Radiation exposure of image-guided intrathecal administration of nusinersen to adult patients with spinal muscular atrophy
To examine diagnostic reference levels (DRL) and achievable doses (AD) of image-guided and size-specific dose estimates (SSDE) and organ and effective doses of CT-guided intrathecal nusinersen administration to adult patients with spinal muscular atrophy (SMA).
This study involved a total of 60 image-guided intrathecal nusinersen treatments between August 2017 and June 2018. Patient cohort comprised 14 adult patients with the following SMA types: type 2 (n = 9) and type 3 (n = 5) with a mean age of 33.6 years (age range 25–57 years). DRL, AD, SSDE, organ, and effective doses were assessed with a dose-monitoring program based on the Monte Carlo simulation techniques.
DRL and AD for computed tomography are summarised as follows: in terms of CT-dose index (CTDIvol), DRL 56.4 mGy and AD 36.7 mGy; in terms of dose-length product (DLP), DRL 233.1 mGy cm and AD 120.1 mGy cm. DRL and AD for fluoroscopic guidance were distributed as follows: in terms of dose-area product (DAP), DRL 239.1 μGy m2 and AD 135.2 mGy cm2. Mean SSDE was 9.2 mGy. Mean effective dose of the CT-guided injections was 2.5 mSv (median 2.0 mSv, IQR 1.3–3.2 mSv). Highest organ doses in the primary beam of radiation were the small intestine 12.9 mSv, large intestine 9.5 mSv, and ovaries 3.6 mSv.
Radiation exposure of SMA patients measured as DRLs is generally not higher compared with patients without SMA despite severe anatomical hazards. Dose monitoring data may allow clinicians to stratify radiation risk, identify organs at risk, and adopt measures for specific radiation dose reduction.
KeywordsSpinal muscular atrophy Radiation exposure Spinal injection Computed tomography Fluoroscopy
International Commission on Radiological Protection
Dose area product
Dose length product
Diagnostic reference levels
Kilovolt (tube voltage)
Milliampere second (tube current–time product)
Millisievert (effective dose)
Spinal muscular atrophy
Survival motor neuron
Size-specific dose estimates
No funding was received for this study.
Compliance with ethical standards
Conflict of interest
B. Stolte received travel reimbursement from Biogen. C. Kleinschnitz acts as consultant, received travel reimbursement, speaker and Advisory Board honoraria from Biogen. T. Hagenacker acts as consultant, received travel reimbursement, speaker and advisory board honoraria from Biogen and speaker honoraria from Novartis and Biogen. C. Mönninghoff acts as consultant, received travel reimbursement, and advisory board honoraria from Biogen.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
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