Yi Ho Jun, Sung Jae Hoon, Lee Dong Hoon, Kim Sang Wook, Lee Sang Won
Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea.
Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea.
World Neurosurg. 2017 Apr;100:216-223. doi: 10.1016/j.wneu.2017.01.004. Epub 2017 Jan 12.
Adverse effects of increased use of cerebral digital subtraction angiography (DSA) include radiation-induced skin reactions and increased risk of malignancy. This study aimed to identify a method for reducing radiation exposure during routine cerebral DSA.
A retrospective review of 138 consecutive adult patients who underwent DSA with a biplane angiography system (Artis Zee, Siemens, Germany) from September 2015 to February 2016 was performed. In January 2016, the dose parameter was reset by the manufacturer from 2.4 μGy to 1.2 μGy. Predose (group 1) and postdose parameter reduction (group 2) groups were established. Angiograms and procedure examination protocols were reviewed according to patient age, gender, and diagnosis and angiography techniques were reviewed on the basis of the following radiation dose parameters: fluoroscopy time, reference point air kerma (Ka,r; in mGy), and kerma-area product (PKA; in μGym).
The mean Ka,r values in groups 1 and 2 were 1841.5 mGy and 1274.8 mGy, respectively. The mean PKA values in groups 1 and 2 were 23212.5 μGym and 14854.0 μGym, respectively. Ka,r and PKA values were significantly lower in group 2 compared with group 1 (P < 0.001). Among individual factors, young age was a determining factor for reduced fluoroscopy time (P < 0.001), Ka,r (P = 0.047), and PKA (P = 0.022).
Increased awareness of radiation risks, as well as the establishment of strategies to reduce radiation dose, led to lower radiation doses for DSA. The use of appropriate examinations and low-dose parameters in fluoroscopy contributed significantly to the radiation dose reductions.
增加脑部数字减影血管造影（DSA）的使用所带来的不良反应包括辐射引起的皮肤反应以及患恶性肿瘤风险增加。本研究旨在确定一种在常规脑部DSA期间减少辐射暴露的方法。
对2015年9月至2016年2月期间使用双平面血管造影系统（德国西门子公司的Artis Zee）进行DSA检查的138例连续成年患者进行回顾性研究。2016年1月，制造商将剂量参数从2.4μGy重新设定为1.2μGy。设立了预剂量组（第1组）和剂量参数降低后组（第2组）。根据患者年龄、性别和诊断对血管造影片和操作检查方案进行回顾，并根据以下辐射剂量参数对血管造影技术进行回顾：透视时间、参考点空气比释动能（Ka,r；单位为mGy）和比释动能面积乘积（PKA；单位为μGym）。
第1组和第2组的平均Ka,r值分别为1841.5 mGy和1274.8 mGy。第1组和第2组的平均PKA值分别为23212.5μGym和14854.0μGym。与第1组相比，第2组的Ka,r和PKA值显著更低（P < 0.001）。在个体因素中，年轻是透视时间缩短（P < 0.001）、Ka,r（P = 0.047）和PKA（P = 0.022）的决定因素。
对辐射风险认识的提高以及降低辐射剂量策略的制定，使得DSA的辐射剂量降低。在透视中使用适当的检查和低剂量参数对辐射剂量的降低有显著贡献。
