Article Figures & Data
Figures
- Fig 1.
Photograph of indicators. A total of 44 indicators were adhered to a cap (right aspect, n = 19; left aspect, n = 19; and parietal aspect, n = 6) at intervals of 5 cm.
- Fig 2.
Effects of tube voltage, filtration, and dose rate on the color difference of the indicator. A, Indicators were irradiated at the dose of 1 Gy by using 4 tube voltages (50, 75, 100, and 125 kV) and 4 types of filtration (2.2 mm of aluminum, 5.2 mm of aluminum, 3.7 mm of aluminum + 0.1 mm of copper; and 3.7 mm of aluminum + 0.4 mm of copper) with a 20-mA tube current. The difference in the color difference was within 2.20. B, The effect of the dose rate was also evaluated by using 2 tube currents (5 and 20 mA) for the 4 types of filtration at the dose of 1 Gy with tube voltage of 75 kVp. For each filtration, the difference in the color between the 2 dose rates was within 0.79. Al indicates aluminum; Cu, copper.
- Fig 3.
Maximum ESD distribution of each procedure. The maximum ESD of the patients exceeded 1 Gy in 84 procedures, 3 Gy in 20 procedures, and 5 Gy in 2 procedures.
- Fig 4.
Scatterplot of DAP and maximum ESD with regression line.
- Fig 5.
Distribution of ESDs in a patient with radiation skin injury. Neuroembolization for internal carotid-posterior communicating aneurysm was performed for a 43-year-old woman. The FOV mainly used was 14 cm. Total fluoroscopic time and DAP were 75.0 minutes and 182 Gy × cm2, respectively; 4° left anterior oblique with 17° cranial angulation view was mostly used. Exposed skin area was localized to the occipital region with the maximum ESD of 3.0 Gy. Temporary epilation was detected at the maximum exposure part (slanted lines) at 2 weeks and 3 months of follow-up. The number in the open square represents the ESD (Gy) at the point. — in the open square means the ESD at the point was less than 0.3 Gy.
Tables
Institution No. of Target Lesions AN AVF CCF AVM Institution 1 39 2 4 3 Institution 2 19 0 1 0 Institution 3 12 3 0 0 Institution 4 8 1 1 0 Institution 5 5 0 0 0 Institution 6 3 1 0 1 Overall 86 7 6 4 Note:—AN indicates cerebral aneurysm; AVF, dural arteriovenous fistula; CCF, internal carotid artery cavernous sinus fistula; AVM, arteriovenous malformation.
Data Institution 1 Institution 2 Institution 3 Institution 4 Institution 5 Institution 6 Angiographic unit (No. of procedures) AXIOM Artis FA (48) AXIOM Artis dBA (20) AXIOM Artis dBA (15) Allura Xper FD20/10 (10) Advantx LCN PLUS (5) Advantx-E LCA (4) OEC9800 (1) Detector I.I. (single plane) FD (Biplane) FD (Biplane) FD (Biplane) I.I. (Biplane) I.I. (Single plane) I.I. (Single plane) Period of use of the unit, y 5 1 1 1 7 7 4 Period of use of the detector, y 5 1 1 1 3 1 4 Dose area product meter Available Available Available Available Not available Not available 4 Mainly used FOV, cm 28, 20, 14 48, 32, 22, 16* 22, 16, 11* 43, 40, 25, 20* 15, 11 23 23 Minimal total filtration 2.5-mm Al 2.5-mm Al 2.5-mm Al 2.7-mm Al 2.9-mm Al 2.9-mm Al 5.5-mm Al Fluoroscopy Removable filter 0.1-, 0.2-, 0.3-mm Cu 0.2-mm Cu 0.1-mm Cu 0.4-mm Cu + 1.0-mm Al 0.1-mm Cu + 1.0-mm Al Pulse rate 15 pulse/s 15 pulse/s 15, 10 pulse/s 30, 15 pulse/s 30 pulse/s 25 pulse/s 8 pulse/s Digital subtraction angiography Removable filter 0.1-, 0.2-, 0.3-mm Cu 0.1-mm Cu 0.1-mm Cu 0.1-mm Cu + 1.0-mm Al 0.1-mm Cu +1.0-mm Al Frame rate 2 frame/s 1 frame/s 6, 4, 3 frame/s 2 frame/s 1.9 frame/s 3.1 frame/s 30 frame/s Note:—I.I. indicates image intensifier; FD, digital flat panel detector; Cu, copper; Al, aluminum.
* The FOV of the digital flat panel detector was specified by the diagonal length.
