Fluoroscopic radiation exposure during spinal cord stimulation procedures: A systematic review and meta-analysis.

What proportion of patients undergoing fluoroscopy‑guided procedures and CT are alive or dead: 12-year study.

Impact of ultrasound-guided popliteal sciatic nerve block on endovascular therapy for below-the-knee lesions in chronic limb-threatening ischemia.

Flat-detector computed tomography (FDCT) is increasingly used for periinterventional cerebral imaging. The recently introduced Sine Spin FDCT (S-FDCT) aims to improve cerebral soft tissue contrast compared with conventional FDCT (C-FDCT). Reliable visualization of healthy brain parenchyma is essential for detecting pathological changes. This study compared gray-white matter differentiation between intraindividually acquired S-FDCT and C-FDCT. A retrospective analysis of a prospectively maintained database included patients with ischemic stroke treated by mechanical thrombectomy who underwent both S-FDCT and C-FDCT within the same interventional session on a latest-generation angiography system. Quantitative image quality was assessed using the contrast-to-noise ratio (CNR). Qualitative image quality was evaluated using a five-point scale at basal ganglia and supratentorial cortex. Analyses focused on healthy brain parenchyma contralateral to infarction. Radiation dose was assessed using entrance-skin dose and dose-area product (DAP). Forty patients (74.2 ± 15.3 years) were analyzed. S-FDCT demonstrated a higher CNR than C-FDCT (mean CNR ± SD: 2.62 ± 1.36 versus 1.03 ± 0.38; p < 0.001). Qualitative ratings were higher for S-FDCT at the basal ganglia (2.45 ± 0.71 versus 1.54 ± 0.53; p < 0.001) and supratentorial cortex (3.01 ± 0.80 versus 1.71 ± 0.60; p < 0.001). Inter-reader agreement was good (κ = 0.798). S-FDCT showed a moderately higher radiation dose than C-FDCT (DAP: 50.6 ± 3.10 versus 46.89 ± 2.86Gy·cm², p < 0.001). S-FDCT improves cerebral soft tissue visualization compared with C-FDCT in periinterventional imaging. These findings highlight the potential of Sine Spin technology to enhance FDCT image quality and support its role in advanced angiography-suite-based neuroimaging.

To compare radiation exposure between transradial (TRA) and transfemoral (TFA) access and identify treatment-related factors associated with radiation exposure in endovascular treatment of intracranial aneurysms. This retrospective single-center study analyzed consecutively treated patients receiving endovascular aneurysm treatment (EAT) from May 2023 to April 2025 at the University Medical Center Hamburg-Eppendorf. EAT was performed by nine experienced board-certified neuroradiologists. The primary outcome was the radiation exposure defined as dose area product (DAP) (Gy·cm2). In addition to access route (TRA vs. TFA), patient-related (e.g. age, gender, aneurysm location) and procedure-related (e.g., interventionalist, incidental vs. symptomatic, used device) characteristics were analyzed with regard to radiation exposure using uni- and multivariable linear regression analysis. A total of 209 patients (156 female, 53 male; median age 59 [51-68]) were analyzed. Median DAP was 72.2 (51.6-96.7). Multivariable linear regression analyses revealed that radiation exposure did not differ significantly between TRA and TFA (β = 8.13 [-3.79 to 20.01]; p = 0.18). Stent-assisted coiling (β = 55.82 [34.91-76.74]; p < .001) and female gender (β = -14.95 [-27.5 to -22.41]; p = 0.02) were associated with increased DAP. Further patient- and procedure-related variables were not significantly associated with radiation exposure. In this study, the choice between TRA and TFA had no significant impact on radiation exposure during endovascular aneurysm treatment. Stent-assisted coiling was independently associated with increased radiation exposure during endovascular treatment of intracranial aneurysms. Question Understanding and minimizing radiation exposure in endovascular aneurysm treatment is essential, as the increasing use of transradial access necessitates comparison with the established transfemoral route. Findings Radiation exposure did not differ between transradial and transfemoral access, while higher doses were independently associated with stent-assisted coiling procedures of increased complexity. Clinical relevance Our findings support the safety of transradial access regarding radiation exposure, allowing operators to select the most suitable access route based on patient anatomy and preference without increasing radiation risk.

