Patient and occupational dose in neurointerventional procedures

Abstract

Neurointerventional procedures can involve very high doses of radiation to the patient. Our purpose was to quantify the exposure of patients and workers during such procedures, and to use the data for optimisation. We monitored the coiling of 27 aneurysms, and embolisation of four arteriovenous malformations. We measured entrance doses at the skull of the patient using thermoluminescent dosemeters. An observer logged the dose-area product (DAP), fluoroscopy time and characteristics of the digital angiographic and fluoroscopic projections. We also measured entrance doses to the workers at the glabella, neck, arms, hands and legs. The highest patient entrance dose was 2.3 Gy, the average maximum entrance dose 0.9+/-0.5 Gy. The effective dose to the patient was estimated as 14.0+/-8.1 mSv. Other average values were: DAP 228+/-131 Gy cm(2), fluoroscopy time 34.8+/-12.6 min, number of angiographic series 19.3+/-9.4 and number of frames 267+/-143. The highest operator entrance dose was observed on the left leg (235+/-174 microGy). The effective dose to the operator, wearing a 0.35 mm lead equivalent apron, was 6.7+/-4.6 microSv. Thus, even the highest patient entrance dose was in the lower part of the range in which nonstochastic effects might arise. Nevertheless, we are trying to reduce patient exposure by optimising machine settings and clinical protocols, and by informing the operator when the total DAP reaches a defined threshold. The contribution of neurointerventional procedures to occupational dose was very small.

Patient Organ Radiation Doses During Treatment for Aneurysmal Subarachnoid Hemorrhage

“…However only 44% or 123 Gy cm 2 of the kermaarea product is due to the coiling procedure, 113 Gy cm 2 is due to treatment of vasospasm including a DSA and 47 Gy cm 2 is due to the DynaCT procedure. Hence the P KA from the coiling procedure alone is in fact identical to the results from our previous study, but lower than reported by Kemerink et al [22] (228 Gy cm 2 ). However, in this study (in contrast to Sandborg et al [15]), the estimated maximum skin doses are higher (Table 6) since we also include skin doses due to CT examinations during the patients' stay at the NSICU.…”

Cumulative Radiation Dose in Patients Admitted with Subarachnoid Hemorrhage: A Prospective Study Using a Self-Developing Film Badge

“…Two investigations reported average procedural skin doses of 1-1.5 Gy. 4,5 Reduction of radiation dose from each individual diagnostic and interventional exposure is critical for minimizing total patient and, thereby, population dose. While many publications suggest strategies to this end, 4,6,7 few address the issue of cumulative dose during the hospitalization.…”

Embolization of Intracranial Arteriovenous Malformations Using Onyx in 53 Patients

“…Another concern with Onyx is that the prolonged time of injection can expose patients to a higher dose of radiation; however, in one study, it was in the lower part of the range in which nonstochastic effects may arise (22). We did not observe hair loss in any of our patients.…”