- Table 3:
Averages of total fluoroscopic time, number of DSA frames, DAP, and maximum ESD in each institution
Variable Institution Overall (n = 103) 1 (n = 48) 2 (n = 20) 3 (n = 15) 4 (n = 10) 5 (n = 5) 6 (n = 5) Total fluoroscopic time, min 62.3 ± 35.1 50.6 ± 30.0 114.8 ± 40.2 32.8 ± 24.0 56.4 ± 14.7 107.8 ± 53.8 67.1 ± 41.6 Total no. of DSA frames 654 ± 376 960 ± 356 1447 ± 368 604 ± 231 1756 ± 2024 770 ± 191 883 ± 626 DAP, Gy × cm2 218 ± 141 327 ± 162 326 ± 98 215 ± 162 * * 257 ± 150 Maximum ESD, Gy 2.1 ± 1.1 1.6 ± 0.8 2.4 ± 1.3 1.5 ± 1.2 1.3 ± 0.7 1.0 ± 0.2 1.9 ± 1.1 Note:—Data are given as average ± SD. DSA indicates digital subtraction angiography; DAP, dose area product; ESD, entrance skin dose.
* DAP meters were not available.
- Table 4:
Averages of total fluoroscopic time, number of DSA frames, DAP, and maximum ESD for each target lesion
Variable Target Lesions AN (n = 86) AVF (n = 7) CCF (n = 6) AVM (n = 4) Total fluoroscopic time, min 59.8 ± 33.7 120.3 ± 67.3 125.9 ± 27.3 40.0 ± 8.7 Total no. of DSA frames 812 ± 22 1405 ± 758 1125 ± 251 1141 ± 320 DAP, Gy × cm2 233 ± 132 380 ± 166 428 ± 233 307 ± 36 Maximum ESD, Gy 1.8 ± 1.1 2.0 ± 1.0 2.6 ± 0.9 1.6 ± 0.5 Note:—Data are given as average ± SD. AN indicates cerebral aneurysm; AVF, dural arteriovenous fistula; CCF, internal carotid artery cavernous sinus fistula; AVM, arteriovenous malformation; DSA, digital subtraction angiography; DAP, dose area product; ESD, entrance skin dose.
Case No. Institution Target Lesions Maximum ESD, Gy Total Fluoroscopic Time, min Most Exposed Area Time of Onset Type of Epilation Case 1 1 AN 2.7 70.5 Left occipital 3 mo Temporary Case 2 1 AN 5.6 96.5 Right temporal 2 wk Temporary Case 3 1 AN 3.0 75.0 Right occipital 2 wk Temporary Case 4 1 AN 3.9 68.0 Right occipital 2 wk Temporary Case 5 3 AN 5.2 111.4 Right occipital 2 wk Temporary Case 6 3 AN 3.2 128.7 Right occipital 2 wk Temporary Note:—AN indicates cerebral aneurysm.
- Table 6:
Data of patient's maximum skin dose (ESD) during neuroembolization in the literature
Target Lesions or Procedure No. of Patients Average Maximum ESD, Gy Average Total Fluoroscopic Time, min Dosimetry Authors Published Year AN 86 1.8 ± 1.1 59.8 ± 33.7 44 points by radiosensitive indicator This study This study AVF 7 2.0 ± 1.0 120.3 ± 67.3 Same as above This study This study CCF 6 2.6 ± 0.9 125.9 ± 27.3 Same as above This study This study AVM 4 1.6 ± 0.5 40.0 ± 8.7 Same as above This study This study GDC embolization with an old angiography unit 12 2.2 56 5 points by TLDs Mooney et al18 2006 GDC embolization with a new angiography unit 12 0.5 31 5 points by TLDs Mooney et al18 2006 AN 143 1.9 73.8 CareGraph Miller et al19 2003 AN 4 0.3 ± 0.1 44.3 ± 20.0 10 points by TLDs Bergeron et al20 1994 AVF 9 3.1 ± 1.6* 33.9 ± 33.5 5 points by TLDs Kuwayama et al2 1994 AVM 169 2.0 91.5 CareGraph Miller et al19 2003 AVM 5 0.7 ± 0.5* 59.8 ± 26.8 2 points by TLDs Berthelsen et al21 1991 AVM 3 1.9 ± 2.7* 24.7 ± 9.6 5 points by TLDs Kuwayama et al2 1994 AVM 2 0.8 ± 0.7 44.5 ± 10.6 10 points by TLDs Bergeron et al20 1994 AN, AVF, AVM 94 2.1 NA PEMNET O'Dea et al5 1999 AN, AVM 31 0.9 ± 0.5 34.8 ± 12.6 23 points by TLDs Kemerink et al6 2002 Note:—AN indicates cerebral aneurysm; AVF, dural arteriovenous fistula; CCF, internal carotid artery cavernous sinus fistula; AVM, arteriovenous malformation; GDC, Guglielmi detachable coil; TLD, thermoluminescent dosimeter; NA, not available; ESD, entrance skin dose.
* Dose in Sv.
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