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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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Weyland CS, Jesser J, Bourgart I, Hilgenfeld T, Breckwoldt MO, Vollherbst D, Schmitt N, Seker F, Bendszus M, Möhlenbruch MA. Occupational radiation exposure of neurointerventionalists during endovascular stroke treatment. Eur J Radiol 2023; 164:110882. [PMID: 37201247 DOI: 10.1016/j.ejrad.2023.110882] [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: 02/13/2023] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Radiological neuro-interventions, especially endovascular stroke treatment (EST), are increasing in case numbers worldwide with increasing occupational radiation exposure. Aim of this study was to define the radiation exposure of neurointerventionalists (NI) during EST and to compare the accumulated dose reaching the left arm with the left temple. METHODS This is a prospective observational study in a tertiary stroke center conducted between 11/2021 and 07/2022. Radiation exposure was measured using real time dosimetry with dosimeters being carried by the NI during EST simultaneously at the left temple and left arm. The effective dose [µSV] per dose area product (DAP) and potential influencing factors were compared in univariate analysis between the two dosimeter positions. RESULTS In total, 82 ESTs were analyzed with a median DAP of 6179 µGy*m2 (IQR 3271 µGy*m2-11720 µGy*m2). The accumulated dose at the left arm and left temple correlated with the DAP and fluoroscopy time of the EST (DAP and arm: p = 0.01, DAP and temple: p = 0.006). The radiation exposure (RE) showed a wide range and did not differ between the two dosimeter positions (median, IQR arm 7 µSV, IQR 3.1-16.9 µSV, min. 0.3 µSV max. 64.5 µSV) vs. head 7 µSv, IQR 3.2-17.4 µSV, min. 0.38 µSV, max. 48.6 µSV, p = 0.94). Occupational RE depends on the number of thrombectomy attempts, but not the target vessel occlusion location or the NI's body height. CONCLUSION Neurointerventionalists experience a generally low but very variable radiation exposure during EST, which depends on the intervention's fluoroscopy time and dose area product as well as thrombectomy attempts but does not differ between left temple and left arm.
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Affiliation(s)
- Charlotte S Weyland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Department of Neuroradiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52076 Aachen, Germany.
| | - Jessica Jesser
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Isabella Bourgart
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Michael O Breckwoldt
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Dominik Vollherbst
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Niclas Schmitt
- 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.
| | - Martin Bendszus
- Department of Neuroradiology, 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.
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Peter G, Hesselmann V, Ilnicki M, Illies T, Karajanev K, Kämmerer F, Neuner B, Paukisch H, Eckert B. Occlusion Type, Number of Recanalization Passages and Dose Program Determine Radiation Dose in Endovascular Stroke Thrombectomy. Clin Neuroradiol 2022; 32:385-392. [PMID: 35391551 DOI: 10.1007/s00062-022-01157-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 03/03/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Identification of independent treatment factors associated with high radiation exposure during endovascular mechanical thrombectomy (EMT) in acute ischemic stroke. METHODS This retrospective analysis included all patients treated by means of EMT during the 2‑year period 2017-2018 in a comprehensive stroke center. The EMT were performed by four internal and three external certified neuroradiologists in a clinic overlapping on call system. Radiation exposure as the dependent variable (dose area product DAP, Gy ⋅ cm2) was dichotomized in < 100 Gy ⋅ cm2 and ≥ 100 Gy ⋅ cm2. Independent variables were age (< 75 years vs. ≥ 75 years), time of intervention (during vs. beyond workday), treating neuroradiologist (internal vs. external), occlusion type ("mono" vs. "tandem"), reperfusion success (TICI 0-2A vs. TICI 2B/3), recanalization attempts (≤ 2 vs. > 2) and dose protocol (normal dose in 2017 vs. low dose in 2018). RESULTS The EMT treatment of 208 patients (111 female, 97 male, mean age 71.6 years) was analyzed. Median DAP was 86.6 Gy ⋅ cm2 and could be reduced from 104.8 Gy ⋅ cm2 (N = 105 in 2017) to 73.3 Gy ⋅ cm2 (N = 103 in 2018) with LD program. Univariable and multivariable binary logistic regression analysis revealed a significantly increased radiation exposure (≥ 100 Gy ⋅ cm2) in tandem occlusion type (P < 0.001), > 2 recanalization attempts (P < 0.001) and normal dose protocol (P = 0.002). CONCLUSION Low dose programs can significantly reduce the radiation exposure in EMT. High radiation exposure is significantly associated with more than two recanalization attempts and in cases of tandem occlusions.
