Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Patient Radiation Dose in Diagnostic and Interventional Procedures for Intracranial Aneurysms: Experience at a Single Center

  • Chun, Chang Woo (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Bum-Soo (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Cheol Hyoun (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Ihn, Yon Kwon (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Shin, Yong-Sam (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2014.05.30
  • Accepted : 2014.08.05
  • Published : 2014.12.01
⟨ Previous Next ⟩

Abstract

Objective: To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms in a large sample size from a single center. Materials and Methods: We studied a sample of 439 diagnostic and 149 therapeutic procedures for intracranial aneurysms in 480 patients (331 females, 149 males; median age, 57 years; range, 21-88 years), which were performed in 2012 with a biplane unit. Parameters including fluoroscopic time, dose-area product (DAP), and total angiographic image frames were obtained and analyzed. Results: Mean fluoroscopic time, total mean DAP, and total image frames were 12.6 minutes, $136.6{\pm}44.8Gy-cm^2$, and $251{\pm}49$ frames for diagnostic procedures, 52.9 minutes, $226.0{\pm}129.2Gy-cm^2$, and 241 frames for therapeutic procedures, and 52.2 minutes, $334.5{\pm}184.6Gy-cm^2$, and 408 frames for when both procedures were performed during the same session. The third quartiles for diagnostic reference levels (DRLs) were 14.0, 61.1, and 66.1 minutes for fluoroscopy time, 154.2, 272.8, and 393.8 Gy-cm2 for DAP, and 272, 276, and 535 for numbers of image frames in diagnostic, therapeutic, and both procedures in the same session, respectively. The proportions of fluoroscopy in DAP for the procedures were 11.4%, 50.5%, and 36.1%, respectively, for the three groups. The mean DAP for each 3-dimensional rotational angiographic acquisition was $19.2{\pm}3.2Gy-cm^2$. On average, rotational angiography was used $1.4{\pm}0.6$ times/session (range, 1-4; n = 580). Conclusion: Radiation dose in our study as measured by DAP, fluoroscopy time and image frames did not differ significantly from other reported DRL studies for cerebral angiography, and DAP was lower with fewer angiographic image frames for embolization. A national registry of radiation-dose data is a necessary next step to refine the dose reference level.

