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Bärenfänger F, Schramm P, Rohde S. Radiation Exposure in Interventional Stroke Treatment : Analysis of the German Neurointerventional Database (DeGIR/DGNR) from 2019 to 2021. Clin Neuroradiol 2023; 33:1023-1033. [PMID: 37280392 PMCID: PMC10654203 DOI: 10.1007/s00062-023-01303-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/27/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE To evaluate patient-related radiation exposure in interventional stroke treatment by analyzing data from the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Society of Neuroradiology (DGNR) quality registry from 2019-2021. METHODS The DeGIR/DGNR registry is the largest database of radiological interventions in Germany. Since the introduction of the registry in 2012, the participating hospitals have entered clinical and dose-related data on the procedures performed. To evaluate the current diagnostic reference level (DRL) for mechanical thrombectomy (MT) in stroke patients, we analyzed interventional data from 2019 to 2021 with respect to the reported dose area product (DAP) and factors that might contribute to the radiation dose, such as the localization of the occlusion, technical success using the modified treatment in cerebral ischemia (mTICI) score, number of passages, technical approach, additional intracranial/extracranial stenting, and case volume per center. RESULTS A total of 41,538 performed MTs from 180 participating hospitals were analyzed. The median DAP for MT was 7337.5 cGy∙cm2 and the corresponding interquartile range (IQR) Q25 = 4064 cGy∙cm2 to Q75 = 12,263 cGy∙cm2. In addition, we discovered that the dose was significantly influenced by occlusion location, number of passages, case volume per center, recanalization score, and additional stenting. CONCLUSION We conducted a retrospective study on radiation exposure during MT in Germany. Based on the results of more than 41,000 procedures, we observed that the DRL of 14,000 cGy·cm2 is currently appropriate but may be lowered over the next years. Furthermore, we identified several factors that contribute to high radiation exposure. This can aid in detecting the cause of an exceeded DRL and optimize the treatment workflow.
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Affiliation(s)
- Felix Bärenfänger
- Faculty for Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
- Department of Medical Physics and Radiation Protection, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Germany.
| | - Peter Schramm
- Department of Radiology and Neuroradiology, Campus Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Stefan Rohde
- Faculty for Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
- Department of Radiology and Neuroradiology, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Germany
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Forbrig R, Ozpeynirci Y, Fischer TD, Trumm CG, Liebig T, Stahl R. Radiation Dose and Fluoroscopy Time of Extracranial Carotid Artery Stenting : Elective vs. Emergency Treatment Including Combined Mechanical Thrombectomy in Tandem Occlusion. Clin Neuroradiol 2023; 33:843-853. [PMID: 37261451 PMCID: PMC10449680 DOI: 10.1007/s00062-023-01288-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/24/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Fluoroscopically guided endovascular carotid artery stenting (CAS) of extracranial carotid stenosis (ECS) is a reasonable alternative to carotid endarterectomy in selected patients. Diagnostic reference levels (DRL) for this common neurointervention have not yet been defined and respective literature data are sparse. We provide detailed dosimetrics for useful expansion of the DRL catalogue. METHODS A retrospective single-center study of patients undergoing CAS between 2013 and 2021. We analyzed dose area product (DAP) and fluoroscopy time considering the following parameters: indications for CAS, semielective/elective versus emergency including additional mechanical thrombectomy (MT) in extracranial/intracranial tandem occlusion, etiology of ECS (atherosclerotic vs. radiation-induced), periprocedural features, e.g., number of applied stents, percutaneous transluminal angioplasty (PTA) and MT maneuvers, and dose protocol. Local DRL was defined as 75% percentile of the DAP distribution. RESULTS A total of 102 patients were included (semielective/elective CAS n = 75, emergency CAS n = 8, CAS + MT n = 19). Total median DAP was 78.2 Gy cm2 (DRL 117 Gy cm2). Lowest and highest median dosimetry values were documented for semielective/elective CAS and CAS + MT (DAP 49.1 vs. 146.8 Gy cm2, fluoroscopy time 27.1 vs. 43.8 min; p < 0.005), respectively. Dosimetrics were significantly lower in patients undergoing 0-1 PTA maneuvers compared to ≥ 2 maneuvers (p < 0.05). Etiology of ECS, number of stents and MT maneuvers had no significant impact on dosimetry values (p > 0.05). A low-dose protocol yielded a 33% reduction of DAP. CONCLUSION This CAS study suggests novel local DRLs for both elective and emergency cases with or without intracranial MT. A dedicated low-dose protocol was suitable for substantial reduction of radiation dose.