This study aimed to establish the first national diagnostic reference levels (DRLs) for coronary angiography (CAG) and interventional cardiology procedures in Korea, based on a nationwide patient-dose survey conducted in 2024. Radiation dose data were collected from 20 cardiovascular centers between April and December 2024 using a dedicated server system for radiation dose-structured reports, namely, Digital Imaging and Communications in Medicine. We classified 1980 procedures into the following seven procedural groups: CAG, CAG with percutaneous coronary intervention (CAG + PCI), CAG with percutaneous transluminal coronary angioplasty (CAG + PTCA), coronary spasm provocation, acute myocardial infarction (AMI), chronic total occlusion (CTO), and PCI alone. The DRLs were defined as the 75th percentile of the cumulative kerma–area product (KAP) and fluoroscopy time (FT). The established DRLs for KAP (Gy·cm2) were: CAG, 18.68; CAG + PCI, 63.40; AMI, 58.52; and CTO, 106.83. The corresponding DRLs for FT (s) were: CAG, 440.00; CAG + PCI, 1201.50; AMI, 947.64; and CTO, 2819.00. This study established the first official national DRLs for CAG and interventional cardiology procedures in Korea, using real-world clinical data. These reference levels provide a practical framework for institutions to benchmark radiation exposure, evaluate practice patterns, and optimize patient radiation safety.

Continuous Radiation Dose Optimisation through Analysis of Imaging System Procedure Logs during Fenestrated Branched Endovascular Aortic Repair after Transition to Different Hybrid Imaging Systems.

Fluoroscopically guided jejunal tube placement via percutaneous endoscopic gastrostomy (PEG-J) provides minimally invasive post-pyloric access in children. Limited data exist regarding routine application and procedural risks. To evaluate the safety and technical success of PEG-J in pediatric patients, performed without general anesthesia or sedation. All pediatric cases of fluoroscopically guided PEG-J procedures performed between 2011 and 2025 were included. Fluoroscopic images were reviewed to determine the final position of the tube tip. Technical success, complications, anatomical variants, and tube patency were assessed. Fluoroscopy time and dose area product (DAP) were documented. A total of 126 PEG-J procedures in 60 children (36 males) were analyzed. The technical success rate was 85% (107/126) with final tube tip placement in the jejunum in 88 cases (82%) and in the duodenum in 19 cases (18%). Nineteen procedures (15%) were unsuccessful, including six with documented anatomical causes (steep vertical duodenal entry, n=2; malrotation, hiatus hernia, hooked stomach in superior mesenteric artery syndrome, steep take-off of the jejunum with kinking of the tube at the ligament of Treitz, n=1 each) and 13 without documented reasons. The median fluoroscopy time was 5min 24s (range, 2s-37min), at a frame rate of 0.5 frames per second. The median DAP was 6.1cGy·cm2 (range, 0.08-343cGy·cm2). Fluoroscopically guided PEG-J placement is a safe and effective procedure in pediatric patients, with high technical success and low radiation exposure.

Cerebral angiography remains the gold standard for the diagnosis and endovascular management of cerebral aneurysms. Three-dimensional rotational angiography (3D-RA) provides superior anatomic resolution compared with conventional 2D imaging; however, it is associated with relatively high radiation exposure, raising specific concerns regarding the ocular lens dose. This study aims to evaluate the potential of copper (Cu) filtration for reducing radiation dose in 3D-RA. Forty subsequent patients undergoing endovascular treatment of unruptured cerebral aneurysms were included. All received 3D-RA using the ARTIS icono angiography system (Siemens Healthineers). In 20 patients, standard hardware with a 0.8mm aluminum (Al) filter was applied; in the subsequent 20 patients, the Al filter was replaced by a 0.1mm Cu filter. Image quality was assessed quantitatively through contrast-to-noise ratio (CNR) and qualitatively using a 5-point scale. There were no differences in image quality between the two groups in the 3D neurovascular native/contrast images, both quantitatively (eg, mean CNR ± SD, Al: 20.72 ± 1.82 vs Cu: 20.66 ± 1.54; P = 0.93) and qualitatively (mean score ± SD, Al: 4.55 ± 0.54 vs Cu: 4.63 ± 0.46; P = 0.75), with excellent image quality achieved in both groups. Total radiation dose was lower with the Cu filter (e.g., mGy ± SD, Al: 110.63 ± 10.75 vs Cu: 68.70 ± 6.03; Gy·cm 2 ± SD, Al: 6.26 ± 1.57 vs 3.35 ± 0.67, P < 0.001 respectively), corresponding to a dose reduction of 38% (entrance-skin dose) and 46% (dose-area product). The use of a copper filter in cerebral 3D-RA substantially reduces radiation dose without compromising diagnostic quality, representing a practical advancement in patient safety in 3D-RA. The method integrates seamlessly into existing protocols and can be readily implemented in clinical practice.

