부산대학교 도서관

Efficacy of Radiation Reduction Protocols for Diagnostic Angiography and Basic Interventions in Endovascular Neurosurgery Arvin R. Wali MD, MAS, Michael G. Brandel MD, MAS, Sarath Pathuri BS, Brian R. Hirshman MD, PhD, Javier Bravo MD, Jeffrey Steinberg MD, Scott Olson MD, J. Scott Pannell MD, David R. Santiago-Dieppa MD, Alexander A. Khalessi MD, MBA  Background Safe radiation practices and “As Low As Reasonably Achievable” (ALARA) principles are critical to mitigate unnecessary radiation to patients, providers, and staff. Radiation has stochastic and deterministic effects that have deleterious effects on health and lead to complications such as cancer, leukemia, and cataracts. As the indications for neuroendovascular procedures continue to grow, Neurointerventionalists must have a strong command over practices that reduce unnecessary radiation dose. We applied a quality improvement protocol to manipulate default pulse rate and frame rate settings on our Siemens Artis Q biplane to determine if radiation safety practices could allow for quality diagnostic angiograms and the performance of safe and effective interventions.  MethodsWe implemented a radiation reduction protocol January 1st 2022 in which the default pulse rate and frame rate in our Siemens Artis Q biplane was reduced from 15 pulses per second (p/s) to 7.5 p/s and 7.5 frames per second (f/s) to 4.0 f/s. We performed a retrospective review of prospectively acquired data to calculate the impact of our radiation reduction protocol on total radiation dose, radiation per angiographic run, total radiation exposure, and exposure per run.  We examined 29 consecutive diagnostic angiograms (16 prior to intervention, and 13 post intervention) and 16 consecutive, unilateral middle meningeal artery embolizations (MMAEs) (8 prior to intervention, and 8 post intervention). A blinded neuroradiologist reviewed the angiograms to determine if there was sufficient diagnostic information in the angiograms before and after intervention. Univariable and multivariable log-linear regression were performed to account for patient body mass index (BMI), number of angiographic runs, and number of vessels catheterized. Statistical analysis was performed using STATA MP Version 17.0 (Stata Corp LP, College Station, Texas). Significance was defined as p < 0.05.  ResultsFor the diagnostic angiograms, univariable analysis revealed that radiation dose (550.5 vs. 353.3 mGy, p=0.005), radiation dose per angiographic run (34.6 vs. 21.9, p