A Patient Dose-Reduction Technique for Neuroendovascular Image-Guided Interventions: Image-Quality Comparison Study

Abstract

Background and Purpose The ROI–dose-reduced intervention (ROI–DRI) technique represents an extension of ROI fluoroscopy combining x-ray entrance skin dose reduction with spatially different recursive temporal filtering to reduce excessive image noise in the dose-reduced periphery in real-time. The aim of our study was to compare the image quality of simulated neurointerventions with regular and reduced radiation doses using a standard flat-panel detector system. Methods Ten 3D-printed intracranial aneurysm models were generated based on a single patient vasculature derived from intracranial DSA and CTA (IRB567513). The incident dose to each model was reduced using a 0.7 mm thick copper attenuator with a circular ROI hole (10 mm diameter) in the middle mounted inside the Toshiba Infinix C-arm (Toshiba America Medical Systems, Tustin, CA). Each model was treated twice with a primary coiling intervention using ROI-DRI and regular-dose intervention (RDI) protocols. Eighty images acquired at various intervention stages were shown twice to two neurointerventionists who independently scored imaging qualities (visibility of aneurysm-parent vessel morphology, associated vessels, and/or devices used). Dose reduction measurements were performed using an ionization chamber. Results Total integral dose reduction of 62% per frame was achieved. Mean scores for RDI and ROIDRI images did not differ significantly, suggesting similar image quality. Overall intrarater agreement for all scored criteria was substantial (Kendall’s τ =0.62887; p<0.0001). Overall interrater agreement for all criteria was fair (κ = 0.2816 with 95% CI of 0.2060–0.3571). Conclusion Substantial dose reduction (62%) with a live peripheral image was achieved without compromising feature visibility during neuroendovascular intervention.

How should radiation exposure be handled in fluoroscopy‐guided endoscopic procedures in the field of gastroenterology?

“…Furthermore, in recent years, a new technology called “spot fluoroscopy” has been developed, in which the fluoroscopic image of the entire abdomen is displayed as a still image on the monitor screen, and only the area where the procedure is being performed, such as the tip of the guidewire, can be observed in real time and moved within the still image 61 . This technology can reportedly perform procedures with reduced exposure dose compared with conventional fluoroscopy 62,63 …”

“…61 This technology can reportedly perform procedures with reduced exposure dose compared with conventional fluoroscopy. 62,63 In addition, there have been many reports in the pediatric urology department to reduce the exposure of pediatric patients, which indicates the need to reduce the exposure of endoscopists.…”