In comparison to conventional medical computed tomography (CT), cone-beam CT (CBCT) has become widely used in dental and maxillofacial applications due to its accurate 3D information, high resolution, minimal radiation dose, and affordable machine cost. In this study, we investigated the image quality and radiation doses of dental CBCT and X-ray machines developed in Thailand. Our in-house reconstruction algorithm including artifact reduction was based on GPU calculations of filtered backprojection and was significantly faster than a CPU-based algorithm. The image quality aspects for CBCT were evaluated in terms of high contrast resolution, gray value uniformity, noise, and geometric accuracy, while image quality assessment for 2D images included high contrast resolution, low contrast levels, and distortion rate. Radiation doses were measured and calculated for the dose-area product (DAP). The technical image quality and radiation dose assessment was compared with those of other commercial extraoral imaging machines. The findings demonstrate that, when compared to other units, the proposed 2D and 3D extraoral imaging systems yielded comparable technical image quality and radiation doses. Based on these results, the Thai-made 2D and 3D extraoral imaging machines appear suitable for further clinical evaluation.

Intraoperative imaging using mobile C‑arms is well established in spine surgery. Traditionally, the C‑arm operation is performed by "non-sterile" OR staff. The full motorization of mobile C‑arms enables direct control from the sterile field and automated movement paths, potentially improving efficiency and imaging quality. This prospective single-center study compared the use of amotorized mobile C‑arm (mC-arm) with anon-motorized standard C‑arm (sC-arm) in terms of intraoperative time, motion, and radiation parameters during spinal procedures. Atotal of 41minimally invasive spine surgeries with either ventral or dorsal spondylodesis were included. C‑arm movements were recorded using the system's log files (mC-arm) or IMU sensors (sC-arm). Additionally, radiation exposure and time-related parameters were collected. In dorsal spondylodesis, there was atrend towards areduction in the number of 2D images (-17.8%; p = 0.284) with improved collimation (+38.6%; p = 0.077) and areduction in the dose area product (DAP) (-27.0% p = 0.483) when using the mC-arm, but without significance. In ventral spondylodesis, the use of the mC-arm showed asignificant reduction in DAP (-53.0%; p = 0.040), asignificant increase in the collimation rate (86.1% vs. 34.7%; p < 0.001), and atendency towards shorter operating times (-22.0%; p = 0.197). The motorization of amobile C‑arm combined with control from the sterile field can optimize intraoperative imaging and reduce radiation exposure. These findings suggest asubstantial potential for workflow improvement that should be further evaluated in future studies.

