Table 1.
Literature review on radiation during cerebral angiography and cerebral interventions (comparison with the results from the current study]
| Reference (first author) | Year | n | DAP, Gy × cm2 | P | CAK, Gy | FT, min | Number of DSA frames | Details |
|---|---|---|---|---|---|---|---|---|
| Cerebral angiography | ||||||||
| This study | 2017 | 398 | 43.1 (33.3–59.7) | FRT: 0.26 (0.20–0.33) LAT: 0.09 (0.07–0.13) FRT+LAT: 0.35 (0.28–0.45) |
5.6 (4.2–7.5) | 245 (193–314) | FPD only | |
| Brambilla [34] | 2004 | 188 | 158a (198b) | <0.01 | – | 13.7a (17.5b) | – | |
| Verdun [35 | 2005 | 91 | 107a (124b) | <0.01 | – | – | – | |
| Aroua [36] | 2007 | 91 | 121a (125b) | <0.01 | – | 12.6a (2–85c) | 679a (32–5,486c) | |
| Vano [22] | 2008 | 72 | (107b) | – | – | (12b) | (550b) | |
| Bleeser [37] | 2008 | 616 | (71b) | – | – | – | – | |
| Sarycheva [25] | 2010 | 138 | 86a (13–313c) | <0.01 | – | 1.5a (0.3–9.9c) | 343a (60–1,125c) | |
| Alexander [27] | 2010 | 432 | 102.4a | <0.01 | – | 11.2a | – | image intensifier only; no DAP values on FPD |
| Kien [38] | 2011 | 1,786 | 152 (229b) | <0.01 | – | 8.9 (14b) | 326 (472b) | cerebral angiography diagnostic: 3 or more axes |
| D'Ercole [39] | 2012 | 113 | 131 (180b) | <0.01 | – | 8.5 (12.3b) | 220 (317b) | |
| Söderman [26] | 2013 | 174 | 47 (28–76) | <0.01 | FRT: 0.21 (0.13–0.37) FAT: 0.06 (0.03–0.11) | 6 (4–9) | 278 (173–402) | FPD only |
| Chun [40] | 2014 | 439 | 136.6a (154.2b) | <0.01 | – | 12.6a (14b) | 251a (273b) | FPD only; control excluded; image frames |
| Chung [24] | 2015 | 42–50d | FRT+FAT: System 0: 1.525a System 1: 1.499a System 2: 1.184a System 3: 0.973a |
system 0: image intensifier; systems 1, 2, 3: FPD | ||||
| Schneider [19] | 2016 | 200 | 78.6 (n/a) | <0.01 | FRT+LAT: 0.653 (n/a) | 6.6 | – | adults only; FPD |
| Neurointerventional procedures | ||||||||
| This study | 2017 | 357 | 66.0 (40.7–110.8) | FRT: 0.46 (0.25–0.80) LAT: 0.18 (0.10–0.30) FRT+FAT: 0.64 (0.37–1.10) |
18.3 (9.1–30.2) | 281 (184–427) | 33 AVF/AVM embolization, 71 aneurysm embolization, 73 stroke mechanical thrombectomy, 180 other interventions | |
| Verdun [35] | 2005 | 52 | 335a (352b) | <0.01 | 1 | – | – | therapeutic obstruction (coiling) during the treatment of AVM, AVF, intracranial aneurisms, tumors, or hemorrhagic lesions |
| Aroua [36] | 2007 | 91 | 121a (125b) | <0.01 | 36.5a (3.3–134c) | 760a (60–3,348c) | therapeutic obstruction (coiling) during the treatment of AVM, AVF, intracranial aneurisms, tumors, or hemorrhagic lesions | |
| Suzuki [41] | 2008 | 103 | 257a | <0.01 | – | 67.3a | 883a | cerebral embolization (AVM, aneurysm, AVF) |
| Alexander [27] | 2010 | 311 | 167.3a | <0.01 | – | – | – | image intensifier only; no DAP values on FPD |
| Sarycheva [25] | 2010 | 66 | 145a (20–548c) | <0.01 | – | 4.1a (1.4–26.2c) | 249a (85–1,572c) | therapeutic |
| D'Ercole [39] | 2012 | 72 | 352 (487b) | <0.01 | – | 34.6 (46.3b) | 559 (717b) | cerebral embolization (aneurysm or AVM) |
| Vano [5] | 2013 | year 2009: n = 90; year 2010: n = 92 |
year 2009: 242 (386b); year 2010: 270 (392b) | <0.01 | year 2009: FRT+LAT: 2.4 (3.9b) year 2010: FRT+LAT: 2.5 (3.3b) |