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Affiliation(s)
- Robert Forbrig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Thomas David Fischer
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christoph G. Trumm
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Robert Stahl
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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Croci DM, Nguyen S, Streitmatter SW, Sherrod BA, Hardy J, Cole KL, Gamblin AS, Bisson EF, Mazur MD, Dailey AT. O-Arm Accuracy and Radiation Exposure in Adult Deformity Surgery. World Neurosurg 2023; 171:e440-e446. [PMID: 36528322 DOI: 10.1016/j.wneu.2022.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In long thoracolumbar deformity surgery, accurate screw positioning is critical for spinal stability. We assessed pedicle and pelvic screw accuracy and radiation exposure in patients undergoing long thoracolumbar deformity fusion surgery (≥4 levels) involving 3-dimensional fluoroscopy (O-Arm/Stealth) navigation. METHODS In this retrospective single-center cohort study, all patients aged >18 years who underwent fusion in 2016-2018 were reviewed. O-Arm images were assessed for screw accuracy. Effective radiation doses were calculated. The primary outcome was pedicle screw accuracy (Heary grade). Secondary outcomes were pelvic fixation screw accuracy, radiation exposure, and screw-related perioperative and postoperative complications or revision surgery within 3 years. RESULTS Of 1477 pedicle screws placed in 91 patients (mean 16.41 ± 5.6 screws/patient), 1208 pedicle screws (81.8%) could be evaluated by 3-dimensional imaging after placement. Heary Grade I placement was achieved in 1150 screws (95.2%), Grade II in 47 (3.9%), Grade III in 10 (0.82%), Grade IV in 1 (0.08%), and Grade V in 0; Grade III-V were replaced intraoperatively. One of 60 (1.6%) sacroiliac screws placed showed medial cortical breach and was replaced. The average O-Arm-related effective dose was 29.54 ± 14.29 mSv and effective dose/spin was 8.25 ± 2.65 mSv. No postoperative neurological worsening, vascular injuries, or revision surgeries for screw misplacement were recorded. CONCLUSIONS With effective radiation doses similar to those in interventional neuroendovascular procedures, the use of O-Arm in multilevel complex deformity surgery resulted in high screw accuracy, no need for surgical revision because of screw malposition, less additional imaging, and no radiation exposure for the surgical team.
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Affiliation(s)
- Davide Marco Croci
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Sarah Nguyen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Seth W Streitmatter
- Medical Imaging Physics and Radiation Safety, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Brandon A Sherrod
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy Hardy
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kyril L Cole
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Austin S Gamblin
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Erica F Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
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Radiation dose and fluoroscopy time of aneurysm coiling in patients with unruptured and ruptured intracranial aneurysms as a function of aneurysm size, location, and patient age. Neuroradiology 2023; 65:637-644. [PMID: 36418556 PMCID: PMC9905176 DOI: 10.1007/s00234-022-03092-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Endovascular treatment of unruptured intracranial aneurysms (UIAs) requires a risk-benefit analysis and adherence to diagnostic reference levels (DRLs). The national DRL (250 Gy·cm2) is only determined for intracranial aneurysm coiling in general, including ruptured intracranial aneurysms (RIAs). This study aims to investigate the dose in the treatment of UIAs and RIAs separately. METHODS In a retrospective study design, dose area product (DAP) and fluoroscopy time (FT) were assessed for all patients undergoing intracranial aneurysm coiling between 2010 and 2021. DRL was set as the 75th percentile of the dose distribution. A multivariable linear regression analysis was performed to investigate DAP and FT for the two groups, UIA and RIA adjusted for patient age, aneurysm size, and location. RESULTS 583 (414 females, mean age 56.5 years, 311 UIAs) are included. In the overall population, DAP (median (IQR)) is 157 Gy·cm2 (108-217) with a median FT of 32.7 min (IQR 24.0-47.0). Local DRL is 183 Gy·cm2 for UIAs and 246 Gy·cm2 for RIAs. After adjustment for the other variables, the UIA and RIA groups have a significant effect on both DAP (p < 0.001; 95% CI - 68.432 - - 38.040) and FT (p < 0.001; 95% CI - 628.279 - - 291.254). In general, both DAP and FT increase significantly with patient age and aneurysm size, whereas the location of the aneurysm did not significantly change neither DAP (p = 0.171; 95% CI - 5.537-31.065) nor FT (p = 0.136; 95% CI - 357.391-48.508). CONCLUSION Both aneurysm size and patient age were associated with increased DAP, whereas aneurysm location did not significantly change DAP or FT. The increased dose in patients with RIAs is likely equivalent to additional diagnostic cerebral four-vessel angiography performed in this group.