Despite limited evidence supporting its benefit, postoperative retrograde radiological imaging following radical cystectomy (RC) for bladder cancer is frequently performed prior to ureteral stent removal. The objective of this study was to evaluate the clinical value of routinely performed retrograde conduitography (rCG) after RC with ileal conduit (IC) diversion and to identify potential procedure-related adverse effects. We retrospectively analyzed 244 patients who underwent RC with IC at the University Hospital of Würzburg between 2012 and 2023. Of these, 116 patients were assigned to the rCG group and 128 to the non-rCG group. Clinical demographics, rCG-related parameters such as radiation dose (dose-area product, DAP), and procedure-related complications were assessed. In addition, data on ureteral stent (MJ) removal without rCG, including associated complications, were collected. Extravasation at the uretero-intestinal anastomosis was detected by rCG in 6 of 116 patients, all of whom were managed conservatively. The mean radiation dose was 75.52 µGy·m² (range: 7-797.4 µGy·m²). Twelve rCG-related complications occurred, all urinary tract infections. In the non-rCG cohort, 15 patients experienced complications following MJ removal. There was no significant difference in complication rates between the two groups (15 vs. 12; p = 0.45). Routine postoperative rCG after RC with IC demonstrated no clinical benefit. The procedure does not prevent complications and carries potential harms, including radiation exposure and infection risk. rCG should therefore not be performed as a standard routine but rather reserved for selected, risk-adapted cases.

To identify patient- and procedure-related factors associated with radiation exposure during middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH), with particular focus on embolic agent (particle vs. liquid) and arterial access route (transradial vs. transfemoral). In this retrospective single-center cohort study, we included all patients who underwent MMA embolization for cSDH between February 2021 and October 2025. MMA embolization was performed by fourteen experienced board-certified neuroradiologists. The primary outcome was dose area product (DAP, Gy · cm2). Univariable and multivariable linear regression analyses were performed to assess associations between DAP and age, sex, access route, treated side (unilateral vs bilateral), embolic agent, anesthesia, interventionalist, and guiding catheter. Atotal of 112 patients (median age 81years; 20% female) were included; 69(62%) underwent embolization with particles and 43(38%) with liquid agents. Transradial access was used in 17(15%) and transfemoral access in 95(85%) procedures. Overall median (IQR) DAP was 74.7 Gy · cm2 (55.6-102.4), with 65.5 Gy · cm2 (50.6-82.0) for unilateral and 107.6 Gy · cm2 (84.1-161.6) for bilateral embolization. Univariable analyses showed no significant association between DAP and age, sex, embolic agent, access route, anesthesia, guiding catheter, or interventionalist. In multivariable analysis, unilateral right and left MMA embolization remained independently associated with significantly lower DAP compared with bilateral procedures, while embolic agent and access route were not significantly associated with radiation exposure. In MMA embolization for cSDH, radiation exposure is primarily driven by procedural extent, with higher DAP in bilateral than in unilateral embolization, whereas the choice of embolic material and arterial access route is not associated with radiation dose. These findings support selecting embolic agents and access routes based on anatomical and clinical considerations rather than radiation concerns.

Background: Quality of life (QoL) after transradial access in diagnostic cerebral angiography may be shaped by procedural demands as well as by the ambulatory setting itself. This study, for the first time, prospectively explored this dimension through follow-up assessments of QoL after the procedure. Methods: In this prospective study, QoL was assessed using the 36-Item Short Form Survey (SF-36), including the Physical and Mental Component Summary (PCS and MCS) as well as eight domain-specific subscales. After right transradial cerebral angiography, the SF-36 questionnaire was administered at baseline (pre-procedure), as well as at 1-month and 3-month follow-up visits. Mean PCS and MCS values were analyzed over time using linear mixed-effects regression models. In post hoc analyses, univariate and multivariable models were used to assess the influence of potential confounders. For subgroup analysis, patients were classified as transient deteriorators if PCS and/or MCS worsened by more than 0.5 SD at 1 month compared with baseline but not at 3 months. Permanent deteriorators were defined as worsening by more than 0.5 SD at both 1 month and 3 months compared with baseline. Results: A total of 35 patients (62.9% female) were recruited over the 12-month study period, with a mean age of 59.1 ± 10.1 years. No significant overall time effect was observed for mean PCS and MCS (p = 0.970 and p = 0.076). MCS showed a significant increase at 1 month compared with baseline (p = 0.046), with a trend toward significance at 3 months (p = 0.053). In post hoc analyses, sex, neurosurgical status, and dose area product were associated with MCS in univariate analyses (p < 0.05), but these associations did not persist after multivariable adjustment. For PCS, only age showed a significant association in univariate analysis (p < 0.05). In subgroup analyses, transient deterioration was more frequent in PCS than in MCS (11.4% [95% CI 3.2–26.7%] vs. 5.7% [95% CI 0.7–19.2%]), and permanent deterioration was also more common in PCS at 1- and 3-month follow-up (14.3% [95% CI 4.8–30.3%] vs. 8.6% [95% CI 1.8–23.1%]). Impairment predominantly involved the bodily pain subscale (88.9% [95% CI 51.8–99.7%]) within PCS and the vitality (80.0% [95% CI 28.4–99.5%]) and mental health sub-scales (80.0% [95% CI 28.4–99.5%]) within MCS. Conclusions: This short-term follow-up assessment demonstrated preserved QoL following transradial diagnostic cerebral angiography. Transient or permanent deterioration occurred in no more than five patients per subgroup (14%). These findings support the notion that a radial-first approach can be safely considered for diagnostic cerebral angiography without compromising patient-reported outcomes.

