Patient radiation doses and reference levels in pediatric interventional radiology

Geryes, Bouchra Habib; Bak, Adeline; Lachaux, Julie; Ozanne, Augustin; Boddaert, Nathalie; Brunelle, Françis; Naggara, Olivier; Saliou, Guillaume

doi:10.1007/s00330-017-4769-0

Cited by 10 publications

(9 citation statements)

References 22 publications

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“…In order to protect the population beyond the acute phase, it is critical to seek for any method that might reduce thrombectomy patients' X-ray exposure. There are currently no established dose reference levels for a thrombectomy procedure that could help measure and improve the treatment quality of ionizing examinations [13] despite recent publications [14,15] as already established for many image-guided diagnostic and interventional procedures [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Proposed achievable levels of dose and impact of dose-reduction systems for thrombectomy in acute ischemic stroke: an international, multicentric, retrospective study in 1096 patients

Guenego

Mosimann²,

Pereira³

et al. 2019

Eur Radiol

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Background International dose reference levels are lacking for mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusions. We studied whether radiation dose-reduction systems (RDS) could effectively reduce exposure and propose achievable levels. Materials and methods We retrospectively included consecutive patients treated with thrombectomy on a biplane angiography system (BP) in five international, high-volume centers between January 2014 and May 2017. Institutional Review Board approvals were obtained. Technical, procedural, and clinical characteristics were assessed. Efficacy, safety, radiation dose, and contrast load were compared between angiography systems with and without RDS. Multivariate analyses were adjusted according to Bonferroni's correction. Proposed international achievable cutoff levels were set at the 75th percentile.Results Out of the 1096 thrombectomized patients, 520 (47%) were treated on a BP equipped with RDS. After multivariate analysis, RDS significantly reduced dose-area product (DAP) (91 vs 140 Gy cm 2 , relative effect 0.74 (CI 0.66; 0.83), 35% decrease, p < 0.001) and air kerma (0.46 vs 0.97 Gy, relative effect 0.63 (CI 0.56; 0.71), 53% decrease, p < 0.001) with 75th percentile levels of 148 Gy cm 2 and 0.73 Gy, respectively. There was no difference in contrast load, rates of successful recanalization, complications, or clinical outcome. Conclusion Radiation dose-reduction systems can reduce DAP and air kerma by a third and a half, respectively, without affecting thrombectomy efficacy or safety. The respective thresholds of 148 Gy cm 2 and 0.73 Gy represent achievable levels that may serve to optimize current and future radiation exposure in the setting of acute ischemic stroke treatment. As technology evolves, we expect these values to decrease.

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Section: Introductionmentioning

confidence: 99%

Proposed achievable levels of dose and impact of dose-reduction systems for thrombectomy in acute ischemic stroke: an international, multicentric, retrospective study in 1096 patients

Guenego

Mosimann²,

Pereira³

et al. 2019

Eur Radiol

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“…29 Less is known about the radiation dose for pediatric DSA; however, in one study, the reported DAP range for cerebral DSA in children younger than 18 years was 3.8 to 23.2 Gy×cm 2 . 11 The mean DAP was higher in our study because some of the analyzed digital subtraction angiograms were obtained for a combination of diagnostic and treatment purposes. Our findings, therefore, suggest a potential role of fe-SPGR in the diagnostic evaluation of AVMs, which is important in the pediatric population given the risk of radiation exposure with CTA and DSA, especially when considering that most of these patients often undergo repeat surveillance imaging.…”

Section: Discussionmentioning

confidence: 71%

High-resolution 3D volumetric contrast-enhanced MR angiography with a blood pool agent (ferumoxytol) for diagnostic evaluation of pediatric brain arteriovenous malformations

Michael

Choudhri

Dodd

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEPatients with brain arteriovenous malformations (AVMs) often require repeat imaging with MRI or MR angiography (MRA), CT angiography (CTA), and digital subtraction angiography (DSA). The ideal imaging modality provides excellent vascular visualization without incurring added risks, such as radiation exposure. The purpose of this study is to evaluate the performance of ferumoxytol-enhanced MRA using a high-resolution 3D volumetric sequence (fe-SPGR) for visualizing and grading pediatric brain AVMs in comparison with CTA and DSA, which is the current imaging gold standard.METHODSIn this retrospective cohort study, 21 patients with AVMs evaluated by fe-SPGR, CTA, and DSA between April 2014 and August 2017 were included. Two experienced raters graded AVMs using Spetzler-Martin criteria on all imaging studies. Lesion conspicuity (LC) and diagnostic confidence (DC) were assessed using a 5-point Likert scale, and interrater agreement was determined. The Kruskal-Wallis test was performed to assess the raters’ grades and scores of LC and DC, with subsequent post hoc pairwise comparisons to assess for statistically significant differences between pairs of groups at p < 0.05.RESULTSAssigned Spetzler-Martin grades for AVMs on DSA, fe-SPGR, and CTA were not significantly different (p = 0.991). LC and DC scores were higher with fe-SPGR than with CTA (p < 0.05). A significant difference in LC scores was found between CTA and fe-SPGR (p < 0.001) and CTA and DSA (p < 0.001) but not between fe-SPGR and DSA (p = 0.146). A significant difference in DC scores was found among DSA, fe-SPGR, and CTA (p < 0.001) and between all pairs of the groups (p < 0.05). Interrater agreement was good to very good for all image groups (κ = 0.77–1.0, p < 0.001).CONCLUSIONSFe-SPGR performed robustly in the diagnostic evaluation of brain AVMs, with improved visual depiction of AVMs compared with CTA and comparable Spetzler-Martin grading relative to CTA and DSA.

