Radiation dose reduction during neurointerventional procedures by modification of default settings on biplane angiography equipment

Abstract

Significant reductions in radiation dose delivered by neurointerventional procedures can be achieved through simple modifications of default radiation dose in F and IA and frame rate during CINE without an increase in procedural complexity (fluoroscopy time) or rate of complications.

Analysis of radiation doses incurred during diagnostic cerebral angiography after the implementation of dose reduction strategies

“…The first is the result of a generalized increase in radiation consciousness and the Hawthorne effect, which has been shown to shorten fluoroscopy times10 and radiation doses 11. As our radiation awareness increased, we actively implemented radiation dose reduction strategies (previously published)8 in 2010 and, importantly, continued to analyze our doses and adjust our technique and equipment-related settings 7. We encourage readers to examine their radiation parameters (K a,r , PKA, and fluoroscopy time) real time during each case and document them in their procedural reports as a first step toward analysis of their own practices.…”

“…This underscores the need to routinely examine the default manufacturer settings, particularly after a system upgrade. Similar to Kahn et al ,7 we have adopted routine use of the VFR for the majority of our studies, with selective use of faster fixed frame rates for lesions requiring greater hemodynamic stratification to delineate the angioarchitecture of high-flow lesions such as AVMs or high-flow arteriovenous fistulas.…”

“…Most recently Kahn et al 7 agreed that altering factory settings on the equipment allows a significant decrease in radiation exposure. Levitt et al 13 claim that increased awareness of lowering radiation dose during endovascular procedures is necessary, although the image quality may be reduced.…”

“…The exposure of patients and staff to ionizing radiation, however, has become an increasing concern1 2 because of deterministic effects such as skin epilation, erythema, and desquamation,3 4 as well as other long-term risks, including cancer 5 6. Therefore, much effort has been devoted to physician education and to identifying methods for minimizing these risks 7 8…”

Pediatric neurointervention: collimation on radiation exposure-associated lifetime excess tumor risk

“…Digital subtraction images are much higher resolution than pulsed fluoroscopy images and should be used only when pulsed fluoroscopy images are inadequate 25. When either digital subtraction angiography or pulsed fluoroscopy is used, the operator can set as few images as are necessary for diagnosis 26. Finally, technical factors including minimizing source to patient distances, air gap, and electronic magnification will limit automatic increases in radiation to meet built-in noise thresholds 22 24.…”