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Murphy H, Scally A, Andrew D, Lord J, Wyse G, Fanning N, Young R, Moore N. Clinical audit comparing radiation dose metrics between WEB and coil embolisation in the treatment of intracranial aneurysms. J Med Imaging Radiat Sci 2021; 53:75-80. [PMID: 34949561 DOI: 10.1016/j.jmir.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Intrasaccular flow disruption is a new and effective endovascular treatment for intracranial aneurysms. While endovascular treatment is a minimally invasive procedure, it does carry a radiation risk. As radiation dose should be kept as low as reasonably achievable (ALARA), the main objective of this study was to analyse KAP (kerma area product), fluoroscopy and procedure time during the treatment of aneurysms treated with coiling and the Woven-EndoBridge (WEB) device. A secondary objective was to look at the reference air kerma (RAK) to determine if the patient receives a dose that could cause tissue effects. METHODS KAP, fluoroscopy and procedure time were retrospectively analysed in patients who had an aneurysm treatment. Aneurysms with diameters of 4-11mm, over a four-year period, in the anterior and posterior circulation of the brain were analysed in this study. Patients were treated by coiling or WEB. RAK were summed together in the working projection to give an estimated entrance surface dose (ESD) in cases with the highest KAP. RESULTS A total of 47 aneurysms treated with WEB and 104 aneurysms treated with coiling techniques met the inclusion criteria. The average KAP was 6884.1 ± 2774.4μGym2 with coiling techniques and 5658.7 ± 1602.5μGym2 with WEB (p=0.006; CI =363-2086μGym2). This demonstrates an 18% reduction with WEB. Mean fluoroscopy time for coiling was 63.5 ± 42.6minutes and 33.8 ± 28.8minutes for WEB (p=<0.001; CI=16-43minutes). Fluoroscopy time was reduced by nearly 50% with WEB. On average, there was a 27-minute reduction of procedure time when using WEB compared to coiling. The RAK determined for the working projections did not exceed the 2Gy threshold for tissue effects. CONCLUSION Treatment of aneurysms using the WEB shows a reduction in KAP, fluoroscopy, and procedure time. This study further demonstrates the benefits of intrasaccular flow disruption for treatment of intracranial aneurysms.
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Affiliation(s)
- Hazel Murphy
- Medical Imaging and Radiation Therapy, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, T12 AK54 Ireland
| | - Andrew Scally
- Medical Imaging and Radiation Therapy, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, T12 AK54 Ireland.
| | - Damon Andrew
- Department of Radiology, Cork University Hospital, Wilton Road, Cork, T12 DFK4 Ireland
| | - James Lord
- Department of Radiology, Cork University Hospital, Wilton Road, Cork, T12 DFK4 Ireland
| | - Gerald Wyse
- Department of Radiology, Cork University Hospital, Wilton Road, Cork, T12 DFK4 Ireland
| | - Noel Fanning
- Department of Radiology, Cork University Hospital, Wilton Road, Cork, T12 DFK4 Ireland
| | - Rena Young
- Medical Imaging and Radiation Therapy, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, T12 AK54 Ireland.
| | - Niamh Moore
- Medical Imaging and Radiation Therapy, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, T12 AK54 Ireland.
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Ihn YK, Kim BS, Jeong HW, Suh SH, Won YD, Lee YJ, Kim DJ, Jeon P, Ryu CW, Suh SI, Choi DS, Choi SS, Kim SH, Byun JS, Rho J, Song Y, Jeong WS, Hong N, Baik SH, Park JJ, Lim SM, Kim JJ, Yoon W. Monitoring Radiation Doses during Diagnostic and Therapeutic Neurointerventional Procedures: Multicenter Study for Establishment of Reference Levels. Neurointervention 2021; 16:240-251. [PMID: 34695909 PMCID: PMC8561028 DOI: 10.5469/neuroint.2021.00437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/18/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To assess patient radiation doses during diagnostic and therapeutic neurointerventional procedures from multiple centers and propose dose reference level (RL). MATERIALS AND METHODS Consecutive neurointerventional procedures, performed in 22 hospitals from December 2020 to June 2021, were retrospectively studied. We collected data from a sample of 429 diagnostic and 731 therapeutic procedures. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time (FT), and total number of image frames (NI) were obtained. RL were calculated as the 3rd quartiles of the distribution. RESULTS Analysis of 1160 procedures from 22 hospitals confirmed the large variability in patient dose for similar procedures. RLs in terms of DAP, CAK, FT, and NI were 101.6 Gy·cm2, 711.3 mGy, 13.3 minutes, and 637 frames for cerebral angiography, 199.9 Gy·cm2, 3,458.7 mGy, 57.3 minutes, and 1,000 frames for aneurysm coiling, 225.1 Gy·cm2, 1,590 mGy, 44.7 minutes, and 800 frames for stroke thrombolysis, 412.3 Gy·cm2, 4,447.8 mGy, 99.3 minutes, and 1,621.3 frames for arteriovenous malformation (AVM) embolization, respectively. For all procedures, the results were comparable to most of those already published. Statistical analysis showed male and presence of procedural complications were significant factors in aneurysmal coiling. Male, number of passages, and procedural combined technique were significant factors in stroke thrombolysis. In AVM embolization, a significantly higher radiation dose was found in the definitive endovascular cure group. CONCLUSION Various RLs introduced in this study promote the optimization of patient doses in diagnostic and therapeutic interventional neuroradiology procedures. Proposed 3rd quartile DAP (Gy·cm2) values were 101.6 for diagnostic cerebral angiography, 199.9 for aneurysm coiling, 225.1 for stroke thrombolysis, and 412.3 for AVM embolization. Continual evolution of practices and technologies requires regular updates of RLs.
