Ihn Yon-Kwon, Kim Bum-Soo, Jeong Hae Woong, Suh Sang Hyun, Won Yoo Dong, Lee Young-Jun, Kim Dong Joon, Jeon Pyong, Ryu Chang-Woo, Suh Sang-Il, Choi Dae Seob, Choi See Sung, Kim Sang Heum, Byun Jun Soo, Rho Jieun, Song Yunsun, Jeong Woo Sang, Hong Noah, Baik Sung Hyun, Park Jeong Jin, Lim Soo Mee, Kim Jung-Jae, Yoon Woong
Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Neurointervention. 2021 Nov;16(3):240-251. doi: 10.5469/neuroint.2021.00437. Epub 2021 Oct 26.
To assess patient radiation doses during diagnostic and therapeutic neurointerventional procedures from multiple centers and propose dose reference level (RL).
Consecutive neurointerventional procedures, performed in 22 hospitals from December 2020 to June 2021, were retrospectively studied. We collected data from a sample of 429 diagnostic and 731 therapeutic procedures. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time (FT), and total number of image frames (NI) were obtained. RL were calculated as the 3rd quartiles of the distribution.
Analysis of 1160 procedures from 22 hospitals confirmed the large variability in patient dose for similar procedures. RLs in terms of DAP, CAK, FT, and NI were 101.6 Gy·cm2, 711.3 mGy, 13.3 minutes, and 637 frames for cerebral angiography, 199.9 Gy·cm2, 3,458.7 mGy, 57.3 minutes, and 1,000 frames for aneurysm coiling, 225.1 Gy·cm2, 1,590 mGy, 44.7 minutes, and 800 frames for stroke thrombolysis, 412.3 Gy·cm2, 4,447.8 mGy, 99.3 minutes, and 1,621.3 frames for arteriovenous malformation (AVM) embolization, respectively. For all procedures, the results were comparable to most of those already published. Statistical analysis showed male and presence of procedural complications were significant factors in aneurysmal coiling. Male, number of passages, and procedural combined technique were significant factors in stroke thrombolysis. In AVM embolization, a significantly higher radiation dose was found in the definitive endovascular cure group.
Various RLs introduced in this study promote the optimization of patient doses in diagnostic and therapeutic interventional neuroradiology procedures. Proposed 3rd quartile DAP (Gy·cm2) values were 101.6 for diagnostic cerebral angiography, 199.9 for aneurysm coiling, 225.1 for stroke thrombolysis, and 412.3 for AVM embolization. Continual evolution of practices and technologies requires regular updates of RLs.
评估多个中心在诊断性和治疗性神经介入手术过程中患者的辐射剂量，并提出剂量参考水平（RL）。
回顾性研究了2020年12月至2021年6月在22家医院进行的连续神经介入手术。我们从429例诊断性手术和731例治疗性手术的样本中收集数据。获取了包括剂量面积乘积（DAP）、累积空气比释动能（CAK）、透视时间（FT）和图像帧数（NI）等参数。RL计算为分布的第3四分位数。
对22家医院的1160例手术进行分析，证实了类似手术中患者剂量存在很大差异。脑血管造影的DAP、CAK、FT和NI的RL分别为101.6 Gy·cm²、711.3 mGy、13.3分钟和637帧；动脉瘤栓塞术的RL分别为199.9 Gy·cm²、3458.7 mGy、57.3分钟和1000帧；中风溶栓的RL分别为225.1 Gy·cm²、1590 mGy、44.7分钟和800帧；动静脉畸形（AVM）栓塞术的RL分别为412.3 Gy·cm²、4447.8 mGy、99.3分钟和1621.3帧。对于所有手术，结果与大多数已发表的结果相当。统计分析表明，男性和手术并发症的存在是动脉瘤栓塞术的重要因素。男性、穿刺次数和手术联合技术是中风溶栓的重要因素。在AVM栓塞术中，确定性血管内治愈组的辐射剂量明显更高。
本研究中引入的各种RL有助于优化诊断性和治疗性介入神经放射学手术中的患者剂量。诊断性脑血管造影的第3四分位数DAP（Gy·cm²）值为101.6，动脉瘤栓塞术为199.9，中风溶栓为225.1，AVM栓塞术为412.3。实践和技术的不断发展需要定期更新RL。
