Adult patient doses in interventional neuroradiology

Abstract

We investigated radiation doses to 149 adult patients who underwent interventional neuroradiologic procedures, consisting of 132 patients who had diagnostic imaging examinations and 17 patients who had therapeutic procedures. The interventional procedures were carried out on a biplane system capable of performing fluoroscopy and digital subtraction angiography (DSA). The x-ray imaging system was interfaced to a patient dosimetry system, which computed surface (skin) doses based on the selected radiographic technique factors in each of the radiographic and fluoroscopic imaging modes. For each patient, an assessment was made of the maximum surface dose received during the procedure, which predicts the possibility of inducing deterministic effects. Knowledge of the surface doses, beam quality and x-ray cross sectional area permitted the computation of the total energy imparted to each patient. Energy imparted values were converted to effective dose, which provides an estimate of the stochastic radiation risk to the patient. The median surface dose for the frontal plane during diagnostic imaging examinations was 1.3 Gy, with a maximum surface dose of 5.1 Gy. The median surface dose for the frontal plane during therapeutic procedures was 2.8 Gy with a maximum surface dose of 5.0 Gy. Ratios of the lateral to frontal median surface doses were 0.47 for diagnostic examinations and 0.68 for interventional procedures. The median energy imparted was 1.8 J during fluoroscopy, and 4.3 J during radiography, showing that on average, 66% of the patient exposure comes from radiographic imaging (DSA). For diagnostic examinations, the median patient effective dose was 33 mSv, with a maximum of 152 mSv. For therapeutic procedures, the median patient effective dose was 74 mSv, with a maximum of 156 mSv. In interventional neuroradiology, surface doses could induce deterministic effects, and the corresponding effective doses are noticeably higher than those normally encountered in diagnostic radiology.