Introduction: Current diagnostic reference levels (DRLs) for endovascular aortic repair (EVAR), based on iodinated contrast media (ICM) protocols, range from 100 to 200 Gy·cm 2 . As CO 2 is a negative contrast agent requiring digital subtraction angiography (DSA) for visualization, it may be associated with increased radiation exposure. This multicenter study presents the largest prospective data set to date evaluating radiation dose during EVAR using CO 2 angiography alone with an automated injector. Methods: A prospective, multicenter, nationwide, nonrandomized, investigator-initiated observational study of dosimetry recorded during EVAR procedures with CO 2 as exclusive contrast medium was conducted. Primary endpoints included dose-area product (DAP) and reference air kerma ( K ar ) measurements across all participating centers. Secondary objectives focused on evaluating optimization strategies to reduce radiation exposure for both patients and operators at a single investigational site. Results: A total of 293 patients were enrolled across 10 centers, between January 2023 and January 2024, median DAP and K ar were 189 Gy·cm 2 (interquartile range [IQR] 107-285) and 626.5 mGy (IQR 145.5-1373.5), respectively, with significant inter-center variability (all p&lt;0.001). Newer angiographic systems demonstrated markedly lower DAP (median: 90 Gy·cm 2 , IQR 71-153) vs older systems (191 Gy·cm 2 , IQR 111-409; p&lt;0.001). Through sequential optimization, we achieved progressive dose reductions: 38.5% via low-dose protocols, 52.3% with modern equipment, culminating in a 56% overall reduction (p&lt;0.001) with synchronized CO 2 -DSA—yielding a final median DAP of 28.5 Gy·cm 2 . Conclusions: CO 2 -guided EVAR exhibits substantial radiation dose variability, driven by angiographic system generation, software, and synchronization protocols. Modern systems with optimized low-dose protocols and CO 2 -DSA synchronization reduce radiation exposure to levels comparable to ICM-based EVAR. Clinical Impact This large multicenter prospective study establishes a reliable radiation dose benchmarks for CO2-guided endovascular aortic repair (EVAR), showing that modern angiographic systems with optimized low-dose protocols and synchronized CO 2 -digital subtraction angiography achieve median dose-area product values comparable with conventional iodinated contrast media EVAR, thereby dispelling concerns about excessive radiation exposure with CO 2 -guided EVAR.

