Abstract：
OBJECTIVE: Radiation doses to adult patients submitted to cerebral angiography and intracranial aneurysms treatments were assessed by using DICOM Radiation Dose Structured Reports (RDSR) and Monte Carlo simulations. Conversion factors to estimate effective and organ doses from Kerma-Area Product (PKA) values were determined.
METHODS: 77 cerebral procedures performed with five angiographic equipment installed in three Italian centres were analyzed. Local settings and acquisition protocols were considered. The geometrical, technical and dosimetric data of 16,244 irradiation events (13305 fluoroscopy, 2811 digital subtraction angiography, 128 cone-beam CT) were extracted from RDSRs by local dose monitoring systems and were input in MonteCarlo PCXMC software to calculate effective and organ doses. Finally, conversion factors to determine effective and organ doses from PKA were determined. Differences between centres were assessed through statistical analysis and accuracy of dose calculation method based on conversion factors was assessed through Bland-Altman analysis.
RESULTS: Large variations in PKA (14-561 Gycm2) and effective dose (1.2-73.5 mSv) were observed due to different degrees of complexity in the procedures and angiographic system technology. The most exposed organs were brain, salivary glands, oral mucosa, thyroid and skeleton. The study highlights the importance of recent technology in reducing patient exposure (about fourfold, even more in DSA). No statistically significant difference was observed in conversion factors between centres, except for some organs. A conversion factor of 0.09 ± 0.02 mSv/Gycm2 was obtained for effective dose.
CONCLUSIONS: Organ and effective doses were assessed for neuro-interventional procedures. Conversion factors for calculating effective and organ doses from PKA were provided.
METHODS: 77 cerebral procedures performed with five angiographic equipment installed in three Italian centres were analyzed. Local settings and acquisition protocols were considered. The geometrical, technical and dosimetric data of 16,244 irradiation events (13305 fluoroscopy, 2811 digital subtraction angiography, 128 cone-beam CT) were extracted from RDSRs by local dose monitoring systems and were input in MonteCarlo PCXMC software to calculate effective and organ doses. Finally, conversion factors to determine effective and organ doses from PKA were determined. Differences between centres were assessed through statistical analysis and accuracy of dose calculation method based on conversion factors was assessed through Bland-Altman analysis.
RESULTS: Large variations in PKA (14-561 Gycm2) and effective dose (1.2-73.5 mSv) were observed due to different degrees of complexity in the procedures and angiographic system technology. The most exposed organs were brain, salivary glands, oral mucosa, thyroid and skeleton. The study highlights the importance of recent technology in reducing patient exposure (about fourfold, even more in DSA). No statistically significant difference was observed in conversion factors between centres, except for some organs. A conversion factor of 0.09 ± 0.02 mSv/Gycm2 was obtained for effective dose.
CONCLUSIONS: Organ and effective doses were assessed for neuro-interventional procedures. Conversion factors for calculating effective and organ doses from PKA were provided.
摘要：
目的：使用DICOM辐射剂量结构报告（RDSR）和蒙特卡罗模拟评估接受脑血管造影和颅内动脉瘤治疗的成年患者的辐射剂量。从Kerma面积乘积(PKA)值确定用于估计有效剂量和器官剂量的转换因子。
方法：分析了在三个意大利中心安装的五个血管造影设备进行的77例脑部手术。考虑了本地设置和采集协议。几何，16244次辐照事件的技术和剂量学数据(13305透视，2811数字减影血管造影,通过本地剂量监测系统从RDSR中提取128锥形束CT），并输入MonteCarloPCXMC软件以计算有效剂量和器官剂量。最后,转换因子以确定PKA的有效剂量和器官剂量。通过统计分析评估中心之间的差异，并通过Bland-Altman分析评估基于转换因子的剂量计算方法的准确性。
结果：由于手术和血管造影系统技术的复杂性不同，观察到PKA（14-561Gycm2）和有效剂量（1.2-73.5mSv）的差异很大。最暴露的器官是大脑，唾液腺,口腔粘膜，甲状腺和骨骼。该研究强调了最新技术在减少患者暴露方面的重要性(约四倍，在DSA中甚至更多）。中心之间的转换因子没有观察到统计学上的显著差异，除了一些器官。有效剂量的转换因子为0.09±0.02mSv/Gycm2。
结论：评估了神经介入手术的器官和有效剂量。提供了用于计算PKA的有效剂量和器官剂量的转换因子。
方法：分析了在三个意大利中心安装的五个血管造影设备进行的77例脑部手术。考虑了本地设置和采集协议。几何，16244次辐照事件的技术和剂量学数据(13305透视，2811数字减影血管造影,通过本地剂量监测系统从RDSR中提取128锥形束CT），并输入MonteCarloPCXMC软件以计算有效剂量和器官剂量。最后,转换因子以确定PKA的有效剂量和器官剂量。通过统计分析评估中心之间的差异，并通过Bland-Altman分析评估基于转换因子的剂量计算方法的准确性。
结果：由于手术和血管造影系统技术的复杂性不同，观察到PKA（14-561Gycm2）和有效剂量（1.2-73.5mSv）的差异很大。最暴露的器官是大脑，唾液腺,口腔粘膜，甲状腺和骨骼。该研究强调了最新技术在减少患者暴露方面的重要性(约四倍，在DSA中甚至更多）。中心之间的转换因子没有观察到统计学上的显著差异，除了一些器官。有效剂量的转换因子为0.09±0.02mSv/Gycm2。
结论：评估了神经介入手术的器官和有效剂量。提供了用于计算PKA的有效剂量和器官剂量的转换因子。
