Skip to main content
SpringerLink
Log in

Investigating the parameters that affect the radiation exposure and establishing typical values based on procedure complexity for cerebral angiography and brain aneurysm embolization

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to investigate the parameters that affect the radiation exposure and to establish typical values (TV) based on procedure complexity for cerebral angiography (CA) and brain aneurysm embolization (BAE).

Methods

Clinical parameters and exposure data were retrospectively reviewed for 348 examinations performed between March 2016 and December 2019 at a single specialized neuroradiology center. TV were derived as the median value of the distribution of exposure parameters such as total air kerma area product (PKA,T), air kerma at the patient entrance reference point, fluoroscopy time, and number of frames. A statistical analysis was conducted to investigate the exposure variability with patient’s gender, number of treated vessels during CA and patient gender, aneurysm location and dimension, and treatment strategies during BAE.

Results

Patient gender was associated with a significant increase in the exposure level for both CA and BAE. For CA, TV were in term of PKA,T of 52 Gycm2 for male vs. 28 Gycm2 for female patients. For BAE, these were 113 Gycm2 for male vs. 75 Gycm2 for female patients. Exposure levels increased significantly with the number of treated vessels in CA. TV were 20 Gycm2 for one vessel vs. 77 Gycm2 for 5–6 vessels CA. For BAE, aneurysm location was also a key factor that affects the patient exposure. TV were 55 Gycm2 for aneurysms grouped in location 1 vs. 105 Gycm2 for those grouped in location 2.

Conclusion

Male gender, number of treated vessels, and aneurysm location are key parameters affecting patient exposure during CA and BAE procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Maingard J, Kok HK, Ranatunga D, Brooks DM, Chandra RV, Lee MJ, Asadi H (2017) The future of interventional and neurointerventional radiology: learning lessons from the past. Br J Radiol 90:201704. https://doi.org/10.1259/bjr.20170473

    Article  Google Scholar 

  2. Sanchez RM, Vano E, Fernandez JM et al (2016) Radiation doses in patient eye lenses during interventional neuroradiology procedures. Am J Neuroradiol 37:402–407. https://doi.org/10.3174/ajnr.A4549

    Article  CAS  PubMed  Google Scholar 

  3. Wagner LK (2007) Radiation injury is a potentially serious complication to fluoroscopically-guided complex interventions. Biomed Imaging Interv J 3(2):e22. https://doi.org/10.2349/biij.3.2.e22

    Article  PubMed  PubMed Central  Google Scholar 

  4. Balter S, Hopewell JW, Miller DL, Wagner LK, Zelefsky MJ (2010) Fluoroscopically guided interventional procedures: a review of radiation effects on patients’ skin and hair. Radiology 254:326–342. https://doi.org/10.1148/radiol.2542082312/-/DC1

    Article  PubMed  Google Scholar 

  5. Peterson EC, Kanal KM, Dickinson RL, Stewart BK, Kim LJ (2013) Radiation-induced complications in endovascular neurosurgery: incidence of skin effects and the feasibility of estimating risk of future tumor formation. Neurosurgery 72:566–572. https://doi.org/10.1227/NEU.0b013e318283c9a5

    Article  PubMed  Google Scholar 

  6. Vañó E, Miller DL, Martin CJ, Rehani MM, Kang K, Rosenstein M, Ortiz-López P, Mattsson S, Padovani R, Rogers A, Authors on behalf of ICRP (2017) Authors on behalf of ICRP. ICRP Publication 135: diagnostic reference levels in medical imaging. Ann ICRP 46:1–144. https://doi.org/10.1177/0146645317717209

    Article  PubMed  Google Scholar 

  7. IAEA (2014) Radiation protection and safety of radiation sources: international basic safety standards, IAEA safety standards series no. GSR Part 3, IAEA, Vienna.