Keywords

References

  1. Bor D, Cekirge S, Türkay T, Turan O, Gulay M, Onal E, et al. Patient and staff doses in interventional neuroradiology. Radiat Prot Dosimetry 2005;117:62-68 https://doi.org/10.1093/rpd/nci725
  2. McParland BJ. A study of patient radiation doses in interventional radiological procedures. Br J Radiol 1998;71:175-185 https://doi.org/10.1259/bjr.71.842.9579182
  3. Struelens L, Vanhavere F, Bosmans H, Van Loon R, Mol H. Skin dose measurements on patients for diagnostic and interventional neuroradiology: a multicentre study. Radiat Prot Dosimetry 2005;114:143-146 https://doi.org/10.1093/rpd/nch537
  4. Mahesh M. Fluoroscopy: patient radiation exposure issues. Radiographics 2001;21:1033-1045 https://doi.org/10.1148/radiographics.21.4.g01jl271033
  5. Suzuki S, Furui S, Matsumaru Y, Nobuyuki S, Ebara M, Abe T, et al. Patient skin dose during neuroembolization by multiple-point measurement using a radiosensitive indicator. AJNR Am J Neuroradiol 2008;29:1076-1081 https://doi.org/10.3174/ajnr.A1045
  6. Aroua A, Rickli H, Stauffer JC, Schnyder P, Trueb PR, Valley JF, et al. How to set up and apply reference levels in fluoroscopy at a national level. Eur Radiol 2007;17:1621-1633 https://doi.org/10.1007/s00330-006-0463-3
  7. D'Ercole L, Thyrion FZ, Bocchiola M, Mantovani L, Klersy C. Proposed local diagnostic reference levels in angiography and interventional neuroradiology and a preliminary analysis according to the complexity of the procedures. Phys Med 2012;28:61-70 https://doi.org/10.1016/j.ejmp.2010.10.008
  8. Bogaert E, Bacher K, Lemmens K, Carlier M, Desmet W, De Wagter X, et al. A large-scale multicentre study of patient skin doses in interventional cardiology: dose-area product action levels and dose reference levels. Br J Radiol 2009;82:303-312 https://doi.org/10.1259/bjr/29449648
  9. Nickoloff EL, Lu ZF, Dutta AK, So JC. Radiation dose descriptors: BERT, COD, DAP, and other strange creatures. Radiographics 2008;28:1439-1450 https://doi.org/10.1148/rg.285075748
  10. Bor D, Sancak T, Olgar T, Elcim Y, Adanali A, Sanlidilek U, et al. Comparison of effective doses obtained from dose-area product and air kerma measurements in interventional radiology. Br J Radiol 2004;77:315-322 https://doi.org/10.1259/bjr/29942833
  11. Brambilla M, Marano G, Dominietto M, Cotroneo AR, Carriero A. Patient radiation doses and references levels in interventional radiology. Radiol Med 2004;107:408-418
  12. Miller DL, Balter S, Cole PE, Lu HT, Schueler BA, Geisinger M, et al. Radiation doses in interventional radiology procedures: the RAD-IR study: part I: overall measures of dose. J Vasc Interv Radiol 2003;14:711-727 https://doi.org/10.1097/01.RVI.0000079980.80153.4B
  13. Verdun FR, Aroua A, Trueb PR, Vock P, Valley JF. Diagnostic and interventional radiology: a strategy to introduce reference dose level taking into account the national practice. Radiat Prot Dosimetry 2005;114:188-191 https://doi.org/10.1093/rpd/nch547
  14. Le Heron JC. Estimation of effective dose to the patient during medical x-ray examinations from measurements of the dose-area product. Phys Med Biol 1992;37:2117-2126 https://doi.org/10.1088/0031-9155/37/11/008
  15. Harrison JD, Streffer C. The ICRP protection quantities, equivalent and effective dose: their basis and application. Radiat Prot Dosimetry 2007;127:12-18 https://doi.org/10.1093/rpd/ncm248
  16. Anxionnat R, Bracard S, Ducrocq X, Trousset Y, Launay L, Kerrien E, et al. Intracranial aneurysms: clinical value of 3D digital subtraction angiography in the therapeutic decision and endovascular treatment. Radiology 2001;218:799-808 https://doi.org/10.1148/radiology.218.3.r01mr09799
  17. Doelken M, Struffert T, Richter G, Engelhorn T, Nimsky C, Ganslandt O, et al. Flat-panel detector volumetric CT for visualization of subarachnoid hemorrhage and ventricles: preliminary results compared to conventional CT. Neuroradiology 2008;50:517-523 https://doi.org/10.1007/s00234-008-0372-z
  18. Kang HS, Han MH, Kwon BJ, Jung SI, Oh CW, Han DH, et al. Postoperative 3D angiography in intracranial aneurysms. AJNR Am J Neuroradiol 2004;25:1463-1469
  19. Richter G, Engelhorn T, Struffert T, Doelken M, Ganslandt O, Hornegger J, et al. Flat panel detector angiographic CT for stent-assisted coil embolization of broad-based cerebral aneurysms. AJNR Am J Neuroradiol 2007;28:1902-1908 https://doi.org/10.3174/ajnr.A0697
  20. van Rooij WJ, Sprengers ME, de Gast AN, Peluso JP, Sluzewski M. 3D rotational angiography: the new gold standard in the detection of additional intracranial aneurysms. AJNR Am J Neuroradiol 2008;29:976-979 https://doi.org/10.3174/ajnr.A0964
  21. Marshall NW, Chapple CL, Kotre CJ. Diagnostic reference levels in interventional radiology. Phys Med Biol 2000;45:3833-3846 https://doi.org/10.1088/0031-9155/45/12/323
  22. Dekker LR, van der Voort PH, Simmers TA, Verbeek XA, Bullens RW, Veer MV, et al. New image processing and noise reduction technology allows reduction of radiation exposure in complex electrophysiologic interventions while maintaining optimal image quality: a randomized clinical trial. Heart Rhythm 2013;10:1678-1682 https://doi.org/10.1016/j.hrthm.2013.08.018

Cited by

  1. Patient Radiation Exposure During Diagnostic and Therapeutic Procedures for Intracranial Aneurysms: A Multicenter Study vol.11, pp.2, 2014, https://doi.org/10.5469/neuroint.2016.11.2.78
  2. Radiation Dose Reduction without Compromise to Image Quality by Alterations of Filtration and Focal Spot Size in Cerebral Angiography vol.18, pp.4, 2014, https://doi.org/10.3348/kjr.2017.18.4.722
  3. Radiation exposure, and procedure and fluoroscopy times in endovascular treatment of intracranial aneurysms: a methodological comparison vol.10, pp.9, 2018, https://doi.org/10.1136/neurintsurg-2017-013596
  4. ESTIMATION OF RADIATION EXPOSURE TO THE PATIENTS IN DIAGNOSTIC AND THERAPEUTIC INTERVENTIONAL PROCEDURES vol.181, pp.3, 2014, https://doi.org/10.1093/rpd/ncy025
  5. Image Quality of Low-Dose Cerebral Angiography and Effectiveness of Clinical Implementation on Diagnostic and Neurointerventional Procedures for Intracranial Aneurysms vol.40, pp.5, 2019, https://doi.org/10.3174/ajnr.a6029
  6. Patient Radiation Doses during Diagnostic Cerebral Angiography Procedures: Experience at a Tertiary Level Center of India vol.53, pp.2, 2014, https://doi.org/10.5005/jp-journals-10028-1315
  7. Feasibility of ultra-low radiation dose digital subtraction angiography: Preliminary study in a simplified cerebral angiography phantom vol.25, pp.5, 2014, https://doi.org/10.1177/1591019919850302
  8. Monitoring Radiation Doses during Diagnostic and Therapeutic Neurointerventional Procedures: Multicenter Study for Establishment of Reference Levels vol.16, pp.3, 2014, https://doi.org/10.5469/neuroint.2021.00437