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Affiliation(s)
- Yon-Kwon Ihn
- Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hae Woong Jeong
- Department of Radiology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
| | - Yoo Dong Won
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Young-Jun Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Joon Kim
- Department of Radiology, Severance Hospital, Yonsei Unviersity College of Medicine, Seoul, Korea
| | - Pyong Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang-Il Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - See Sung Choi
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - Sang Heum Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jun Soo Byun
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Jieun Rho
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yunsun Song
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Sang Jeong
- Department of Radiology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Noah Hong
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
| | - Soo Mee Lim
- Department of Radiology, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Jung-Jae Kim
- Department of Neurosurgery, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Woong Yoon
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
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Peter Y, Speelman A, Daries V. Measurement of the average radiation dose to the local skin and thyroid gland during intracranial aneurysm coil embolization. Radiography (Lond) 2021; 27:255-259. [DOI: 10.1016/j.radi.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/07/2023]
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Mortality after mechanical thrombectomy in anterior circulation stroke may be higher at nighttime and on weekends. Eur Radiol 2020; 31:4148-4155. [PMID: 33341907 PMCID: PMC8128827 DOI: 10.1007/s00330-020-07615-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/11/2020] [Accepted: 12/07/2020] [Indexed: 12/02/2022]
Abstract
Objectives The objective of this study was to compare clinical outcome and procedural differences of mechanical thrombectomy (MT) during on-call with regular operating hours. We particularly focused on dosimetric data which may serve as potential surrogates for patient outcome. Methods A total of 246 consecutive patients who underwent MT in acute anterior circulation stroke between November 2017 and March 2020 were retrospectively included. Patients treated (1) during standard operational hours (n = 102), (2) daytime on-call duty (n = 38) and (3) nighttime on-call duty (n = 106) were compared with respect to their pre-interventional status, procedural specifics, including dosimetrics (dose area product (DAP), fluoroscopy time and procedural time), and outcome. Results The collectives treated outside the regular operational hours showed an increased in-hospital mortality (standard operational hours 7% (7/102), daytime on-call duty 16% (6/38), nighttime on-call duty 20% (21/106), p = 0.02). Neither the dosimetric parameters nor baseline characteristics other procedural specifics and outcome parameters differed significantly between groups (p > 0.05 each). In most cases (> 90%), a successful reperfusion was achieved (TICI ≥ 2b). Conclusions We found an increased in-hospital mortality in patients admitted at night and during weekends which was not explained by technical aspects of MT. Key Points • There is an increased mortality of stroke patients admitted at night and on weekends. • This is not explained by technical aspects of mechanical thrombectomy. • There were no statistical differences in the comparison of parameters linked to the radiation exposure, such as DAP, fluoroscopy time and procedure time.
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Forbrig R, Stahl R, Geyer LL, Ozpeynirci Y, Liebig T, Trumm CG. Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae. Clin Neuroradiol 2020; 31:1149-1157. [PMID: 33313974 PMCID: PMC8648699 DOI: 10.1007/s00062-020-00982-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022]
Abstract
Purpose Intracranial lateral dural arteriovenous fistula (LDAVF) represents a specific subtype of cerebrovascular fistulae, harboring a potentially life-threatening risk of brain hemorrhage. Fluoroscopically guided endovascular embolization is the therapeutic gold standard. We provide detailed dosimetry data to suggest novel diagnostic reference levels (DRL). Methods Retrospective single-center study of LDAVFs treated between January 2014 and December 2019. Regarding dosimetry, the dose area product (DAP) and fluoroscopy time were analyzed for the following variables: Cognard scale grade, endovascular technique, angiographic outcome, and digital subtraction angiography (DSA) protocol. Results A total of 70 patients (19 female, median age 65 years) were included. Total median values for DAP and fluoroscopy time were 325 Gy cm2 (25%/75% percentile: 245/414 Gy cm2) and 110 min (68/142min), respectively. Neither median DAP nor fluoroscopy time were significantly different when comparing low-grade with high-grade LDAVF (Cognard I + IIa versus IIb–V; p > 0.05, each). Transvenous coil embolization yielded the lowest dosimetry values, with significantly lower median values when compared to a combined transarterial/transvenous technique (DAP 290 Gy cm2 versus 388 Gy cm2, p = 0.031; fluoroscopy time 85 min versus 170 min, p = 0.016). A significant positive correlation was found between number of arterial feeders treated by liquid embolization and both DAP (rs = 0.367; p = 0.010) and fluoroscopy time (rs = 0.295; p = 0.040). Complete LDAVF occlusion was associated with transvenous coiling (p = 0.001). A low-dose DSA protocol yielded a 20% reduction of DAP (p = 0.021). Conclusion This LDAVF study suggests several local DRLs which varied substantially dependent on the endovascular technique and DSA protocol.
