From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).
Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.
AJNR Am J Neuroradiol. 2018 Apr;39(4):734-741. doi: 10.3174/ajnr.A5552. Epub 2018 Feb 15.
The ROI-dose-reduced intervention technique represents an extension of ROI fluoroscopy combining x-ray entrance skin dose reduction with spatially different recursive temporal filtering to reduce excessive image noise in the dose-reduced periphery in real-time. The aim of our study was to compare the image quality of simulated neurointerventions with regular and reduced radiation doses using a standard flat panel detector system.
Ten 3D-printed intracranial aneurysm models were generated on the basis of a single patient vasculature derived from intracranial DSA and CTA. The incident dose to each model was reduced using a 0.7-mm-thick copper attenuator with a circular ROI hole (10-mm diameter) in the middle mounted inside the Infinix C-arm. Each model was treated twice with a primary coiling intervention using ROI-dose-reduced intervention and regular-dose intervention protocols. Eighty images acquired at various intervention stages were shown twice to 2 neurointerventionalists who independently scored imaging qualities (visibility of aneurysm-parent vessel morphology, associated vessels, and/or devices used). Dose-reduction measurements were performed using an ionization chamber.
A total integral dose reduction of 62% per frame was achieved. The mean scores for regular-dose intervention and ROI dose-reduced intervention images did not differ significantly, suggesting similar image quality. Overall intrarater agreement for all scored criteria was substantial (Kendall τ = 0.62887; < .001). Overall interrater agreement for all criteria was fair (κ = 0.2816; 95% CI, 0.2060-0.3571).
Substantial dose reduction (62%) with a live peripheral image was achieved without compromising feature visibility during neuroendovascular interventions.
基于 ROI 透视的 ROI 剂量减少干预技术是 ROI 透视的扩展，它结合了 X 射线入射皮肤剂量减少和空间上不同的递归时间滤波，以实时减少剂量减少周边的过度图像噪声。我们的研究目的是使用标准平板探测器系统比较模拟神经介入治疗中常规和减少辐射剂量的图像质量。
基于从颅内 DSA 和 CTA 获得的单个患者血管，生成了 10 个 3D 打印颅内动脉瘤模型。使用中间安装在 Infinix C 臂内的 0.7mm 厚的铜衰减器和中间的圆形 ROI 孔（直径 10mm）来减少每个模型的入射剂量。每个模型都用 ROI 剂量减少干预和常规剂量干预方案进行两次原发性线圈干预治疗。在不同的干预阶段采集了 80 张图像，由 2 位神经介入医生各观看两次，他们独立对成像质量（动脉瘤-母血管形态、相关血管和/或使用的设备的可见性）进行评分。使用电离室进行剂量减少测量。
每个图像帧的总积分剂量减少了 62%。常规剂量干预和 ROI 剂量减少干预图像的平均评分无显著差异，提示图像质量相似。所有评分标准的整体内部观察者一致性较高（Kendall τ = 0.62887；<0.001）。所有标准的整体外部观察者一致性为中等（κ = 0.2816；95%CI，0.2060-0.3571）。
在不影响神经血管内介入期间特征可见度的情况下，实现了实质性的剂量减少（62%），同时获得了实时周边图像。