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Affiliation(s)
- Gregor Peter
- Institut für Radiologie und Neuroradiologie, Asklepios Klinik Altona, Hamburg, Germany.
| | - Volker Hesselmann
- Radiologie/Neuroradiologie, Asklepios Klinik Nord-Heidberg, Hamburg, Germany
| | - Maciej Ilnicki
- Institut für Radiologie und Neuroradiologie, Asklepios Klinik Altona, Hamburg, Germany
| | - Till Illies
- Institut für Radiologie und Neuroradiologie, Asklepios Klinik Altona, Hamburg, Germany
| | | | - Felix Kämmerer
- Institut für Radiologie und Neuroradiologie, Asklepios Klinik Altona, Hamburg, Germany
- Neuroradiology, Ruhr-University, St. Josef Hospital, Bochum, Germany
| | - Bruno Neuner
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Harald Paukisch
- Neuroradiologie - Albers-Schönberg-Institut für Strahlendiagnostik, Asklepios Klinik St. Georg, Hamburg, Germany
- Universitätsklinik für Neuroradiologie, Otto von Guericke Universität, Magdeburg, Germany
| | - Bernd Eckert
- Institut für Radiologie und Neuroradiologie, Asklepios Klinik Altona, Hamburg, Germany
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Canton GP, Luvizutto GJ, Hamamoto Filho PT, Minicucci MF, Modolo GP, Trindade AP, Bazan R, Souza JTD. Safety of the effective radiation dose received during stroke hospitalization. J Vasc Bras 2021; 20:e20210142. [PMID: 35096032 PMCID: PMC8759585 DOI: 10.1590/1677-5449.210142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background Neuroimaging is widely used for diagnosis and treatment of stroke. However, little is known about whether the radiation doses received by patients comply with international safety guidelines. Objectives The aim of this study was to evaluate the effective radiation dose received while in hospital for stroke and analyze its safety according to current guidelines. Methods This cross-sectional study included 109 patients who were hospitalized and diagnosed with ischemic stroke. The National Institutes of Health Stroke Scale was used to evaluate stroke severity, the Bamford clinical classification was used for topography, and the TOAST classification was used for etiology. The computed tomography dose index and size-specific dose estimates were used to calculate the effective radiation dose (ERD) received while in hospital. A Mann-Whitney test was used to compare the ERD received by thrombolysed and non-thrombolysed patients. Non-parametric statistics were used to analyze the data with a 95% confidence interval. Results During the study period, the median ERD received was 10.9 mSv. Length of stay was not associated with radiation exposure. No differences were demonstrated in ERD according to stroke etiology or Bamford clinical classification. Patients who had CT perfusion (only or in addition to CT or angiotomography) received the highest ERD (46.5 mSv) and the difference compared to those who did not (10.8 mSv) was statistically significant (p<0.001). No differences were found in the ERD between thrombolysed and non-thrombolysed patients. There was no correlation between ERD while in hospital and stroke severity. Conclusions According to the current national guidelines, the protocol for examining images at our stroke unit is safe in terms of the ERD received by the patient while in hospital. There was no difference in the ERD received by patients stratified by thrombolytic treatment or stroke severity.