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Affiliation(s)
- Robert Forbrig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Robert Stahl
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Lucas L. Geyer
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Christoph G. Trumm
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
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Investigating the parameters that affect the radiation exposure and establishing typical values based on procedure complexity for cerebral angiography and brain aneurysm embolization. Neuroradiology 2020; 63:787-794. [PMID: 33057746 DOI: 10.1007/s00234-020-02580-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study is to investigate the parameters that affect the radiation exposure and to establish typical values (TV) based on procedure complexity for cerebral angiography (CA) and brain aneurysm embolization (BAE). METHODS Clinical parameters and exposure data were retrospectively reviewed for 348 examinations performed between March 2016 and December 2019 at a single specialized neuroradiology center. TV were derived as the median value of the distribution of exposure parameters such as total air kerma area product (PKA,T), air kerma at the patient entrance reference point, fluoroscopy time, and number of frames. A statistical analysis was conducted to investigate the exposure variability with patient's gender, number of treated vessels during CA and patient gender, aneurysm location and dimension, and treatment strategies during BAE. RESULTS Patient gender was associated with a significant increase in the exposure level for both CA and BAE. For CA, TV were in term of PKA,T of 52 Gycm2 for male vs. 28 Gycm2 for female patients. For BAE, these were 113 Gycm2 for male vs. 75 Gycm2 for female patients. Exposure levels increased significantly with the number of treated vessels in CA. TV were 20 Gycm2 for one vessel vs. 77 Gycm2 for 5-6 vessels CA. For BAE, aneurysm location was also a key factor that affects the patient exposure. TV were 55 Gycm2 for aneurysms grouped in location 1 vs. 105 Gycm2 for those grouped in location 2. CONCLUSION Male gender, number of treated vessels, and aneurysm location are key parameters affecting patient exposure during CA and BAE procedures.
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Paulo G, Bartal G, Vano E. Radiation Dose of Patients in Fluoroscopically Guided Interventions: an Update. Cardiovasc Intervent Radiol 2020; 44:842-848. [PMID: 33034703 DOI: 10.1007/s00270-020-02667-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022]
Abstract
The benefits of fluoroscopically guided interventional procedures are significant and have established new standards in the clinical management of many diseases. Despite the benefits, it is known that they come with known risks, such as the exposure to ionizing radiation. To minimize such risks, it is crucial that the health professionals involved in the procedures have a common understanding of the concepts related to radiation protection, such as dose descriptors, diagnostic reference levels and typical dose values. An update about these concepts will be presented with the objective to raise awareness amongst health professionals and contribute to the increase in knowledge, skills and competences in radiation protection in fluoroscopically guided interventional procedures.
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Affiliation(s)
- Graciano Paulo
- Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Rua 5 de Outubro, S. Martinho Do Bispo, 3046-854, Coimbra, Portugal.
| | | | - Eliseo Vano
- Radiology Department, Complutense University, Madrid, Spain
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12
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Crowley C, Ekpo EU, Carey BW, Joyce S, Kennedy C, Grey T, Duffy B, Kavanagh R, James K, Moloney F, Normoyle B, Moore N, Chopra R, O'Driscoll JC, McEntee MF, Maher MM, O' Connor OJ. Radiation dose tracking in computed tomography: Red alerts and feedback. Implementing a radiation dose alert system in CT. Radiography (Lond) 2020; 27:67-74. [PMID: 32693990 DOI: 10.1016/j.radi.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION This study investigates instances of elevated radiation dose on a radiation tracking system to determine their aetiologies. It aimed to investigate the impact of radiographer feedback on these alerts. METHODS Over two six-month periods 11,298 CT examinations were assessed using DoseWatch. Red alerts (dose length products twice the median) were identified and two independent reviewers established whether alerts were true (unjustifiable) or false (justifiable). During the second time period radiographers used a feedback tool to state the cause of the alert. A Chi-Square test was used to assess whether red alert incidence decreased following the implementation of radiographer feedback. RESULTS There were 206 and 357 alerts during the first and second time periods, respectively. These occurred commonly with CT pulmonary angiography, brain, and body examinations. Procedural documentation errors and patient size accounted for 57% and 43% of false alerts, respectively. Radiographer feedback was provided for 17% of studies; this was not associated with a significant change in the number of alerts, but the number of true alerts declined (from 7 to 3) (χ2 = 4.14; p = 0.04). CONCLUSION Procedural documentation errors as well as patient-related factors are associated with false alerts in DoseWatch. Implementation of a radiographer feedback tool reduced true alerts. IMPLICATIONS FOR PRACTICE The implementation of a radiographer feedback tool reduced the rate of true dose alerts. Low uptake with dose alert systems is an issue; the workflow needs to be considered to address this.
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Affiliation(s)
- C Crowley
- Department of Radiology, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland
| | - E U Ekpo
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, 2141, Australia
| | - B W Carey
- Department of Radiology, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland; Department of Radiology, School of Medicine, University College Cork, College Road, Cork, Ireland
| | - S Joyce
- Department of Radiology, School of Medicine, University College Cork, College Road, Cork, Ireland.
