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AJNR Am J Neuroradiol. 2018 Apr;39(4):734-741. doi: 10.3174/ajnr.A5552. Epub 2018 Feb 15.

A Patient Dose-Reduction Technique for Neuroendovascular Image-Guided Interventions: Image-Quality Comparison Study.

Sonig A1,2, Setlur Nagesh SV3, Fennell VS1,2, Gandhi S4,2,5, Rangel-Castilla L1,2, Ionita CN1,3,6, Snyder KV1,7,4,2, Hopkins LN1,7,2,3,8, Bednarek DR1,7,3, Rudin S1,7,2,3,6,9,10, Siddiqui AH1,7,2,3,8, Levy EI11,7,2,3.

Author information

1
From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).
2
Department of Neurosurgery (A.S., V.S.F., S.G., L.R.-C., K.V.S., L.N.H., S.R., A.H.S., E.I.L.), Gates Vascular Institute at Kaleida Health, Buffalo, New York.
3
Toshiba Stroke and Vascular Research Center (S.V.S.N., C.N.I., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).
4
Neurology (S.G., K.V.S.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.
5
Buffalo Neuroimaging Analysis Center (S.G.), Buffalo, New York.
6
Department of Biomedical Engineering (C.N.I., S.R.).
7
Radiology (K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.).
8
Jacobs Institute (L.N.H., A.H.S.), Buffalo, New York.
9
Department of Mechanical and Aerospace Engineering (S.R.).
10
Department of Electrical Engineering (S.R.), University at Buffalo, State University of New York, Buffalo, New York.
11
From the Departments of Neurosurgery (A.S., V.S.F., L.R.-C., C.N.I., K.V.S., L.N.H., D.R.B., S.R., A.H.S., E.I.L.) elevy@ubns.com.

Abstract

BACKGROUND AND PURPOSE:

The ROI-dose-reduced intervention technique represents an extension of ROI fluoroscopy combining x-ray entrance skin dose reduction with spatially different recursive temporal filtering to reduce excessive image noise in the dose-reduced periphery in real-time. The aim of our study was to compare the image quality of simulated neurointerventions with regular and reduced radiation doses using a standard flat panel detector system.

MATERIALS AND METHODS:

Ten 3D-printed intracranial aneurysm models were generated on the basis of a single patient vasculature derived from intracranial DSA and CTA. The incident dose to each model was reduced using a 0.7-mm-thick copper attenuator with a circular ROI hole (10-mm diameter) in the middle mounted inside the Infinix C-arm. Each model was treated twice with a primary coiling intervention using ROI-dose-reduced intervention and regular-dose intervention protocols. Eighty images acquired at various intervention stages were shown twice to 2 neurointerventionalists who independently scored imaging qualities (visibility of aneurysm-parent vessel morphology, associated vessels, and/or devices used). Dose-reduction measurements were performed using an ionization chamber.

RESULTS:

A total integral dose reduction of 62% per frame was achieved. The mean scores for regular-dose intervention and ROI dose-reduced intervention images did not differ significantly, suggesting similar image quality. Overall intrarater agreement for all scored criteria was substantial (Kendall τ = 0.62887; P < .001). Overall interrater agreement for all criteria was fair (κ = 0.2816; 95% CI, 0.2060-0.3571).

CONCLUSIONS:

Substantial dose reduction (62%) with a live peripheral image was achieved without compromising feature visibility during neuroendovascular interventions.

PMID:
29449282
PMCID:
PMC5895507
DOI:
10.3174/ajnr.A5552
[Indexed for MEDLINE]
Free PMC Article

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