Patient and occupational dose in neurointerventional procedures

Abstract

Neurointerventional procedures can involve very high doses of radiation to the patient. Our purpose was to quantify the exposure of patients and workers during such procedures, and to use the data for optimisation. We monitored the coiling of 27 aneurysms, and embolisation of four arteriovenous malformations. We measured entrance doses at the skull of the patient using thermoluminescent dosemeters. An observer logged the dose-area product (DAP), fluoroscopy time and characteristics of the digital angiographic and fluoroscopic projections. We also measured entrance doses to the workers at the glabella, neck, arms, hands and legs. The highest patient entrance dose was 2.3 Gy, the average maximum entrance dose 0.9±0.5 Gy. The effective dose to the patient was estimated as 14.0±8.1 mSv. Other average values were: DAP 228±131 Gy cm², fluoroscopy time 34.8±12.6 min, number of angiographic series 19.3±9.4 and number of frames 267±143. The highest operator entrance dose was observed on the left leg (235±174 µGy). The effective dose to the operator, wearing a 0.35 mm lead equivalent apron, was 6.7±4.6 µSv. Thus, even the highest patient entrance dose was in the lower part of the range in which nonstochastic effects might arise. Nevertheless, we are trying to reduce patient exposure by optimising machine settings and clinical protocols, and by informing the operator when the total DAP reaches a defined threshold. The contribution of neurointerventional procedures to occupational dose was very small.