| | - C Kennedy
- Department of Radiology, School of Medicine, University College Cork, College Road, Cork, Ireland
| | - T Grey
- Department of Radiology, School of Medicine, University College Cork, College Road, Cork, Ireland
| | - B Duffy
- Department of Radiology, School of Medicine, University College Cork, College Road, Cork, Ireland
| | - R Kavanagh
- Department of Radiology, School of Medicine, University College Cork, College Road, Cork, Ireland
| | - K James
- Department of Radiology, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland; Department of Radiology, School of Medicine, University College Cork, College Road, Cork, Ireland
| | - F Moloney
- Department of Radiology, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland; Department of Radiology, School of Medicine, University College Cork, College Road, Cork, Ireland
| | - B Normoyle
- Department of Radiography, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland
| | - N Moore
- Discipline of Diagnostic Radiography, School of Medicine, University College Cork, College Road, Cork, Ireland
| | - R Chopra
- Department of Radiography, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland
| | - J C O'Driscoll
- Discipline of Diagnostic Radiography, School of Medicine, University College Cork, College Road, Cork, Ireland
| | - M F McEntee
- Discipline of Diagnostic Radiography, School of Medicine, University College Cork, College Road, Cork, Ireland
| | - M M Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland; Department of Radiology, School of Medicine, University College Cork, College Road, Cork, Ireland
| | - O J O' Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland; Department of Radiology, School of Medicine, University College Cork, College Road, Cork, Ireland
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13
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Weyland CS, Seker F, Potreck A, Hametner C, Ringleb PA, Möhlenbruch MA, Bendszus M, Pfaff JAR. Radiation exposure per thrombectomy attempt in modern endovascular stroke treatment in the anterior circulation. Eur Radiol 2020; 30:5039-5047. [PMID: 32328765 PMCID: PMC7431433 DOI: 10.1007/s00330-020-06837-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 01/03/2023]
Abstract
Objective To quantify radiation exposure (RE) of endovascular stroke treatment (EST) in the anterior circulation per thrombectomy attempt and determine causes for interventions associated with high RE. Methods A retrospective single-center study of an institutional review board−approved stroke database of patients receiving EST for large vessel occlusions in the anterior circulation between January 2013 and April 2018 to evaluate reference levels (RL) per thrombectomy attempt. ESTs with RE above the RL were analyzed to determine causes for high RE. Results Overall, n = 544 patients (occlusion location, M1 and M2 segments of the middle cerebral artery 53.5% and 27.2%, carotid artery 17.6%; successful recanalization rate 85.7%) were analyzed. In the overall population, DAP (in Gy cm2, median (IQR)) was 113.7 (68.9–181.7) with a median fluoroscopy time of 31 min (IQR, 17–53) and a median of 2 (IQR, 1–4) thrombectomy attempts. RE increased significantly with every thrombectomy attempt (DAP1, 68.7 (51.2–106.8); DAP2, 106.4 (84.8–115.6); p value1vs2, < 0.001; DAP3, 130.2 (89.1–183.6); p value2vs3, 0.044; DAP4, 169.9 (128.4–224.1); p value3vs4, 0.001; and DAP5, 227.6 (146.3–294.6); p value4vs5, 0.019). Procedures exceeding the 90th percentile of the attempt-dependent radiation exposure level were associated with procedural complications (n = 17/52, 29.8%) or a difficult vascular access (n = 8/52, 14%). Conclusions Radiation exposure in endovascular stroke treatment is depending on the number of thrombectomy attempts. Radiation exposure doubles when three attempts and triples when five attempts are necessary compared with single-maneuver interventions. Procedural complications and difficult vascular access were associated with a high radiation exposure in this collective. Key Points • Radiation exposure of endovascular stroke treatment (EST) is dependent on the number of thrombectomy attempts. • Reference levels as means for quality control in hospitals performing endovascular stroke treatment should be defined by the number of thrombectomy attempts—we suggest 107 Gy cm2, 156 Gy cm2, 184 Gy cm2, 244 Gy cm2, and 295 Gy cm2for 1 to 5 maneuvers, respectively, for EST of the anterior circulation • Cases with high rates of radiation exposure are associated with periprocedural complications and difficult anatomical access as a probable cause for a high radiation exposure.
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Affiliation(s)
- Charlotte S Weyland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Fatih Seker
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Arne Potreck
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christian Hametner
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Peter A Ringleb
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Johannes A R Pfaff
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Srinivasan VM, Hadley CC, Prablek M, LoPresti M, Chen SH, Peterson EC, Sweid A, Jabbour P, Young C, Levitt M, Osbun JW, Burkhardt JK, Johnson J, Kan P. Feasibility and safety of transradial access for pediatric neurointerventions. J Neurointerv Surg 2020; 12:893-896. [DOI: 10.1136/neurintsurg-2020-015835] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 02/02/2023]
Abstract
BackgroundDiagnostic cerebral angiograms are increasingly being performed by transradial access (TRA) in adults, following data from the coronary literature supporting fewer access-site complications. Despite this ongoing trend in neuroangiography, there has been no discussion of its use in the pediatric population. Pediatric TRA has scarcely been described even for coronary or other applications. This is the first dedicated large study of transradial access for neuroangiography in pediatric patients.MethodsA multi-institutional series of consecutively performed pediatric transradial angiograms and interventions was collected. This included demographic, procedural, outcomes, and safety data. Data was prospectively recorded and retrospectively analyzed.ResultsThirty-seven diagnostic angiograms and 24 interventions were performed in 47 pediatric patients. Mean age, height, and weight was 14.1 years, 158.6 cm, and 57.1 kg, respectively. The radial artery measured 2.09+/-0.54 mm distally, and 2.09+/-0.44 mm proximally. Proximal and distal angiography were performed for both diagnostic and interventional application (17 distal angiograms, two distal interventions). Clinically significant vasospasm occurred in eight patients (13.1%). Re-access was successfully performed 11 times in seven patients. Conversion to femoral access occurred in five cases (8.2%). The only access-related complication was a small asymptomatic wrist hematoma after TR band removal.ConclusionsTransradial access in pediatric patients is safe and feasible. It can be performed successfully in many cases but carries some unique challenges compared with the adult population. Despite the challenge of higher rates of vasospasm and conversion to femoral access, it is worth exploring further, given the potential benefits.