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Weyland CS, Potreck A, Neuberger U, Möhlenbruch MA, Nagel S, Ringleb PA, Bendszus M, Pfaff JAR. Radiation exposure in endovascular stroke treatment of acute basilar artery occlusions-a matched-pair analysis. Neuroradiology 2020; 62:1701-1707. [PMID: 32651621 PMCID: PMC7666669 DOI: 10.1007/s00234-020-02490-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/30/2020] [Indexed: 01/13/2023]
Abstract
Abstract Purpose To determine the radiation exposure in endovascular stroke treatment (EST) of acute basilar artery occlusions (BAO) and compare it with radiation exposure of EST for embolic middle cerebral artery occlusions (MCAO). Methods In this retrospective analysis of an institutional review board−approved prospective stroke database of a comprehensive stroke center, we focused on radiation exposure (as per dose area product in Gy × cm2, median (IQR)), procedure time, and fluoroscopy time (in minutes, median [IQR]) in patients receiving EST for BAO. Patients who received EST for BAO were matched case by case with patients who received EST for MCAO according to number of thrombectomy attempts, target vessel reperfusion result, and thrombectomy technique. Results Overall 180 patients (n = 90 in each group) were included in this analysis. General anesthesia was conducted more often during EST of BAO (BAO: 75 (83.3%); MCAO: 18 (31.1%), p < 0.001). Procedure time (BAO: 31 (20–43); MCAO: 27 (18–38); p value 0.226) and fluoroscopy time (BAO: 29 (20–59); MCAO: 29 (17–49), p value 0.317) were comparable. Radiation exposure was significantly higher in patients receiving EST for BAO (BAO: 123.4 (78.7–204.2); MCAO: 94.3 (65.5–163.7), p value 0.046), which represents an increase by 23.7%. Conclusion Endovascular stroke treatment of basilar artery occlusions is associated with a higher radiation exposure compared with treatment of middle cerebral artery occlusions.
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Affiliation(s)
- Charlotte S Weyland
- 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
| | - Ulf Neuberger
- Department of Neuroradiology, 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
| | - Simon Nagel
- 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
| | - 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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Weyland CS, Neuberger U, Seker F, Nagel S, Arthur Ringleb P, Möhlenbruch MA, Bendszus M, Pfaff JA. Effect of treatment technique on radiation exposure in mechanical thrombectomy for acute ischaemic stroke: A matched-pair analysis. Neuroradiol J 2020; 33:286-291. [PMID: 32419602 DOI: 10.1177/1971400920925433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE This study aimed to compare radiation exposure (RE) in patients receiving mechanical thrombectomy (MT) for large-vessel occlusions in the anterior circulation using direct thrombo-aspiration (DT) versus stent-retriever thrombectomy under continuous distal aspiration (STA). METHODS This was a retrospective single-centre analysis of an Institutional Review Board-approved stroke database of a comprehensive stroke centre focusing on RE per dose area product, procedure time (PT) and fluoroscopy time (FT) in patients receiving MT. Patients who received MT with DT were matched with patients treated using STA according to occlusion location, mode of anaesthesia, manoeuvre count and sex. RESULTS Apart from patient age (DT: M = 74 years (standard deviation (SD)=13 years); STA: M = 79 years (SD = 11 years); p = 0.023), there was no difference in baseline patient characteristics (n = 68 per group). PT (DT: median = 26 minutes (interquartile range (IQR) = 21-38 minutes); STA: median = 49 minutes (IQR 37-77 minutes); p < 0.0001) and FT (DT: median = 12 minutes (IQR 7-18 minutes); STA: median = 26 minutes (IQR 14-43 minutes); p < 0.0001) were shorter in patients who received MT using DT. RE (DT: median = 62.6 Gy·cm2 (IQR 41.7-89.4 Gy·cm2); STA: median = 89.8 Gy·cm2 (IQR 53.7-131.7 Gy·cm2); p = 0.034) was significantly lower in patients who received MT using DT. This represents a relative increase of RE, FT and PT by 43.6%, 116.6% and 88.5%, respectively, in patients who received MT using STA. CONCLUSION MT using DT is associated with shorter FT and PT and lower RE compared to matched patients treated with STA.
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Affiliation(s)
| | - Ulf Neuberger
- Department of Neuroradiology, Heidelberg University Hospital, Germany
| | - Fatih Seker
- Department of Neuroradiology, Heidelberg University Hospital, Germany
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Germany
| | | | | | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Germany
| | - Johannes Ar Pfaff
- Department of Neuroradiology, Heidelberg University Hospital, Germany
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