BACKGROUND: Percutaneous coronary intervention (PCI) is a cornerstone treatment for coronary artery disease. As procedural volumes continue to rise, the associated radiation risk from angiography systems has drawn increasing concern. Thus, we developed a novel ultra-low-dose Noise-Free technology to optimize angiography systems. This study aims to investigate whether it effectively reduces radiation exposure in real-world coronary interventions. METHODS: A comparative study on a single-center, real-world, observational cohort. The primary end point was an intergroup comparison of procedural radiation exposure, including dose area product, air kerma, and dose rate, stratified by exposure mode (fluoroscopy or cine) and procedure type (diagnostic coronary angiography, single-vessel PCI, or chronic total occlusion PCI). The secondary end point included an expert semi-quantitative assessment and a quantitative contrast-to-noise ratio for image quality. RESULTS: A total of 380 procedures (102 coronary angiography, 78 single-vessel PCI, and 200 chronic total occlusion PCI) were performed in 380 patients using 4 different angiography systems. There was no significant difference in baseline patient characteristics, procedural time, or operator experience. In coronary angiography procedures, the ultra-low-dose technique demonstrated a total air kerma of 60.3 (38.5–74.1) mGy, total dose area product of 4.0 (2.9–5.2) Gy·cm 2 , fluoroscopy dose rate of 7.9 (6.0–9.6) mGy/min, and cine dose rate of 51.7 (37.4–64.9) mGy/min, corresponding to 40% to 70%, 37% to 66%, 16% to 62%, and 25% to 79% reductions than others, respectively. Similar radiation reductions were observed for single-vessel PCI. For chronic total occlusion PCI, the corresponding percentages of radiation reduction in total air kerma, total dose area product, fluoroscopy dose rate, and cine dose rate were 59% to 73%, 54% to 69%, 22% to 64%, and 60% to 79%, respectively, relative to the other 3 systems. The semi-quantitative assessment and contrast-to-noise ratio analysis showed comparable image quality between the 4 systems. CONCLUSIONS: The Noise-Free technique reduced radiation exposure across cumulative and rate metrics while preserving diagnostic image quality, with the greatest reduction observed in complex cases. These findings support its clinical utility for lowering radiation risk.

Background/Objectives: Cardiovascular interventions require prolonged fluoroscopy, which increases the risk of radiation. Diagnostic Reference Levels (DRLs), set at the 75th percentile of the dose distribution, are vital benchmarks for dose optimization. Following the release of national DRLs by the Korea Disease Control and Prevention Agency in March 2025, this study established institutional DRLs at a tertiary center to evaluate local optimization against national and international standards. Methods: This study analyzed radiation doses from 2022 to 2024 using DICOM Radiation Dose Structured Reports data from a single center's angiography system. The total kerma-area product values and fluoroscopy times were evaluated across the categorized procedures. Following the International Commission on Radiological Protection guidelines, institutional DRLs were established at the 75th percentile of the dose distribution to benchmark against national and international DRLs. Results: Analysis of 1663 radiation dose structured reports established institutional DRLs, with the total kerma-area product ranging from 23.43 Gy·cm2 for coronary angiography to 329.45 Gy·cm2 for chronic total occlusion interventions. Complexity significantly increased the radiation burden; multivessel percutaneous coronary intervention and acute myocardial infarction nearly doubled the doses and fluoroscopy times in single-vessel interventions. Although the diagnostic procedures were cine image-driven, for moderate-complexity interventions, the contribution of fluoroscopy was greater. Conclusions: These findings support institutional optimization and development of safety guidelines to enhance patient protection during high-complexity cardiovascular procedures.

Neurointerventional procedures expose both patients and medical personnel to significant radiation, raising concerns about long-term health risks. This study investigated whether real-time radiation monitoring systems reduce occupational radiation doses and improve radiation protection behaviors among staff. We conducted a retrospective and prospective cohort study at Prince of Songkla University Minimally Invasive Surgical-Interventional Radiology Center between October 2023 and July 2024. The study included 167 patients undergoing cerebral angiograms and 28 medical personnel (interventional neuroradiologists, nurses, andradiologic technologists). Patient radiation metrics (Air Kerma, Dose-Area Product, Fluoroscopy Time) were collected via Radimetrics™ software. Personnel doses were measured using Optically Stimulated Luminescence dosimeters, with real-time Personal Dose Meters (RaySafe i3) implemented from January 2024 providing immediate feedback during procedures. Patients received a median Dose-Area Product of 32.25 Gy·cm2 and Air Kerma of 129.19 mGy, with mean fluoroscopy time of 2.7 minutes; all values remained below Thai national standards. Among personnel, interventional neuroradiologists demonstrated significant dose reduction following real-time monitoring implementation. Personal dose equivalent Hp(10) decreased from 1.628 mSv in 2023 to 0.335 mSv in 2024, representing a 79.4% reduction (p = .01). Hp(0.07) and Hp(3) values decreased by 15.7% and 16.1%, respectively (p = .01). Real-time monitoring enhanced personnel aware of the radiation dose levels in the angiography suite increased from 42.9% to 85.7%, with protective equipment utilization and optimal positioning practices improving significantly. Implementation of real-time personal radiation dosimeters significantly reduced occupational radiation exposure during neurointerventional procedures, particularly for interventional neuroradiologists. This reduction was achieved through enhanced staff awareness and improved radiation protection behaviors without compromising patient care quality.

