Abstract
Purpose
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).
Methods
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.
Results
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.
Conclusion
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.
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Abbreviations
- AD:
-
Achievable doses
- CT:
-
Computed tomography
- CTDIvol :
-
CT-dose index
- ICRP:
-
International Commission on Radiological Protection
- IQR:
-
Interquartile range
- DAP:
-
Dose area product
- DLP:
-
Dose length product
- DRL:
-
Diagnostic reference levels
- kV:
-
Kilovolt (tube voltage)
- mAs:
-
Milliampere second (tube current–time product)
- mSv:
-
Millisievert (effective dose)
- SD:
-
Standard deviation
- SMA:
-
Spinal muscular atrophy
- SMN:
-
Survival motor neuron
- SSDE:
-
Size-specific dose estimates
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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.
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Oldenburg, D., Guberina, N., Stolte, B. et al. Radiation exposure of image-guided intrathecal administration of nusinersen to adult patients with spinal muscular atrophy. Neuroradiology 61, 565–574 (2019). https://doi.org/10.1007/s00234-019-02189-x
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DOI: https://doi.org/10.1007/s00234-019-02189-x