cerebral embolization; cumulative skin dose; FPD | ||
| Söderman [26] | 2013 | 138 | 109 (67–196) | <0.01 | FRT: 0.68 (0.38–1.35) FAT: 0.21 (0.10–0.45) | 12 (5–16) | 464 (299–845) | FPD; 4 AVM, 38 aneurysms, 45 stroke, 51 other interventions |
| Kahn [42] | 2016 | 30 | 150a | <0.01 | FRT+FAT: 1.650a | 51.1a | aneurysm coiling, balloon angioplasty, stroke intervention, tumor and AVM embolization; reduced dose group | |
| AVF/AVM embolization | ||||||||
| This study | 2017 | 33 | 149.6 (114.7–206.4) | FRT: 0.99 (0.65–1.55) LAT: 0.56 (0.28–0.75) FRT+LAT: 1.65 (0.96–2.35) |
57.0 (36.4–76.1) | 706 (522–904) | AVF/AVM embolization | |
| Miller [43] | 2003 | 177 | 339a (39.8–1,351c) | <0.01 | FRT+LAT: 3.79a (0.04–13.410c) | 92.5a (2.6–313.7c) | 1,037a (71–2,654c) | AVM embolization |
| Miller [20] | 2009 | 530d | – | FRT+LAT: 6.00d | 135d | 1,500d | AVM embolization | |
| Alexander [27] | 2010 | 74 | 160.9a | >0.05 | – | 36.5a | – | AVM; fistula; image intensifier only, no DAP values |
| 8 | 195.6a | – | – | 44.5a | – | on FPD | ||
| Kien [38] | 2011 | 370 | 269 (435b) | <0.01 | – | 38 (61b) | 770 (1,410b) | AVM embolization |
| Kien [38] | 2011 | 75 | 364 (726b) | <0.01 | – | 59 (82b) | 770 (1,036b) | AVF embolization |
| Slater [44] | 2014 | 44 | 338 (225–528) | <0.01 | – | – | – | AVM embolization |
| Aneurysm embolization | ||||||||
| This study | 2017 | 71 | 78.7 (59.5–111.9) | FRT: 0.71 (0.48–0.94) LAT: 0.29 (0.23–0.40) FRT+LAT: 1.04 (0.73–1.34) |
25.7 (19.9–34.8) | 300 (212–428) | aneurysm embolization | |
| Miller [43] | 2003 | 149 | 282.7a (67.9–825.5c) | <0.01 | FRT+LAT: 3.77a (1.28–9.81c) | 75a (15.2–401.3c) | 1,070a (292–2,440°) | aneurysm embolization |
| Miller [20] | 2009 | 360d | – | FRT+LAT: 4.75d | 90d | 1,350d | aneurysm embolization | |
| Alexander [27] | 2010 | 60 | 172.3a | <0.01 | – | 36.5a | – | aneurysm (image intensifier only, no DAP values on FPD) |
| Kien [38] | 2011 | 1,034 | 235 (349b) | <0.01 | – | 37 (58b) | 810 (1,199b) | aneurysm embolization |
| Kien [38] | 2011 | 628 | 188 (272b) | <0.01 | – | – | – | aneurysm embolization; FPD only |
| Chun [40] | 2014 | 111 | 226.0a (272.8b) | <0.01 | – | 52.9a (61.1b) | 241a (276.0b) | endovascular coil; embolization of intracranial aneurysms; image frames; FPD |
| Slater [44] | 2014 | 188 | 211 (130–328) | <0.01 | – | – | – | cerebral aneurysm embolization |
| Ihn [45] | 2016 | 371 | 179.0 (104.5–271.0) | <0.01 | FRT+LAT: 2.80 (1.69–4.47) | 44.5 (30.4–64.7) | 412.5 (241.5–567.3) | aneurysmal coil embolization |
Values are given as median (IQR) unless otherwise indicated. AVF, arteriovenous fistula; AVM, arteriovenous malformation; CAK, cumulative air kerma; DAP, dose-area product; DSA, digital subtraction angiography; FPD, flat-panel detector; FRT, frontal plane; FRT+LAT, cumulated on frontal and lateral plane; FT, fluoroscopy time; LAT, lateral plane; n/a, not available.
a
Mean.
b
Third quartile.
c
Range.
d
Dose reference level (based on 75th percentile) p value from nonparametric 1-sample sign test when referenced data provided as median and 1-sample t test when referenced data provided as mean.