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“…For pediatric non-cardiologic interventional procedures, data is even scarcer. There is only one multicenter study from France publishing reference levels of three interventional neuroradiological procedures (cerebral digital subtraction angiography (DSA), embolization of brain arteriovenous malformation (bAVM), and percutaneous sclerotherapy of head and neck superficial vascular malformation (SVM)) [36]. Authors differentiated patient collective to different age groups: younger than 2 years (A1), aged 2-7 years (A5), 8-12 years (A10), and 13-18 years (A15).…”

Section: Discussionmentioning

confidence: 99%

“…For IR procedures, the patient dose depends on several factors, including the age and size of the patient, the complexity of the specific situation, and the experience of the medical staff. In general, therapeutic procedures have been reported to yield higher dose than diagnostic procedures [36]. Therefore, pediatric DRLs should be defined separately for specified diagnostic or therapeutic procedures [5].…”

Section: Discussionmentioning

confidence: 99%

Estimation of radiation exposure of children undergoing superselective intra-arterial chemotherapy for retinoblastoma treatment: assessment of local diagnostic reference levels as a function of age, sex, and interventional success

et al. 2020

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Purpose This study aims to determine local diagnostic reference levels (LDRLs) of intra-arterial chemotherapy (IAC) procedures of pediatric patients with retinoblastoma (RB) to provide data for establishing diagnostic reference levels (DRLs) in pediatric interventional radiology (IR). Methods In a retrospective study design, LDRLs and achievable dose (AD) were assessed for children undergoing superselective IAC for RB treatment. All procedures were performed at the flat-panel angiography systems (I) ArtisQ biplane (Siemens Healthineers) and (II) Allura Xper (Philips Healthcare). Patients were differentiated according to age (A1: 1–3 months; A2: 4–12 months; A3: 13–72 months; A4: 73 months–10 years; A5: > 10 years), sex, conducted or not-conducted chemotherapy. Results 248 neurointerventional procedures of 130 pediatric patients (median age 14.5 months, range 5–127 months) with RB (68 unilateral, 62 bilateral) could be included between January 2010 and March 2020. The following diagnostic reference values, AD, and mean values could be determined: (A2) DRL 3.9 Gy cm2, AD 2.9 Gy cm2, mean 3.5 Gy cm2; (A3) DRL 7.0 Gy cm2, AD 4.3 Gy cm2, mean 6.0 Gy cm2; (A4) DRL 14.5 Gy cm2, AD 10.7 Gy cm2, mean 10.8 Gy cm2; (A5) AD 8.8 Gy cm2, mean 8.8 Gy cm2. Kruskal-Wallis-test confirmed a significant dose difference between the examined age groups (A2–A5) (p < 0.001). There was no statistical difference considering sex (p = 0.076) and conducted or not-conducted chemotherapy (p = 0.627). A successful procedure was achieved in 207/248 cases. Conclusion We report on radiation exposure during superselective IAC of a pediatric cohort at the German Retinoblastoma Referral Centre. Although an IAC formally represents a therapeutic procedure, our results confirm that radiation exposure lies within the exposure of a diagnostic interventional procedure. DRLs for superselective IAC are substantially lower compared with DRLs of more complex endovascular interventions.

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Patient radiation doses and reference levels in pediatric interventional radiology

Abstract: • We determined reference levels (RLs) for bAVM embolization, DSA and SVM sclerotherapy. • The proposed RLs will permit benchmarking practice with an external standard. • The proposed RLs by age may help to develop paediatric dose guidelines.

Cited by 10 publications

References 22 publications

Proposed achievable levels of dose and impact of dose-reduction systems for thrombectomy in acute ischemic stroke: an international, multicentric, retrospective study in 1096 patients

Proposed achievable levels of dose and impact of dose-reduction systems for thrombectomy in acute ischemic stroke: an international, multicentric, retrospective study in 1096 patients

High-resolution 3D volumetric contrast-enhanced MR angiography with a blood pool agent (ferumoxytol) for diagnostic evaluation of pediatric brain arteriovenous malformations

Estimation of radiation exposure of children undergoing superselective intra-arterial chemotherapy for retinoblastoma treatment: assessment of local diagnostic reference levels as a function of age, sex, and interventional success

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