Monitoring neurointerventional radiation doses using dose-tracking software: implications for the establishment of local diagnostic reference levels
- 101 Downloads
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.cm2 for aneurysm coiling procedures, 259 Gy.cm2 for arteriovenous malformation (AVM) embolisation procedures, 87 Gy.cm2 for stroke thrombolysis/thrombectomy, and 74 Gy.cm2 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.
KeywordsRadiation exposure Intracranial aneurysm Cerebral angiography Intracranial arteriovenous malformation Thrombectomy
Diagnostic reference level
International Atomic Energy Agency
International Commission on Radiological Protection
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Dr. Owen J O’Connor.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise (C.O’T.).
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• performed at one institution
- 5.Authors on behalf of ICRP, Stewart FA, Akleyev AV et al (2012) ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs—threshold doses for tissue reactions in a radiation protection context. Ann ICRP 41:1–322Google Scholar
- 6.Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom. Available via: https://ec.europa.eu/energy/sites/ener/files/documents/CELEX-32013L0059-EN-TXT.pdf
- 15.Faulkner K, Christofides S, Lillicrap S, Horton P, Malone J (2012) Criteria for the acceptability of radiological equipment. Radiation protection no. 162. European Union, LuxembourgGoogle Scholar
- 18.ICRP (2017) Diagnostic reference levels in medical imaging. ICRP Publication 135. Ann ICRP 46(1)Google Scholar
- 21.IAEA (2013) Diagnostic reference levels (DRLs) in medical imaging. Available via: https://rpop.iaea.org/RPOP/RPoP/Content/InformationFor/HealthProfessionals/1_Radiology/Optimization/diagnostic-reference-levels.htm. Accessed 13 Nov 17
- 31.(2017) EUCLID—European study on clinical diagnostic reference levels for X-ray medical imaging. ESR EuroSafe Imaging. Available via: http://www.eurosafeimaging.org/euclid