van der Marel K, Vedantham S, van der Bom I M J, Howk M, Narain T, Ty K, Karellas A, Gounis M J, Puri A S, Wakhloo A K
From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts.
Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands.
AJNR Am J Neuroradiol. 2017 Mar;38(3):442-449. doi: 10.3174/ajnr.A5049. Epub 2017 Jan 19.
Advancements in medical device and imaging technology as well as accruing clinical evidence have accelerated the growth of the endovascular treatment of cerebrovascular diseases. However, the augmented role of these procedures raises concerns about the radiation dose to patients and operators. We evaluated patient doses from an x-ray imaging platform with radiation dose-reduction technology, which combined image noise reduction, motion correction, and contrast-dependent temporal averaging with optimized x-ray exposure settings.
In this single-center, retrospective study, cumulative dose-area product inclusive of fluoroscopy, angiography, and 3D acquisitions for all neurovascular procedures performed during a 2-year period on the dose-reduction platform were compared with a reference platform. Key study features were the following: The neurointerventional radiologist could select the targeted dose reduction for each patient with the dose-reduction platform, and the statistical analyses included patient characteristics and the neurointerventional radiologist as covariates. The analyzed outcome measures were cumulative dose (kerma)-area product, fluoroscopy duration, and administered contrast volume.
A total of 1238 neurointerventional cases were included, of which 914 and 324 were performed on the reference and dose-reduction platforms, respectively. Over all diagnostic and neurointerventional procedures, the cumulative dose-area product was significantly reduced by 53.2% (mean reduction, 160.3 Gy × cm; < .0001), fluoroscopy duration was marginally significantly increased (mean increase, 5.2 minutes; = .0491), and contrast volume was nonsignificantly increased (mean increase, 15.3 mL; = .1616) with the dose-reduction platform.
A significant reduction in patient radiation dose is achievable during neurovascular procedures by using dose-reduction technology with a minimal impact on workflow.
医疗设备和成像技术的进步以及不断积累的临床证据加速了脑血管疾病血管内治疗的发展。然而，这些手术作用的增强引发了对患者和操作人员辐射剂量的担忧。我们评估了采用辐射剂量降低技术的X射线成像平台对患者的剂量，该技术结合了图像降噪、运动校正以及与优化X射线曝光设置相关的对比度依赖时间平均。
在这项单中心回顾性研究中，将在剂量降低平台上进行的为期2年的所有神经血管手术的透视、血管造影和三维采集的累积剂量面积乘积与参考平台进行比较。主要研究特点如下：神经介入放射科医生可以使用剂量降低平台为每位患者选择目标剂量降低，统计分析将患者特征和神经介入放射科医生作为协变量。分析的结果指标为累积剂量（比释动能）面积乘积、透视持续时间和注入的对比剂体积。
共纳入1238例神经介入病例，其中分别在参考平台和剂量降低平台上进行了914例和324例。在所有诊断和神经介入手术中，剂量降低平台使累积剂量面积乘积显著降低53.2%（平均降低160.3Gy×cm；P<.0001），透视持续时间略有显著增加（平均增加5.2分钟；P = .0491），对比剂体积无显著增加（平均增加15.3mL；P = .1616）。
在神经血管手术中，使用剂量降低技术可显著降低患者辐射剂量，且对工作流程影响最小。
