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Radiation exposure of image-guided intrathecal administration of nusinersen to adult patients with spinal muscular atrophy

  • D. OldenburgEmail author
  • N. Guberina
  • B. Stolte
  • K. Kizina
  • E. Stenzel
  • A. Radbruch
  • C. Kleinschnitz
  • T. Hagenacker
  • M. Forsting
  • C. Mönninghoff
Spinal Neuroradiology

Abstract

Purpose

To examine diagnostic reference levels (DRL) and achievable doses (AD) of image-guided and size-specific dose estimates (SSDE) and organ and effective doses of CT-guided intrathecal nusinersen administration to adult patients with spinal muscular atrophy (SMA).

Methods

This study involved a total of 60 image-guided intrathecal nusinersen treatments between August 2017 and June 2018. Patient cohort comprised 14 adult patients with the following SMA types: type 2 (n = 9) and type 3 (n = 5) with a mean age of 33.6 years (age range 25–57 years). DRL, AD, SSDE, organ, and effective doses were assessed with a dose-monitoring program based on the Monte Carlo simulation techniques.

Results

DRL and AD for computed tomography are summarised as follows: in terms of CT-dose index (CTDIvol), DRL 56.4 mGy and AD 36.7 mGy; in terms of dose-length product (DLP), DRL 233.1 mGy cm and AD 120.1 mGy cm. DRL and AD for fluoroscopic guidance were distributed as follows: in terms of dose-area product (DAP), DRL 239.1 μGy m2 and AD 135.2 mGy cm2. Mean SSDE was 9.2 mGy. Mean effective dose of the CT-guided injections was 2.5 mSv (median 2.0 mSv, IQR 1.3–3.2 mSv). Highest organ doses in the primary beam of radiation were the small intestine 12.9 mSv, large intestine 9.5 mSv, and ovaries 3.6 mSv.

Conclusion

Radiation exposure of SMA patients measured as DRLs is generally not higher compared with patients without SMA despite severe anatomical hazards. Dose monitoring data may allow clinicians to stratify radiation risk, identify organs at risk, and adopt measures for specific radiation dose reduction.

Keywords

Spinal muscular atrophy Radiation exposure Spinal injection Computed tomography Fluoroscopy 

Abbreviations

AD

Achievable doses

CT

Computed tomography

CTDIvol

CT-dose index

ICRP

International Commission on Radiological Protection

IQR

Interquartile range

DAP

Dose area product

DLP

Dose length product

DRL

Diagnostic reference levels

kV

Kilovolt (tube voltage)

mAs

Milliampere second (tube current–time product)

mSv

Millisievert (effective dose)

SD

Standard deviation

SMA

Spinal muscular atrophy

SMN

Survival motor neuron

SSDE

Size-specific dose estimates

Notes

Funding

No funding was received for this study.

Compliance with ethical standards

Conflict of interest

B. Stolte received travel reimbursement from Biogen. C. Kleinschnitz acts as consultant, received travel reimbursement, speaker and Advisory Board honoraria from Biogen. T. Hagenacker acts as consultant, received travel reimbursement, speaker and advisory board honoraria from Biogen and speaker honoraria from Novartis and Biogen. C. Mönninghoff acts as consultant, received travel reimbursement, and advisory board honoraria from Biogen.

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.

For this type of study formal consent is not required.

Informed consent

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

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital EssenEssenGermany
  2. 2.Department of NeurologyUniversity Hospital EssenEssenGermany

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