Patient Radiation Exposure During Diagnostic and Therapeutic Procedures for Intracranial Aneurysms: A Multicenter Study

Ihn, Yon Kwon; Kim, Bum Soo; Byun, Jun Soo; Suh, Sang Hyun; Won, Yoo Dong; Lee, Deok Hee; Kim, Byung Moon; Kim, Young Soo; Jeon, Pyeong; Ryu, Chang‐Woo; Suh, Sang Il; Choi, Dae Seob; Choi, See Sung; Choi, Jin Wook; Chang, Hyuk Won; Lee, Jae Woo; Kim, Sang Heum; Shin, Sang‐Goo; Lim, Soo Mee; Yoon, Woong; Jeong, Hae Woong; Han, Moon Hee

doi:10.5469/neuroint.2016.11.2.78

Cited by 30 publications

(21 citation statements)

References 19 publications

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“…For comparison, the dose of a routine CT examination of the abdomen is about 8–20 mSv, while the DAP for diagnostic cerebral angiography in patients with aneurysms is about 10,600 cGycm². 25 Image-guided therapy can be challenging in SMA patients and requires a high expertise as well as interdisciplinary cooperation between neurologists and neuroradiologists to successfully administer nusinersen and to minimise radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of intrathecal treatment with nusinersen in adult patients with spinal muscular atrophy

Stolte

Totzeck

Kizina

et al. 2018

Ther Adv Neurol Disord

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Background:Nusinersen is an intrathecally administered antisense oligonucleotide (ASO) and the first approved drug for the treatment of spinal muscular atrophy (SMA). However, progressive neuromyopathic scoliosis and the presence of spondylodesis can impede lumbar punctures in SMA patients. Our aim was to assess the feasibility and safety of the treatment in adults with SMA.Methods:For the intrathecal administration of nusinersen, we performed conventional, fluoroscopy-assisted and computer tomography (CT)-guided lumbar punctures in adult patients with type 2 and type 3 SMA. We documented any reported adverse events and performed blood tests.Results:We treated a total of 28 adult SMA patients (9 patients with SMA type 2 and 19 patients with SMA type 3) aged between 18–61 years with nusinersen. The mean Revised Upper Limb Module (RULM) score at baseline in SMA type 2 and SMA type 3 patients was 9.9 ± 4.6 and 29.5 ± 8.5, respectively. The mean Hammersmith Functional Motor Scale Expanded (HFMSE) score at baseline was 3.1 ± 2.5 and 31.2 ± 18.1, respectively. Half of the SMA type 3 patients were ambulatory at treatment onset. In total, we performed 122 lumbar punctures with 120 successful intrathecal administrations of nusinersen. Lumbar punctures were well tolerated, and no serious adverse events occurred.Conclusions:Our data demonstrate the feasibility and tolerability of intrathecal treatment with nusinersen in adults with SMA type 2 and type 3. However, treatment can be medically and logistically challenging, particularly in patients with SMA type 2 and in patients with spondylodesis.

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Section: Discussionmentioning

confidence: 99%

Feasibility and safety of intrathecal treatment with nusinersen in adult patients with spinal muscular atrophy

Stolte

Totzeck

Kizina

et al. 2018

Ther Adv Neurol Disord

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“…Ihn et al evaluated 371 aneurysm treatments nationwide in 2015 [ 25 ]. Total mean DAP, air kerma and fluoroscopy time were 219 Gycm 2 , 3.3 Gy and 51 min, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Direct measurement of the absolute entrance skin doses is not practicable and therefore surrogate markers such as DAP (Gycm 2 ) and air kerma (Gy) are usually used [23][24][25][26][27].…”

