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Radiation dose and image quality in intraoperative CT (iCT) angiography of the brain with stereotactic head frames

  • Computed Tomography
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European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Intraoperative CT (iCT) angiography of the brain with stereotactic frames is an integral part of navigated neurosurgery. Validated data regarding radiation dose and image quality in these special examinations are not available. We therefore investigated two iCT protocols in this IRB-approved study.

Methods

Retrospective analysis of patients, who received a cerebral stereotactic iCT angiography on a 128 slice CT scanner between February 2016 and December 2017. In group A, automated tube current modulation (ATCM; reference value 410 mAs) and automated tube voltage selection (reference value 120 kV) were enabled, and only examinations with a selected voltage of 120 kV were included. In group B, fixed parameters were applied (300 mAs, 120 kV). Radiation dose was measured by assessing the volumetric CT dose index (CTDIvol), dose length product (DLP) and effective dose (ED). Signal-to-noise ratio (SNR) and image noise were assessed for objective image quality, visibility of arteries and grey-white differentiation for subjective image quality.

Results

Two hundred patients (n = 100 in each group) were included. In group A, median selected tube current was 643 mAs (group B, 300 mAs; p < 0.001). Median values of CTDIvol, DLP and ED were 91.54 mGy, 1561 mGy cm and 2.97 mSv in group A, and 43.15 mGy, 769 mGy cm and 1.46 mSv in group B (p < 0.001). Image quality did not significantly differ between groups (p > 0.05).

Conclusions

ATCM yielded disproportionally high radiation dose due to substantial tube current increase at the frame level, while image quality did not improve. Thus, ATCM should preferentially be disabled.

Key Points

• Automated tube current modulation (ATCM) yields disproportionally high radiation dose in intraoperative CT angiography of the brain with stereotactic head frames.

• ATCM does not improve overall image quality in these special examinations.

• ATCM is not yet optimised for CT angiography of the brain with major extracorporeal foreign materials within the scan range.

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Abbreviations

ADM:

Automated dose modulation

ATCM:

Automated tube current modulation

CTDIvol :

Volumetric computed tomography dose index

DLP:

Dose length product

ED:

Effective dose

FET-PET:

O-(2-18F-fluoroethyl)-l-tyrosine positron emission tomography

HU:

Hounsfield unit

iCT:

Intraoperative computed tomography

MAR:

Metal artefact reduction

SD:

Standard deviation

SNR:

Signal-to-noise ratio

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Acknowledgements

Part of the data was presented orally at the ECR 2018 in Vienna, Austria, and the XXI Symposium Neuroradiologicum 2018 in Taipei, Taiwan.

Funding

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

Author information

Authors and Affiliations

  1. Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany

    Robert Forbrig, Maximilian Patzig, Moriz Herzberg, Thomas Liebig & Franziska Dorn

  2. Center of Radiology and Neuroradiology, Klinikum Ingolstadt, Ingolstadt, Germany

    Lucas L. Geyer

  3. Department of Radiology, University Hospital, LMU Munich, Munich, Germany

    Robert Stahl

  4. Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany

    Jun Thorsteinsdottir, Christian Schichor & Friedrich-Wilhelm Kreth

  5. Institute for Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Städtisches Klinikum München Harlaching, Munich, Germany

    Christoph G. Trumm

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  1. Robert Forbrig
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Correspondence to Robert Forbrig.

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Guarantor

The scientific guarantor of this publication is PD Dr. Christoph G. Trumm.

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

PD Dr. Robert Stahl kindly provided statistical advice for this manuscript.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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Forbrig, R., Geyer, L.L., Stahl, R. et al. Radiation dose and image quality in intraoperative CT (iCT) angiography of the brain with stereotactic head frames. Eur Radiol 29, 2859–2867 (2019). https://doi.org/10.1007/s00330-018-5930-0

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  • DOI: https://doi.org/10.1007/s00330-018-5930-0

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