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

Anantaya Senkhaw, BSc¹ ORCID , Withoon Upamai, BSc¹ ORCID , Chanapa Fungchukiat, BSc¹ ORCID , Jongwat Cheewakul, MSc² ORCID , Keerati Hongsakul, MD² ORCID

Affiliation : ¹ Prince of Songkla University Minimally Invasive Surgical-Interventional Radiology Center, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; ² Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

Abstract / Graphical 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.

Received 7 January 2026 | Revised 1 May 2026 | Accepted 20 May 2026
J Med Assoc Thai 2026;109(9):725-9
DOI: 10.35755/jmedassocthai.2026.9.04130

Keywords : Hemodialysis access intervention; Digital subtraction angiography (DSA); Angiogram mode; Road-map mode; Dose area product (DAP); Reference point air kerma (Ka,r)


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