  8. The Council of the European Union (2014) Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom a. Off J Eur Commun 57:1–73

    Google Scholar 

  9. Balter S, Miller DL, Vano E, Ortiz Lopez P, Bernardi G, Cotelo E, Faulkner K, Nowotny R, Padovani R, Ramirez A (2008) A pilot study exploring the possibility of establishing guidance levels in x-ray directed interventional procedures. Med Phys 35:673–680. https://doi.org/10.1118/1.2829868

    Article  CAS  PubMed  Google Scholar 

  10. Ruiz-Cruces R, Vano E, Carrera-Magariño F, Moreno-Rodriguez F, Soler-Cantos MM, Canis-Lopez M, Hernández-Armas J, Diaz-Romero FJ, Rosales-Espizua F, Fernandez-Soto JM, Sanchez-Casanueva R, Martin-Palanca A, Perez-Martinez M, Gil-Agudo A, Zarca-Diaz MA, Parra-Osorio V, Muñoz Ruiz-Canela JJ, Moreno-Sanchez T, Lopez-Medina A, Moreno-Saiz C, Galan-Montenegro P, Gallego-Beuter JJ, Gonzalez-de-Garay M, Zapata-Jimenez JC, Pastor-Vega JM, Cañete S (2016) Diagnostic reference levels and complexity indices in interventional radiology: a national programme. Eur Radiol 26:4268–4276. https://doi.org/10.1007/s00330-016-4334-2

    Article  CAS  PubMed  Google Scholar 

  11. Aroua A, Rickli H, Stauffer JC, Schnyder P, Trueb PR, Valley JF, Vock P, Verdun FR (2007) How to set up and apply reference levels in fluoroscopy at a national level. Eur Radiol 17:1621–1633. https://doi.org/10.1007/s00330-006-0463-3

    Article  CAS  PubMed  Google Scholar 

  12. Vano E, Järvinen H, Kosunen A et al (2008) Patient dose in interventional radiology: a European survey. Radiat Prot Dosim 129:39–45. https://doi.org/10.1093/rpd/ncn024

    Article  CAS  Google Scholar 

  13. Kien N, Rehel JL, Étard C, Aubert B (2011) Dose patient en neuroradiologie interventionnelle: bilan d’une enquête multicentrique. J Radiol 92:1101–1112. https://doi.org/10.1016/j.jradio.2011.08.005

    Article  CAS  PubMed  Google Scholar 

  14. D’Ercole L, Thyrion FZ, Bocchiola M, Mantovani L, Klersy C (2012) Proposed local diagnostic reference levels in angiography and interventional neuroradiology and a preliminary analysis according to the complexity of the procedures. Phys Medica 28:61–70. https://doi.org/10.1016/j.ejmp.2010.10.008

    Article  Google Scholar 

  15. Etard C, Bigand E, Salvat C, Vidal V, Beregi JP, Hornbeck A, Greffier J (2017) Patient dose in interventional radiology: a multicentre study of the most frequent procedures in France. Eur Radiol 27:4281–4290. https://doi.org/10.1007/s00330-017-4780-5

    Article  PubMed  Google Scholar 

  16. Erskine BJ, Brady Z, Marshall EM (2014) Local diagnostic reference levels for angiographic and fluoroscopic procedures: Australian practice. Australas Phys Eng Sci Med 37:75–82. https://doi.org/10.1007/s13246-014-0244-2

    Article  PubMed  Google Scholar 

  17. Hassan AE, Amelot S (2017) Radiation Exposure during neurointerventional procedures in modern biplane angiographic systems: a single-site experience. Interv Neurol 6:105–116. https://doi.org/10.1159/000456622

    Article  PubMed  PubMed Central  Google Scholar 

  18. Rizk C, Farah J, Vanhavere F, Fares G (2019) National diagnostic reference levels in interventional radiology suites in Lebanon: a multicenter survey. Radiat Prot Dosim 187:50–60. https://doi.org/10.1093/rpd/ncz137

    Article  CAS  Google Scholar 

  19. Ihn YK, Kim B-S, Byun JS, Suh SH, Won YD, Lee DH, Kim BM, Kim YS, Jeon P, Ryu CW, Suh SI, Choi DS, Choi SS, Choi JW, Chang HW, Lee JW, Kim SH, Lee YJ, Shin SH, Lim SM, Yoon W, Jeong HW, Han MH (2016) Patient radiation exposure during diagnostic and therapeutic procedures for intracranial aneurysms: a multicenter study. Neurointervention 11:78–85. https://doi.org/10.5469/neuroint.2016.11.2.78

