Operator experience, the use of low frame rates during both fluoroscopy and DSA, and the application of modern medical equipment are crucial for ensuring optimal image quality while maintaining minimal exposure to ionising radiation during cerebral angiography. Our centre achieves this by using the lowest possible fluoroscopy frame rate (3.125 frames per second), a the operator set the nominal acquisition parameters at 2 fps for digital subtraction angiography (DSA), three-dimensional (3D) rotational angiography, two-dimensional /3D mapping, and roadmapping, without compromising the quality of the images obtained. A total of 213 diagnostic procedures for intracranial aneurysms, performed at a single medical centre between 2018 and 2024, were analyzed. Key exposure parameters were collected and analyzed for each procedure, including dose area product (DAP), air kerma (Ka,r), fluoroscopy time (FT), and the total number of DSA frames. The local diagnostic reference level (DRL) and typical values for cerebral angiography were determined and compared with data available in the relevant literature. The 75th percentile (P75) values, assumed to be the DRL, were 23.57 Gy · cm ² for DAP (literature range: 90–209), 153 mGy for Ka,r (literature range: 711.3–1401 mGy), 10 min and 46 s for FT, and 257 for the number of DSA frames during diagnostic procedures. Typical values (50th percentile [P50]) were 13.4 Gy · cm ² for DAP (literature range: 43.1–157), 92 mGy for Ka,r (literature range: 312–598 mGy), six minutes and 20 s for FT, and 182 for the number of DSA frames during diagnostic procedures. The P50 dose DRLs, measured via DAP, Ka,r, FT, and the number of DSA frames, were at least three times lower at our facility than those reported in studies on cerebral angiography published between 2013 and 2023. The use of low frame rates during both fluoroscopy and DSA has a significant impact on the radiation dose measured by DAP, Ka,r, FT, and the number of DSA frames. The proposed DRLs could be used to ensure quality and patient safety in diagnostic procedures.

Background/Objectives: Operator experience, the implementation of low frame rates during both fluoroscopy and digital subtraction angiography (DSA), and the use of modern angiographic systems are essential for maintaining diagnostic image quality while minimizing ionizing radiation exposure during stent-assisted endovascular treatment of intracranial aneurysms. At the study center, a low-dose protocol is employed, using the lowest available fluoroscopy frame rate (3.125 frames per second) and a nominal acquisition rate of 2 frames per second for DSA, three-dimensional (3D) rotational angiography, 2D/3D mapping, and roadmapping. Methods: A retrospective analysis was performed on 132 stent-assisted procedures conducted at a single tertiary center between 2018 and 2024. For each procedure, data were collected for dose-area product (DAP), reference air kerma (Ka,r), fluoroscopy time (FT), and the total number of DSA frames. Local diagnostic reference levels (DRLs; 75th percentile [P75]) and typical values (50th percentile [P50]) were established and compared with values reported in the literature. Results: For all patients the P75 values, representing DRLs, were 19.89 Gy·cm² for DAP, 332 mGy for Ka,r, 25 min 32 s for FT, and 354 DSA frames. The P50 values were 13.71 Gy·cm² for DAP, 219.5 mGy for Ka,r, 20 min 36 s for FT, and 277 DSA frames. Conclusions: In this single-center cohort, dose metrics for stent-assisted coil embolization were within the lower range of published values. Cross-study comparisons remain descriptive and require cautious interpretation. The proposed local DRLs may support quality assurance, dose optimization, and patient safety in similar clinical settings. Further multicenter and multi-operator studies are necessary to assess transferability and applicability beyond coil-only procedures. Limitations include the retrospective single-center design (single operator) and the lack of a contemporaneous control group and formal image-quality/outcome assessment.

Background/Objectives: Optimizing routine neurointerventional workflow and minimizing exposure to ionizing radiation during coil-only endovascular treatment of intracranial aneurysms depend on operator experience, reduced frame rates during both fluoroscopy and digital subtraction angiography (DSA), and the use of advanced angiographic systems. The low-dose protocol implemented in this study used the lowest available fluoroscopy frame rate (3.125 frames per second [fps]) and a nominal acquisition rate of 2 fps (actual = 2.45 fps) for DSA, three-dimensional (3D) rotational angiography, two-dimensional (2D)/3D mapping, and roadmapping. Methods: This retrospective analysis encompassed 245 coil-only procedures performed at a single tertiary center from 2018 to 2024. Data collected for each procedure included dose-area product (DAP), reference air kerma (K_a,r), fluoroscopy time (FT), and the total number of DSA frames. Local diagnostic reference levels (DRLs; 75th percentile [P75]) and typical values (50th percentile [P50]) were determined and descriptively compared with values reported in the literature. Results: The P75 values, representing DRLs, were 22.4 Gy·cm² for DAP (literature range, 123–272.8 Gy·cm²), 268 mGy for K_a,r (1171–4240 mGy), 18 min 56 s for FT, and 285 DSA frames. The P50 values were 13.8 Gy·cm² for DAP (78.7–179.0 Gy·cm²), 196 mGy for K_a,r (801–2804 mGy), 13 min 25 s for FT, and 208 DSA frames. Conclusions: In this single-center cohort, dose metrics for coil-only intracranial aneurysm treatment were within the lower range of published values. Cross-study comparisons are descriptive and require cautious interpretation. The proposed local DRLs may support quality assurance, dose optimization, and patient safety in comparable clinical settings. Further multi-center and multi-operator studies are warranted to evaluate transferability and applicability beyond coil-only procedures.

LAPAROSCOPIC ASSISTED TREATMENT OF HYDROCEPHALUS IN ADULTS: OUR OWN MODIFICATION - Archiv-EuroMedica

Indications for Dual Antiplatelet Therapy in Coil-Only Treatment of Ruptured Intracranial Aneurysms: A Narrative Review - Article abstract #952805

Background/Objectives: Endovascular treatment of cerebral arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) is associated with substantial radiation exposure due to procedural complexity and repeated angiographic acquisitions. This study evaluates radiation exposure during AVM and AVF embolization and establishes local diagnostic reference levels (DRLs). Methods: A single-center retrospective dose audit was conducted, encompassing 114 endovascular procedures performed using a low-dose workflow. Radiation exposure was quantified using dose area product (DAP), reference air kerma (K_a,r), fluoroscopy time (FT), and the number of digital subtraction angiography (DSA) frames per procedure. Median values were defined as the median (P50), and local DRLs as the 75th percentile (P75). Comparative analyses were conducted between AVM and AVF procedures, between male and female patients, and within selected AVM subgroups. Results: The analysis comprised 86 AVM procedures and 28 AVF procedures. For AVMs, the local DRLs (P75) were 28.9 Gy·cm² for DAP, 400 mGy for K_a,r, 310 DSA frames per procedure, and 1619 s for FT. For AVFs, the respective values were 47.3 Gy·cm², 465 mGy, 478 DSA frames, and 1820 s. No statistically significant differences were identified between female and male patients. However, AVF procedures demonstrated significantly higher radiation exposure than AVM procedures for all parameters except FT. Within the AVM subgroup, no significant differences were observed between single-stage and other AVM procedures or between female and male patients. Conclusions: AVM and AVF embolization procedures are dose-intensive neuroendovascular interventions. Establishing local DRLs for AVM and AVF may enhance radiation monitoring and facilitate procedure-specific dose optimization.