Radiation dose and fluoroscopy time of modern endovascular treatment techniques in patients with saccular unruptured intracranial aneurysms

Abstract

Objectives Modern endovascular treatment of unruptured intracranial aneurysms (UIAs) demands for observance of diagnostic reference levels (DRLs). The national DRL (250 Gy cm2) is only defined for coiling. We provide dosimetric data for the following procedures: coiling, flow diverter (FD), Woven EndoBridge (WEB), combined techniques. Methods A retrospective single-centre study of saccular UIAs treated between 2015 and 2019. Regarding dosimetric analysis, the parameters dose area product (DAP) and fluoroscopy time were investigated for the following variables: endovascular technique, aneurysm location, DSA protocol, aneurysm size, and patient age. Results Eighty-seven patients (59 females, mean age 54 years) were included. Total mean and median DAP (Gy cm2) were 119 ± 73 (89–149) and 94 (73; 130) for coiling, 128 ± 53 (106–151) and 134 (80; 176) for FD, 128 ± 56 (102–153) and 118 (90; 176) for WEB, and 165 ± 102 (110–219) and 131 (98; 209) for combined techniques (p > .05). Regarding the aneurysm location, neither DAP nor fluoroscopy time was significantly different (p > .05). The lowest and highest fluoroscopy times were recorded for WEB and combined techniques, respectively (median 26 and 94 min; p < .001). A low-dose protocol yielded a 43% reduction of DAP (p < .001). Significantly positive correlations were found between DAP and both aneurysm size (r = .320, p = .003) and patient age (r = .214, p = .046). Conclusions This UIA study establishes novel local DRLs for modern endovascular techniques such as FD and WEB. A low-dose protocol yielded a significant reduction of radiation dose. Key Points • This paper establishes local diagnostic reference levels for modern endovascular treatment techniques of unruptured intracranial aneurysms, including flow diverter stenting and Woven EndoBridge device. • Dose area product was not significantly different between endovascular techniques and aneurysm locations, but associated with aneurysm size and patient age. • A low-dose protocol yielded a significant reduction of dose area product and is particularly useful when applying materials with a high radiopacity (e.g. platinum coils).

Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae

“…For establishment of DRLs, which are defined as the 3rd quartile of the distribution of the DRL quantity, the International Commission on Radiological Protection (ICRP) 135 publication requires utilization of several dosimetry parameters such as DAP and fluoroscopy time [20]. As a consequence, the 3rd quartile of DAP, which represents a subsidiary dimension for X-ray energy delivered to the patient [21], is commonly reported in neurointerventional studies [7][8][9][10][11][12][13][14][15]. In the present study, the median DAP and fluoroscopy time of the whole study population (n = 70) was 325 Gy cm 2 and 110 min with a 3rd quartile value of 414 Gy cm 2 and 142 min, respectively.…”

“…Regarding radiation dose optimization in the field of interventional neuroradiology, several techniques have been proposed in recent years [7,8,12,16,29] in order to reduce the potential risk of deterministic radiation effects particularly when considering complex and time-consuming interventions and/or the necessity of multiple sessions [25,26]. In this study, a LD DSA protocol, which was predetermined by the manufacturer, yielded a 20% reduction of the median total DAP when compared to a ND protocol (315 versus 393 Gy cm 2 ).…”

“…The frame rate of pulsed fluoroscopy was 7.5 f/s. With respect to the DSA acquisition type, two protocols were preset by the manufacturer as previously reported [7] and applied under discretion of the treating physicians:…”

“…In recent years, several authors published dosimetry data for neuroradiological interventions, including mechanical thrombectomy in acute stroke as well as endovascular treatment of intracranial aneurysms and arteriovenous malformations [7][8][9][10][11][12][13][14][15][16]; however, dosimetry data on the minimally invasive embolization of intracranial DAVFs are sparse [13][14][15][16]. Furthermore, these studies did not take the fistula subgroups (particularly LDAVF), the Cognard grade or the dedicated endovascular treatment technique (transarterial and/or transvenous embolization) into consideration.…”

Comparison of operating room variables, radiation exposure and implant costs for WEB versus stent assisted coiling for treatment of wide neck bifurcation aneurysms

“…10 Our fluoroscopy time of 34 minutes (AE18) is similar to other WEB related studies. 27,28 For all variables related to procedure times and radiation, the use of single implant solutions versus implantation of multiple devices carries an intuitive advantage.…”