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15
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Forbrig R, Ozpeynirci Y, Grasser M, Dorn F, Liebig T, Trumm CG. Radiation dose and fluoroscopy time of modern endovascular treatment techniques in patients with saccular unruptured intracranial aneurysms. Eur Radiol 2020; 30:4504-4513. [PMID: 32193640 PMCID: PMC8093177 DOI: 10.1007/s00330-020-06777-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 02/06/2023]
Abstract
Objectives Modern endovascular treatment of unruptured intracranial aneurysms (UIAs) demands for observance of diagnostic reference levels (DRLs). The national DRL (250 Gy cm2) is only defined for coiling. We provide dosimetric data for the following procedures: coiling, flow diverter (FD), Woven EndoBridge (WEB), combined techniques. Methods A retrospective single-centre study of saccular UIAs treated between 2015 and 2019. Regarding dosimetric analysis, the parameters dose area product (DAP) and fluoroscopy time were investigated for the following variables: endovascular technique, aneurysm location, DSA protocol, aneurysm size, and patient age. Results Eighty-seven patients (59 females, mean age 54 years) were included. Total mean and median DAP (Gy cm2) were 119 ± 73 (89–149) and 94 (73; 130) for coiling, 128 ± 53 (106–151) and 134 (80; 176) for FD, 128 ± 56 (102–153) and 118 (90; 176) for WEB, and 165 ± 102 (110–219) and 131 (98; 209) for combined techniques (p > .05). Regarding the aneurysm location, neither DAP nor fluoroscopy time was significantly different (p > .05). The lowest and highest fluoroscopy times were recorded for WEB and combined techniques, respectively (median 26 and 94 min; p < .001). A low-dose protocol yielded a 43% reduction of DAP (p < .001). Significantly positive correlations were found between DAP and both aneurysm size (r = .320, p = .003) and patient age (r = .214, p = .046). Conclusions This UIA study establishes novel local DRLs for modern endovascular techniques such as FD and WEB. A low-dose protocol yielded a significant reduction of radiation dose. Key Points • This paper establishes local diagnostic reference levels for modern endovascular treatment techniques of unruptured intracranial aneurysms, including flow diverter stenting and Woven EndoBridge device. • Dose area product was not significantly different between endovascular techniques and aneurysm locations, but associated with aneurysm size and patient age. • A low-dose protocol yielded a significant reduction of dose area product and is particularly useful when applying materials with a high radiopacity (e.g. platinum coils).
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Affiliation(s)
- Robert Forbrig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | | | - Franziska Dorn
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christoph G Trumm
- Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Klepanec A, Salat D, Harsany J, Hoferica M, Krastev G, Haring J, Mako M, Janega P, Janosikova L, Lehotska V. Neurointerventionalist and Patient Radiation Doses in Endovascular Treatment of Acute Ischemic Stroke. Cardiovasc Intervent Radiol 2020; 43:604-612. [PMID: 31974745 DOI: 10.1007/s00270-020-02412-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the patient and the neurointerventionalist radiation dose levels during endovascular treatment of acute ischemic stroke, and to analyze factors affecting doses. MATERIALS AND METHODS From October 2017 to January 2019, we prospectively collected patient radiation data and neurointerventionalist data from real-time dosimetry from all consecutive thrombectomies. Multivariate analysis was performed to analyze patient total dose area product (DAP) and neurointerventionalist dose variability in terms of clinical characteristics and the technical parameters of thrombectomies. Local dose reference levels (RL) were derived as the 75th percentile of the patient dose distributions. RESULTS A total of 179 patients were treated during the study period and included in this study. Local dose RL for thrombectomy was derived for total DAP to 34 Gy cm2, cumulative air kerma of 242 mGy and fluoroscopy time of 12 min. The mean neurointerventionalist dose for thrombectomy was 7.7 ± 7.4 µSv. Height (P = 0.018), weight (P = 0.004), body mass index (P = 0.015), puncture to recanalisation (P < 0.001), fluoro time (P < 0.001), number of passes (P < 0.001), thrombolysis in cerebral infarction 2b/3 recanalisation (P = 0.034) and aspiration thrombectomy (P < 0.001) were independent factors affecting patient total DAP, whereas baseline National Institutes of Health Stroke Scale (P = 0.043), puncture to recanalisation (P = 0.003), fluoroscopy time (P = 0.009) and number of passes (P = 0.009) were factors affecting the neurointerventionalist dose. CONCLUSION New reference patient doses lower than those in previously published studies were defined. However, the operator's doses were higher than those in the only available study reporting on operator's dose during cerebral interventions.
