European Radiology

, Volume 28, Issue 9, pp 3669–3675 | Cite as

Monitoring neurointerventional radiation doses using dose-tracking software: implications for the establishment of local diagnostic reference levels

  • Holly Acton
  • Karl James
  • Richard G. Kavanagh
  • Colm O’Tuathaigh
  • Deirdre Moloney
  • Gerald Wyse
  • Noel Fanning
  • Michael Maher
  • Owen J. O’Connor



There is potential for high radiation exposure during neurointerventional procedures. Increasing regulatory requirements mandate dose monitoring of patients and staff, and justification of high levels of radiation exposure. This paper demonstrates the potential to use radiation dose-tracking software to establish local diagnostic reference levels.


Consecutive neurointerventional procedures, performed in a single institution within a one-year period, were retrospectively studied. Dose area product (DAP) data were collected using dose-tracking software and clinical data obtained from a prospectively generated patient treatment database.


Two hundred and sixty-four procedures met the selection criteria. Median DAP was 100 Gy.cm2 for aneurysm coiling procedures, 259 Gy.cm2 for arteriovenous malformation (AVM) embolisation procedures, 87 Gy.cm2 for stroke thrombolysis/thrombectomy, and 74 Gy.cm2 for four-vessel angiography. One hundred and nine aneurysm coiling procedures were further studied. Six significant variables were assessed using stepwise regression analysis to determine effect on DAP. Aneurysm location (anterior vs posterior circulation) had the single biggest effect (p = 0.004).


This paper confirms variable radiation exposures during neurointerventional procedures. The 75th percentile (used to define diagnostic reference levels) of DAP measurements represents a reasonable guidance metric for monitoring purposes. Results indicate that aneurysm location has the greatest impact on dose during coiling procedures and that anterior and posterior circulation coiling procedures should have separate diagnostic reference levels.

Key Points

Dose-tracking software is useful for monitoring patient radiation dose during neurointerventional procedures

This paper provides a template for methodology applicable to any interventional suite

Local diagnostic reference levels were defined by using the 75th percentile of DAP as per International Commission on Radiological Protection recommendations

Aneurysm location is the biggest determinant of radiation dose during coiling procedures.

Anterior and posterior circulation coiling procedures should have separate diagnostic reference levels.


Radiation exposure Intracranial aneurysm Cerebral angiography Intracranial arteriovenous malformation Thrombectomy 



Arteriovenous malformation


Dose-area product


Diagnostic reference level


International Atomic Energy Agency


International Commission on Radiological Protection



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Owen J O’Connor.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise (C.O’T.).

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Holly Acton
    • 1
  • Karl James
    • 1
    • 2
  • Richard G. Kavanagh
    • 1
    • 2
  • Colm O’Tuathaigh
    • 1
  • Deirdre Moloney
    • 2
  • Gerald Wyse
    • 2
  • Noel Fanning
    • 2
  • Michael Maher
    • 1
    • 2
  • Owen J. O’Connor
    • 1
    • 2
  1. 1.School of MedicineUniversity College CorkCorkIreland
  2. 2.Department of RadiologyCork University HospitalCorkIreland

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