Rofo 2019; 191(12): 1099-1106
DOI: 10.1055/a-0924-5945
Interventional Radiology
© Georg Thieme Verlag KG Stuttgart · New York

Investigation of Radiation Exposure of Patients with Acute Ischemic Stroke during Mechanical Thrombectomy

Article in several languages: English | deutsch
Felix Bärenfänger
1   Department of Experimental Physics 5, TU Dortmund, Germany
,
Andreas Block
2   Department of Medical Radiation Physics and Radiation Protection, Hospital of Dortmund gGmbH, Dortmund, Germany
,
Stefan Rohde
3   Department of Radiology and Neuroradiology, Hospital of Dortmund gGmbH, Dortmund, Germany
› Author Affiliations
Further Information

Publication History

16 November 2018

29 April 2019

Publication Date:
24 July 2019 (online)

Abstract

Purpose In radiological interventions, the skin is the most exposed organ. The aim of this study was to investigate the local dose exposure and the resulting risk of deterministic radiation effects for patients who underwent mechanichal thrombectomy.

Materials and Methods The examination protocols of 50 consecutive stroke patients who underwent mechanical thrombectomy from September 2016 to April 2017 were evaluated in this study. All procedures were performed on a biplanar angiographic suite. The local skin equivalent dose H P(0.07) was calculated retrospectively using the recorded radiation data and previously measured conversion factors. The in-vitro determination of the conversion factors was performed with a silicon semiconductor detector on the surface of an Alderson-Rando head phantom depending on the radiation quality.

Results Vessel occlusion was located in the M1 and M2 segments of the cerebral artery media (n = 32), the internal carotid artery or carotid-T (n = 12) and the basilar artery (n = 6). The fluoroscopy times ranged from 5.7 minutes to 137.3 minutes with an average value of 39.5 ± 4.1 minutes. The determined skin equivalent dose values ranged from 0.16 ± 0.02 Gy to 4.80 ± 0.51 Gy, with the mean value being 1.00 ± 0.14 Gy. In 3 out of 50 cases (6 %), the threshold value for skin reactions of 3 Gy published by the German Radiation Protection Commission was exceeded. A further 15 patients (36 %) were exposed to a dose of 1–3 Gy. The highest dose values were achieved during long procedures with occlusions in the posterior circulation and carotid occlusions. In addition, a local dose reference level of 1.24 ± 0.15 Gy could be determined for the skin equivalent dose in mechanical thrombectomies for our center.

Conclusion Even during a modern neuroradiological intervention, such as mechanical thrombectomy, radiation doses to the patient are produced and can lead to deterministic radiation damage to the skin in approximately 6 % of cases. Systematic monitoring of local dose quantities, such as H P(0.07), seems appropriate. Possibilities for recording and reducing the local dose load should be developed by the interventional teams in cooperation with a medical physics expert.

Key Points:

  • In 64 % of the thrombectomies the skin equivalent doses were in the harmless range (< 1 Gy).

  • In 6 % of the patients higher H P(0.07) values were determined, which can lead to deterministic radiation damage to the skin.

  • To avoid deterministic damage during neurointerventions, H P(0.07) should be recorded (combined measuring chambers).

  • For longer interventions, precautions should be taken to reduce the radiation dose.

Citation Format

  • Bärenfänger F, Block A, Rohde S. Investigation of Radiation Exposure of Patients with Acute Ischemic Stroke during Mechanical Thrombectomy. Fortschr Röntgenstr 2019; 191: 1099 – 1106

 
  • References

  • 1 Interventionelle Radiologie – Empfehlung der Strahlenschutzkommission. Strahlenschutzkommission; 2007
  • 2 Krogias C, Bartig D, Kitzrow M. et al. Verfügbarkeit der mechanischen Thrombektomie bei akutem Hirninfakt – Analyse der Versorgungsrealität in Deutschland. Nervenarzt 2017; 88: 1177-1185 . doi:10.1007/s00115-017-0324-0
  • 3 DIN 6814-3. Begriffe in der radiologischen Technik – Dosimetrie. Deutsches Institut für Normung e. V; 2014
  • 4 ICRP. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 2007; 103: 99-100
  • 5 DIN 13005. Leitfaden zur Angabe der Unsicherheit beim Messen. Deutsches Institut für Normung e. V; 1999
  • 6 ICRP. Diagnostic Reference Levels in Medical Imaging. ICRP Publication 135. Ann ICRP 2017; 135: 44-47
  • 7 Farah J, Rouchaud A, Henry T. et al. Dose reference levels and clinical determinants in stroke neuroradiology interventions. European Radiology 2018; DOI: 10.1007/s00330-018-5593-x.
  • 8 Bundesamt für Strahlenschutz. Bekanntmachung der aktualisierten diagnostischen Referenzwerte für interventionelle Röntgenanwendungen. 2018
  • 9 Brix G, Griebel J, Czarwinski R. Melde- und Informationssystem für bedeutsame Vorkommnisse bei Strahlenanwendungen in der Medizin: Struktur, Zuständigkeiten und Meldekriterien. Zeitschrift für Medizinische Physik 2019; 29: 66-76 . doi:10.1016/j.zemedi.2018.11.003
  • 10 Chu FCH, Conrad JT, Bane HN. et al. Quantitative and Qualitative Evaluation of Skin Erythema – I. Technic of Measurement and Description of the Reaction. Radiology 1960; DOI: https://doi.org/10.1148/75.3.406.
  • 11 Glicksman AS, Chu FCH, Bane HN. et al. Quantitative and Qualitative Evaluation of Skin Erythema – II. Clinical Study in Patients on a Standardized Irradiation Schedule. Radiology 1960; DOI: https://doi.org/10.1148/75.3.411.
  • 12 Friedrich B, Maegerlein C, Lobsien D. et al. Endovascular Stroke Treatment on Single-Plane vs. Bi-Plane Angiography Suites. Clinical Neuroradiology 2018; DOI: 10.1007/s00062-017-0655-z.
  • 13 Mooney RB, McKinstry CS, Kamel HA. Absorbed dose and deterministic effects to patients from interventional neuroradiology. The British Journal of Radiology 2000; 73: 745-751
  • 14 Struelens L, Vanhavere F, Bosmans H. et al. Skin dose measurements on patients for diagnostic and interventional neuroradiology: A multicentre study. Radiation Protection Dosimetry 2005; 114: 143-146
  • 15 Kemerink GJ, Frantzen MJ, Oei K. et al. Patient and occupational dose in neurointerventional procedures. Neuroradiology 2002; 44: 522-528
  • 16 Theodorakou C, Horrocks JA. A study on radiation doses and irradiated areas in cerebral embolisation. The British Journal of Radiology 2003; 76: 546-552
  • 17 Seifert H, El-Jamal A, Roth R. et al. Reduzierung der Strahlenexposition von Patienten bei ausgewählten interventionellen und angiographischen Maßnahmen. RöFo 2000; 12: 1057-1064