Department of Applied Medical Physics, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
2
2nd Department of Radiology, National and Kapodistrian University of Athens, Chaidari Athens, 12461 Athens, Greece
*
Author to whom correspondence should be addressed.
J. Imaging 2026, 12(7), 333; https://doi.org/10.3390/jimaging12070333 (registering DOI)
Submission received: 17 June 2026 / Revised: 10 July 2026 / Accepted: 15 July 2026 / Published: 22 July 2026
(This article belongs to the Special Issue Diagnostic Imaging: From Basic Knowledge to Latest Advancements)
Versions Notes

Abstract

Angiography is a key imaging modality for the diagnosis and treatment of vascular diseases, and the growing sophistication of interventional procedures has heightened the need for radiation dose optimization. Diagnostic Reference Levels (DRLs) are widely used to monitor patient exposure and to support optimization in accordance with the ALARA principle. This study compared radiation dose metrics from a newly installed angiographic system at Attikon University Hospital with those obtained from the institution’s previous system and with values reported in the published literature. Radiation dose and procedural parameters were retrospectively collected for digital cerebral subtraction angiography (DSA), embolization, nephrostomy, vertebroplasty, transjugular intrahepatic portosystemic shunt (TIPS), chemoembolization, and injection procedures. Dose area product (DAP), fluoroscopy-related DAP, patient entrance dose indicators, and fluoroscopy time were analyzed. Median DAP values ranged from 5.72 to 349.60 Gy·cm2 depending on the procedure. Compared with data acquired approximately a decade earlier, DAP values increased by an average of 96.4%, whereas fluoroscopy times remained largely unchanged. Despite this increase, dose levels were generally lower than those reported in the international literature. Median DAP values ranged from 5.72 to 349.60 Gy·cm2 depending on the procedure. Compared with data acquired approximately a decade earlier, DAP values increased by an average of 96.4%, whereas fluoroscopy times remained largely unchanged. Although these differences may reflect the combined influence of technological developments, evolving procedural complexity, operator-related factors, and changes in clinical practice over time, these variables were not directly assessed in the present retrospective study. Nevertheless, the updated institutional Diagnostic Reference Levels provide a valuable benchmark for radiation dose optimization, quality assurance, and future multicenter studies aimed at supporting national DRL establishment.
Keywords: angiography procedures; Diagnostic Reference Levels; interventional radiology; radiation protection; fluoroscopy; dose area product angiography procedures; Diagnostic Reference Levels; interventional radiology; radiation protection; fluoroscopy; dose area product

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MDPI and ACS Style

Antonakos, I.; Annousis, E.; Roko, T.; Alexiadou, A.; Dmitropoulou, M.; Filippiadis, D.; Spiliopoulos, S.; Palialexis, K.; Giannakis, A.; Parmenidou, N.; et al. Decadal Changes in Institutional Diagnostic Reference Levels for X-Ray Angiography: A Retrospective Comparative Study. J. Imaging 2026, 12, 333. https://doi.org/10.3390/jimaging12070333

AMA Style

Antonakos I, Annousis E, Roko T, Alexiadou A, Dmitropoulou M, Filippiadis D, Spiliopoulos S, Palialexis K, Giannakis A, Parmenidou N, et al. Decadal Changes in Institutional Diagnostic Reference Levels for X-Ray Angiography: A Retrospective Comparative Study. Journal of Imaging. 2026; 12(7):333. https://doi.org/10.3390/jimaging12070333

Chicago/Turabian Style

Antonakos, Ioannis, Emmanouil Annousis, Tatiana Roko, Antonia Alexiadou, Maria Dmitropoulou, Dimitris Filippiadis, Stavros Spiliopoulos, Konstantinos Palialexis, Athanasios Giannakis, Niki Parmenidou, and et al. 2026. "Decadal Changes in Institutional Diagnostic Reference Levels for X-Ray Angiography: A Retrospective Comparative Study" Journal of Imaging 12, no. 7: 333. https://doi.org/10.3390/jimaging12070333

APA Style

Antonakos, I., Annousis, E., Roko, T., Alexiadou, A., Dmitropoulou, M., Filippiadis, D., Spiliopoulos, S., Palialexis, K., Giannakis, A., Parmenidou, N., & Efstathopoulos, E. (2026). Decadal Changes in Institutional Diagnostic Reference Levels for X-Ray Angiography: A Retrospective Comparative Study. Journal of Imaging, 12(7), 333. https://doi.org/10.3390/jimaging12070333

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