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Affiliation(s)
- Andrej Klepanec
- University Hospital Trnava, A. Zarnova 11, 917 75, Trnava, Slovakia.,University of Ss. Cyril and Methodius in Trnava, Namestie J. Herdu 2, 917 01, Trnava, Slovakia
| | - Dusan Salat
- University of Ss. Cyril and Methodius in Trnava, Namestie J. Herdu 2, 917 01, Trnava, Slovakia
| | - Jan Harsany
- University Hospital Trnava, A. Zarnova 11, 917 75, Trnava, Slovakia
| | - Matus Hoferica
- University Hospital Trnava, A. Zarnova 11, 917 75, Trnava, Slovakia
| | - Georgi Krastev
- University Hospital Trnava, A. Zarnova 11, 917 75, Trnava, Slovakia
| | - Jozef Haring
- University Hospital Trnava, A. Zarnova 11, 917 75, Trnava, Slovakia
| | - Miroslav Mako
- University Hospital Trnava, A. Zarnova 11, 917 75, Trnava, Slovakia
| | - Pavol Janega
- Faculty of Medicine, Comenius University in Bratislava, Špitálska 24, 813 72, Bratislava, Slovakia
| | - Lenka Janosikova
- University of Ss. Cyril and Methodius in Trnava, Namestie J. Herdu 2, 917 01, Trnava, Slovakia
| | - Viera Lehotska
- Faculty of Medicine, Comenius University in Bratislava, Heydukova 10, 812 50, Bratislava, Slovakia.
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Betti M, Mazzoni LN, Belli G, Bernardi L, Bicchi S, Busoni S, Fedele D, Fedeli L, Gasperi C, Gori C, Quattrocchi M, Taddeucci A, Vigliotti M, Vaiano A, Rossi F. Surgeon eye lens dose monitoring in catheterization lab: A multi-center survey: Invited for ECMP 2018 Focus Issue. Phys Med 2019; 60:127-131. [PMID: 31000072 DOI: 10.1016/j.ejmp.2019.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To perform a multi-centre survey on the eye lens equivalent dose absorbed by primary interventionalist during catheterization procedures, using a personal dosimeter placed close to the eye lens. METHODS 15 different cardiologists working in 3 different centers, for a total of 5 operating rooms were enrolled. All of them were provided with a single thermoluminescent dosimeter positioned on the inner side of the temples of eyeglasses. The dose monitoring, performed on a two-months basis, started in 2016 and is still running. All dose measurements were performed by a ISO 17025 standard accredited dosimetry service thus providing certified uncertainties as well. Correlation of eye lens and wrist dose with KAP was also investigated. RESULTS A total number of 101 eye lens measurements were performed. Annual eye lens dose estimation was obtained for all 15 surgeons (mean, mode, range, standard deviation: 10.8, 8, 4.9-27.3, 5.6 mSv, respectively). Uncertainties on annual eye lens dose estimations ranged between 10% and 20%. No significant correlation was found between eye lens dose and KAP. CONCLUSIONS Cardiologists involved in catheterization procedures may receive annual eye lens doses close to the ICRP 118 dose limit and thus individual monitoring with a dedicated dosimeter should be carried out. Uncertainty assessment play a relevant role in eye lens equivalent dose estimation to ensure not to exceed dose limit.
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Affiliation(s)
- Margherita Betti
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | | | - Giacomo Belli
- Azienda Ospedaliero-Universitaria Careggi, Medical Physics Unit, Firenze, Italy
| | - Luca Bernardi
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | - Sara Bicchi
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | - Simone Busoni
- Azienda Ospedaliero-Universitaria Careggi, Medical Physics Unit, Firenze, Italy
| | - David Fedele
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | - Luca Fedeli
- Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Sesto Fiorentino, Firenze, Italy
| | - Chiara Gasperi
- Azienda Usl Toscana Sud-Est, Medical Physics Unit, Arezzo, Italy
| | - Cesare Gori
- Università degli Studi di Firenze, Dipartimento di Fisica e Astronomia, Sesto Fiorentino, Firenze, Italy; INFN, Sezione di Firenze, Sesto Fiorentino, Italy
| | | | - Adriana Taddeucci
- Azienda Ospedaliero-Universitaria Careggi, Medical Physics Unit, Firenze, Italy
| | | | - Angela Vaiano
- Azienda Usl Toscana Centro, Medical Physics Unit Pistoia Prato, Italy
| | - Francesco Rossi
- Azienda Ospedaliero-Universitaria Careggi, Medical Physics Unit, Firenze, Italy
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Proposed achievable levels of dose and impact of dose-reduction systems for thrombectomy in acute ischemic stroke: an international, multicentric, retrospective study in 1096 patients. Eur Radiol 2019; 29:3506-3515. [DOI: 10.1007/s00330-019-06062-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/08/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
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