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chun CW, Kim BS, Lee CH, Ihn YK, Shin YS (2014) Patient radiation dose in diagnostic and interventional procedures for intracranial aneurysms: experience at a single center. Korean J Radiol 15:844–849. https://doi.org/10.3348/kjr.2014.15.6.844

    Article  PubMed  PubMed Central  Google Scholar 

  21. Farah J, Rouchaud A, Henry T, Regen C, Mihalea C, Moret J, Spelle L (2018) Dose reference levels and clinical determinants in stroke neuroradiology interventions. Eur Radiol 29:1–9. https://doi.org/10.1007/s00330-018-5593-x

    Article  Google Scholar 

  22. Acton H, James K, Kavanagh RG, O’Tuathaigh C, Moloney D, Wyse G, Fanning N, Maher M, O’Connor OJ (2018) Monitoring neurointerventional radiation doses using dose-tracking software: implications for the establishment of local diagnostic reference levels. Eur Radiol 28:3669–3675. https://doi.org/10.1007/s00330-018-5405-3

    Article  PubMed  Google Scholar 

  23. Cheung NK, Boutchard M, Carr MW, Froelich JJ (2018) Radiation exposure, and procedure and fluoroscopy times in endovascular treatment of intracranial aneurysms: a methodological comparison. J Neurointerv Surg 10:902–906. https://doi.org/10.1136/neurintsurg-2017-013596

    Article  PubMed  Google Scholar 

  24. Miller TR, Jindal G, Krejza J, Gandhi D (2014) Impact of endovascular technique on fluoroscopy usage: stent-assisted coiling versus flow diversion for paraclinoid internal carotid artery aneurysms. Neuroradiol J 27:725–731. https://doi.org/10.15274/NRJ-2014-10094

    Article  PubMed  PubMed Central  Google Scholar 

  25. Colby GP, Lin LM, Nundkumar N, Jiang B, Huang J, Tamargo RJ, Coon AL (2015) Radiation dose analysis of large and giant internal carotid artery aneurysm treatment with the pipeline embolization device versus traditional coiling techniques. J Neurointerv Surg 7:380–384. https://doi.org/10.1136/neurintsurg-2014-011193

    Article  PubMed  Google Scholar 

  26. Colby GP, Paul AR, Radvany MG, Gandhi D, Gailloud P, Huang J, Tamargo RJ, Coon AL (2012) A single center comparison of coiling versus stent assisted coiling in 90 consecutive paraophthalmic region aneurysms. J Neurointerv Surg 4:116–120. https://doi.org/10.1136/jnis.2011.004911

    Article  PubMed  Google Scholar 

  27. Ormeci AR, Gürbüz H, Ayata A, Çetin H (1997) Adult head circumferences and centiles. J Turgut Özal Med Cent 4:261–264

    Google Scholar 

  28. Chalouhi N, McMahon JF, Moukarzel LA et al (2014) Flow diversion versus traditional aneurysm embolization strategies: analysis of fluoroscopy and procedure times. J Neurointerv Surg 6:291–295. https://doi.org/10.1136/neurintsurg-2013-010777

    Article  PubMed  Google Scholar 

Download references

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Lebanese Atomic Energy Commission, National Council for Scientific Research, Beirut, 11-8281, Lebanon

    Chadia Rizk

  2. Department of Neuroradiology, Sacre Coeur Hospital, Baabda, BP, 116, Lebanon

    Ghassan Abi Chedid

  3. Department of Radiology, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon

    Christine Salem

  4. Radiology and Nuclear Medicine Department, Paris-Sud University Hospitals, 94270, Le Kremlin-Bicetre, France

    Jad Farah

Authors
  1. Chadia Rizk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ghassan Abi Chedid
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christine Salem
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jad Farah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chadia Rizk.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rizk, C., Abi Chedid, G., Salem, C. et al. Investigating the parameters that affect the radiation exposure and establishing typical values based on procedure complexity for cerebral angiography and brain aneurysm embolization. Neuroradiology 63, 787–794 (2021). https://doi.org/10.1007/s00234-020-02580-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-020-02580-z

Keywords

Search

Navigation