Section: Radiation Exposurementioning

confidence: 99%

Endovascular treatment of basilar tip aneurysms in the era of endosaccular flow disruption: a comparative study

et al. 2020

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Purpose This study aims to compare endosaccular flow disruptor (EFD) for treatment of basilar tip aneurysm (BTA) with coiling in terms of safety and efficacy. Methods We retrospectively reviewed patients treated with an EFD for BTAs at our institution between 2013 and 2019 to standard coiling from the same period (control group). Patient demographics, aneurysm characteristics, procedural data, complications and clinical and angiographic outcome were compared between groups. Results Twenty-three (56%) patients were treated with an EFD and eighteen (44%) patients were treated with coiling. Average aneurysm size was 8 mm in the EFD group and 6.9 mm in the coiling group, respectively (P = 0.2). Average fluoroscopy time, treatment DAP and air kerma were 33 min, 76 Gycm2 and 1.7 Gy in the EFD group and 81 min, 152 Gycm2 and 3.8 Gy in the coiling group, respectively (P < 0.001). In the EFD group, clinically relevant thromboembolic complications occurred in one patient (4%) vs. in 5 patients (28%) in the coiling group (P = 0.07). In each group, 4 patients had an unfavourable outcome at discharge (P = 0.7). Adequate occlusion rates were 96% in the EFD group and 100% and coiling group. Six (26%) patients were prescribed long-term antiplatelet therapy in the EFD group vs. eleven (61%) patients in the coiling group (P = 0.02). Conclusion Both treatment concepts provided similar technical success and safety. However, procedure time, radiation exposure and a need for long-term antiaggregation were lower with EFD.

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“…[24] It was reported that the advantage of the rotational angiography in treating aneurysms provide a better understanding of the vasculature without the need for increased number of 2D image acquisitions compared to AVM interventions. [25] However, the number of 2D images acquired is at the discretion of the interventionists. Experienced interventionists with knowledge on radiation safety acquired 18% lower image frames during paediatric imaging compared to adults.…”

Section: Discussionmentioning

confidence: 99%

Radiation dose reference card for interventional radiology procedures: Experience in a tertiary referral centre

Varghese

Keshava

Moses

et al. 2019

Indian Journal of Radiology and Imaging

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Background:Fluoroscopy-guided interventions can potentially increase radiation risk to patients, if awareness on angiographic imaging technique and radiation dose is neglected.Aim:To develop patient radiation dose reference card from standardized imaging techniques for various radiology interventions performed using flat detector based angiography system.Materials and Methods:Real-time monitoring of angiographic exposure parameters and radiation dose were performed for 16 types of radiological interventions. Effective dose (ED) was estimated from dose area product (DAP) using PCXMC Monte Carlo simulation software. Radiation risk levels were estimated based on Biological Effects of Ionising radiation (BEIR) report VII predictive models for an Asian population.Results:Pulse rates of 7.5 pps and 0.6 mm Copper filtration during fluoroscopy and 4 frames per second (fps) and 0.1-0.3 mm Cu filtration during image acquisitions were found to reduce radiation dose. Owing to increased number of image acquisitions, DAP was highest during diagnostic spinal angiography 186.7 Gycm2 (44.0–377.5). This resulted in highest ED of 59.4 mSv with moderate risk levels (1 in 1000 to 1 in 500). Most of the radiological interventions had low radiation risk levels (1 in 10,000 to 1 in 1000).Conclusion:The patient radiation dose reference card is valuable to the medical community and can aid in patient counselling on radiation induced risk from radiological interventions.

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Patient Radiation Exposure During Diagnostic and Therapeutic Procedures for Intracranial Aneurysms: A Multicenter Study

Cited by 30 publications

References 19 publications

Feasibility and safety of intrathecal treatment with nusinersen in adult patients with spinal muscular atrophy

Feasibility and safety of intrathecal treatment with nusinersen in adult patients with spinal muscular atrophy

Endovascular treatment of basilar tip aneurysms in the era of endosaccular flow disruption: a comparative study

Radiation dose reference card for interventional radiology procedures: Experience in a tertiary referral centre

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