Two-view chest X-ray (CXR) is a widely utilized diagnostic tool due to its accessibility, cost-effectiveness, and ability to evaluate thoracic pathologies. The current diagnostic reference levels (DRLs) in Germany for posterior-anterior (PA) and lateral CXR are 12.0 and 40.0 cGy × cm², respectively. This study assessed the dose contributions of PA and lateral CXR for different body mass index (BMI) groups, aiming to determine the best possible BMI thresholds to predict exceedance of the national DRLs. In this retrospective study, 3,982 patients underwent a total of 4,958 two-view chest radiograms using a twin robotic X-ray system. Dose-area products (DAP) of each BMI group were compared between projections using Wilcoxon signed rank tests. Receiver operating characteristic statistics were employed to identify BMI values likely to result in doses above the DRLs. For each BMI group, lateral CXR resulted in higher DAP than PA radiograms (all p<0.001). The smallest median DAP difference was found for underweight patients (BMI <18.5 kg/m²; 12.2 versus 4.8 cGy × cm²; 154.2% higher DAP in lateral CXR), whereas the largest difference was observed among severely obese individuals (>40.0 kg/m²; 142.1 versus 21.7 cGy × cm²; 554.8%). The correlation of BMI and DAP was strong for both lateral and PA CXR (r = 0.614 and 0.641, both p<0.001). The best possible BMI thresholds to predict DRL exceedance were determined to be 26.5 kg/m² for lateral CXR (72.6% sensitivity / 76.1% specificity) and 27.8 kg/m² for PA radiograms (78.1% / 74.4%). BMI information facilitates prediction of DRL exceedance. The findings presented may serve as a basis for future discussions on whether BMI-dependent reference levels could help to optimize dose management in chest imaging. · Lateral views contribute the majority of radiation dose in two-view CXR.. · Patient BMI correlates strongly with dose exposure.. · Recording patient height and weight information is helpful for radiation dose management.. · Huflage H, Razinskas G, Weick S et al. Predicting Exceedance of the National Diagnostic Reference Levels for Two-view Chest Radiography in Germany based on Patients' Body Mass Index. Rofo 2026; DOI 10.1055/a-2810-5285.

BACKGROUND: The healthcare sector is a major contributor to climate change, mainly due to greenhouse gas emissions from electricity generation. Radiology imaging devices account for considerable energy consumption, but there is limited knowledge of the energy consumption of cardiac catheterisation units and of specific cardiac interventions. OBJECTIVES: To quantify energy consumption in kilowatt-hours (kWh) during diagnostic and therapeutic cardiac procedures and to identify potential areas for saving energy. METHODS: Current transformers measured true power in three cardiac catheterisation units in May and June 2024. The data were matched to system operational modes ‘off’, ‘idle’ and ‘intervention’. Clinical software provided information about the intervention type, operators and dose-area product. RESULTS: The total energy consumption was 6647.62 kWh, 76.5% of which was used for non-productive modes (62.8% ‘idle’ and 13.7% ‘off’). Interventions accounted for 23.5% of energy consumption and 9.1% of total time. The median (IQR) energy consumption of 564 performed interventions was 2.20 (2.02) kWh. Coronary interventions with ≥4 stents (4.86 [1.48] kWh) and mitral valve edge-to-edge repair (4.37 [2.59] kWh) used the most, while diagnostic coronary angiograms (0.91 [0.74] kWh) used the least energy from first to last scanning action. Energy consumption correlated significantly with intervention time (r = 0.98, p &lt;0.001) and dose-area product (r = 0.62, p &lt;0.001). CONCLUSION: Non-productive operational modes accounted for more than ¾ of overall energy consumption. Reducing ‘idle’ energy consumption appears to have the largest energy-saving potential.