Patient Radiation Exposure During Diagnostic and Therapeutic Procedures for Intracranial Aneurysms: A Multicenter Study.
OBJECTIVE
To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms across multi-centers and propose a diagnostic reference level (DRL).


METHODS
We studied a sample of 490 diagnostic and 371 therapeutic procedures for intracranial aneurysms, which were performed at 23 hospitals in Korea in 2015. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time and total angiographic image frames were obtained and analyzed.


RESULTS
Total mean DAP, CAK, fluoroscopy time, and total angiographic image frames were 106.2 ± 66.4 Gy-cm(2), 697.1 ± 473.7 mGy, 9.7 ± 6.5 minutes, 241.5 ± 116.6 frames for diagnostic procedures, 218.8 ± 164.3 Gy-cm(2), 3365.7 ± 2205.8 mGy, 51.5 ± 31.1 minutes, 443.5 ± 270.7 frames for therapeutic procedures, respectively. For diagnostic procedure, the third quartiles for DRLs were 144.2 Gy-cm(2) for DAP, 921.1 mGy for CAK, 12.2 minutes for fluoroscopy times and 286.5 for number of image frames, respectively. For therapeutic procedures, the third quartiles for DRLs were 271.0 Gy-cm(2) for DAP, 4471.3 mGy for CAK, 64.7 minutes for fluoroscopy times and 567.3 for number of image frames, respectively. On average, rotational angiography was used 1.5 ± 0.7 times/session (range, 0-4; n=490) for diagnostic procedures and 1.6 ± 1.2 times/session (range, 0-4; n=368) for therapeutic procedures, respectively.


CONCLUSIONS
Radiation dose as measured by DAP, fluoroscopy time and image frames were lower in our patients compared to another study regarding cerebral angiography, and DAP was lower with fewer angiographic image frames for therapeutic procedures. Proposed DRLs can be used for quality assurance and patient safety in diagnostic and therapeutic procedures.
Department of Radiology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Korea.
Yon Kwon
YK
Ihn
Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Bum-Soo
BS
Kim
Department of Radiology, Chung-Ang University Hospital, Seoul, Korea.
Jun Soo
JS
Byun
Department of Radiology, Gangnam Severance Hospital, Yonsei University, Seoul, Korea.
Sang Hyun
SH
Suh
Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Korea.
Yoo Dong
YD
Won
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Deok Hee
DH
Lee
Department of Radiology, Severance Hospital Stroke Center, Yonsei Unviersity College of Medicine, Seoul, Korea.
Byung Moon
BM
Kim
Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University, Yangsan, Korea.
Young Soo
YS
Kim
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Pyong
P
Jeon
Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
Chang-Woo
CW
Ryu
Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Sang-Il
SI
Suh
Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
Dae Seob
DS
Choi
Department of Radiology, Wonkwang University Hospital, Iksan, Korea.
See Sung
SS
Choi
Department of Radiology, Ajou University School of Medicine, Gyeonggi-do, Korea.
Jin Wook
JW
Choi
Department of Radiology, Keimyung University College of Medicine, Dongsan Medical Center, Daegu, Korea.
Hyuk Won
HW
Chang
Department of Radiology, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Korea.
Jae-Wook
JW
Lee
Department of Radiology, CHA Bundang Medical Center, CHA University, Gyeonggi-do, Korea.
Sang Heum
SH
Kim
Department of Radiology, Hanyang University College of Medicine, Seoul, Korea.
Young Jun
YJ
Lee
Department of Radiology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea.
Shang Hun
SH
Shin
Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea.
Soo Mee
SM
Lim
Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.
Woong
W
Yoon
Department of Radiology, Busan Paik Hospital, Inje University, Busan, Korea.
Hae Woong
HW
Jeong
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Moon Hee
MH
Han
Cerebral angiography; Cerebral embolization; Diagnostic reference levels; Radiation dose