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Digital subtraction angiography(DSA)is compared to five other noninvasive imaging methods with respect to physical attributes and medical applications. 1) Digital subtraction angiography measures flow channel (vessel) anatomy and vascular leaks in regions where signals from under and overlying vascular pools do not conflict in strength with the vessel or tissue of interest. 2) X-ray computed tomography, in principle, can separate the under and overlying signals, yet presently it is limited in speed, axial coverage, and computational burden for tasks DSA can efficiently perform. Possible exceptions are the dynamic spatial reconstructor (DSR) of Mayo Clinic and the system under construction at the University of California, San Francisco. 3) Heavy ion imaging measures electron density and is less sensitive to injected contrast than x-ray imaging which has the advantage of the photoelectric effect. A unique attribute of heavy ion imaging is its potential for treatment planning and the fact that beam hardening is not a physical problem. 4) Ultrasound detects surfaces, bulk tissue characteristics, and blood velocity. Doppler ultrasound competes with DSA in some regions of the body and generally involves less equipment and patient procedures. Ultrasound vessel imaging and range-gated Doppler have limitations due to sound absorption by atheromatous tissue and available imaging windows. 5) Emission tomography measures receptor site distribution, metabolism, permeability, and tissue perfusion. Resolution is limited to 7mm full width half maximum (FWHM) in the near future, and extraction of metabolic and perfusion information usually requires kinetic analyses with statistically poor data. The ability of positron tomography to measure metabolism (sugar, fatty acid, and oxygen utilization) and the ability to measure tissue perfusion with single photon tomography (17 mm FWHM) or PET (7 mm FWHM) using non-cyclotron produced radionuclides are the major unique features of emission tomography. 6) Nuclear magnetic resonance procedures measure the concentration of some nuclei (e.g., 1H, 23Na, 32P) as well as their chemical state and the local physical-chemical environment of the resolution volume. Velocity and diffusion are also potential measurements. Two unique capabilities of contemporary interest are the ability to image the spatial distribu-tion of relaxation parameters which give information about the local tissue characteristics, and the ability of NMR spectroscopy to sample (not image) the energy state of phosphorous in selected regions of the body. A third attribute of importance is that possible tissue heating seems to be the only hazard and this can be controlled.
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