School of Medicine, University College Cork, Cork, Ireland.
Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
Eur Radiol. 2018 Sep;28(9):3669-3675. doi: 10.1007/s00330-018-5405-3. Epub 2018 Apr 12.
There is potential for high radiation exposure during neurointerventional procedures. Increasing regulatory requirements mandate dose monitoring of patients and staff, and justification of high levels of radiation exposure. This paper demonstrates the potential to use radiation dose-tracking software to establish local diagnostic reference levels.
Consecutive neurointerventional procedures, performed in a single institution within a one-year period, were retrospectively studied. Dose area product (DAP) data were collected using dose-tracking software and clinical data obtained from a prospectively generated patient treatment database.
Two hundred and sixty-four procedures met the selection criteria. Median DAP was 100 Gy.cm for aneurysm coiling procedures, 259 Gy.cm for arteriovenous malformation (AVM) embolisation procedures, 87 Gy.cm for stroke thrombolysis/thrombectomy, and 74 Gy.cm for four-vessel angiography. One hundred and nine aneurysm coiling procedures were further studied. Six significant variables were assessed using stepwise regression analysis to determine effect on DAP. Aneurysm location (anterior vs posterior circulation) had the single biggest effect (p = 0.004).
This paper confirms variable radiation exposures during neurointerventional procedures. The 75th percentile (used to define diagnostic reference levels) of DAP measurements represents a reasonable guidance metric for monitoring purposes. Results indicate that aneurysm location has the greatest impact on dose during coiling procedures and that anterior and posterior circulation coiling procedures should have separate diagnostic reference levels.
• Dose-tracking software is useful for monitoring patient radiation dose during neurointerventional procedures • This paper provides a template for methodology applicable to any interventional suite • Local diagnostic reference levels were defined by using the 75th percentile of DAP as per International Commission on Radiological Protection recommendations • Aneurysm location is the biggest determinant of radiation dose during coiling procedures. • Anterior and posterior circulation coiling procedures should have separate diagnostic reference levels.
神经介入手术过程中存在潜在的高辐射暴露风险。不断增加的监管要求规定必须对患者和医护人员的剂量进行监测，并对高剂量辐射暴露进行正当化说明。本文展示了使用辐射剂量跟踪软件来建立局部诊断参考水平的潜力。
回顾性研究了在一家机构一年内进行的连续神经介入手术。使用剂量跟踪软件收集剂量面积乘积（DAP）数据，并从前瞻性生成的患者治疗数据库中获取临床数据。
符合选择标准的 264 例手术。在动脉瘤线圈栓塞术中，中位数 DAP 为 100Gy.cm；在动静脉畸形（AVM）栓塞术中，中位数 DAP 为 259Gy.cm；在脑卒中溶栓/血栓切除术时，中位数 DAP 为 87Gy.cm；在四血管造影中，中位数 DAP 为 74Gy.cm。进一步研究了 109 例动脉瘤线圈栓塞术。使用逐步回归分析评估了 6 个显著变量对 DAP 的影响。动脉瘤位置（前循环与后循环）具有最大的影响（p=0.004）。
本文证实了神经介入手术过程中辐射暴露存在差异。DAP 测量的第 75 百分位数（用于定义诊断参考水平）是监测目的的合理指导指标。结果表明，动脉瘤位置对线圈栓塞术中的剂量影响最大，且前循环和后循环线圈栓塞术应具有单独的诊断参考水平。
剂量跟踪软件可用于监测神经介入手术过程中的患者辐射剂量。
本文提供了适用于任何介入手术室的方法模板。
根据国际辐射防护委员会的建议，使用 DAP 的第 75 百分位数定义了局部诊断参考水平。
动脉瘤位置是线圈栓塞术中辐射剂量的最大决定因素。
前循环和后循环线圈栓塞术应具有单独的诊断参考水平。
