Korean Journal of Radiology

  • 제24권7호
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  • Pages.681-689
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  • 2023
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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Reduction of Radiation Dose to Eye Lens in Cerebral 3D Rotational Angiography Using Head Off-Centering by Table Height Adjustment: A Prospective Study

  • Jae-Chan Ryu (Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jong-Tae Yoon (Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center) ;
  • Byung Jun Kim (Advanced Therapies, Siemens Healthineers Ltd.) ;
  • Mi Hyeon Kim (Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center) ;
  • Eun Ji Moon (Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Pae Sun Suh (Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yun Hwa Roh (Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hye Hyeon Moon (Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Boseong Kwon (Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Deok Hee Lee (Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yunsun Song (Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2023.02.18
  • 심사 : 2023.04.24
  • 발행 : 2023.07.01
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초록

Objective: Three-dimensional rotational angiography (3D-RA) is increasingly used for the evaluation of intracranial aneurysms (IAs); however, radiation exposure to the lens is a concern. We investigated the effect of head off-centering by adjusting table height on the lens dose during 3D-RA and its feasibility in patient examination. Materials and Methods: The effect of head off-centering during 3D-RA on the lens radiation dose at various table heights was investigated using a RANDO head phantom (Alderson Research Labs). We prospectively enrolled 20 patients (58.0 ± 9.4 years) with IAs who were scheduled to undergo bilateral 3D-RA. In all patients' 3D-RA, the lens dose-reduction protocol involving elevation of the examination table was applied to one internal carotid artery, and the conventional protocol was applied to the other. The lens dose was measured using photoluminescent glass dosimeters (GD-352M, AGC Techno Glass Co., LTD), and radiation dose metrics were compared between the two protocols. Image quality was quantitatively analyzed using source images for image noise, signal-to-noise ratio, and contrast-to-noise ratio. Additionally, three reviewers qualitatively assessed the image quality using a five-point Likert scale. Results: The phantom study showed that the lens dose was reduced by an average of 38% per 1 cm increase in table height. In the patient study, the dose-reduction protocol (elevating the table height by an average of 2.3 cm) led to an 83% reduction in the median dose from 4.65 mGy to 0.79 mGy (P < 0.001). There were no significant differences between dose-reduction and conventional protocols in the kerma area product (7.34 vs. 7.40 Gy·cm2, P = 0.892), air kerma (75.7 vs. 75.1 mGy, P = 0.872), and image quality. Conclusion: The lens radiation dose was significantly affected by table height adjustment during 3D-RA. Intentional head off-centering by elevation of the table is a simple and effective way to reduce the lens dose in clinical practice.

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참고문헌

  1. Abe T, Hirohata M, Tanaka N, Uchiyama Y, Kojima K, Fujimoto K, et al. Clinical benefits of rotational 3D angiography in endovascular treatment of ruptured cerebral aneurysm. AJNR Am J Neuroradiol 2002;23:686-688 
  2. Anxionnat R, Bracard S, Ducrocq X, Trousset Y, Launay L, Kerrien E, et al. Intracranial aneurysms: clinical value of 3D digital subtraction angiography in the therapeutic decision and endovascular treatment. Radiology 2001;218:799-808  https://doi.org/10.1148/radiology.218.3.r01mr09799
  3. van Rooij WJ, Sprengers ME, de Gast AN, Peluso JP, Sluzewski M. 3D rotational angiography: the new gold standard in the detection of additional intracranial aneurysms. AJNR Am J Neuroradiol 2008;29:976-979  https://doi.org/10.3174/ajnr.A0964
  4. Guberina N, Lechel U, Forsting M, Monninghoff C, Dietrich U, Ringelstein A. Dose comparison of classical 2-plane DSA and 3D rotational angiography for the assessment of intracranial aneurysms. Neuroradiology 2016;58:673-678  https://doi.org/10.1007/s00234-016-1671-4
  5. Schueler BA, Kallmes DF, Cloft HJ. 3D cerebral angiography: radiation dose comparison with digital subtraction angiography. AJNR Am J Neuroradiol 2005;26:1898-1901 
  6. Stewart FA, Akleyev AV, Hauer-Jensen M, Hendry JH, Kleiman NJ, Macvittie TJ, et al. ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs--threshold doses for tissue reactions in a radiation protection context. Ann ICRP 2012;41:1-322  https://doi.org/10.1016/j.icrp.2012.02.001
  7. Ki HJ, Kim BS, Kim JK, Choi JH, Shin YS, Choi Y, et al. Low-dose 3D rotational angiography in measuring the size of intracranial aneurysm: in vitro feasibility study using aneurysm phantom. Neurointervention 2021;16:59-63  https://doi.org/10.5469/neuroint.2020.00437
  8. Ki HJ, Kim BS, Kim JK, Choi JH, Shin YS, Choi Y, et al. Low-dose three-dimensional rotational angiography for evaluating intracranial aneurysms: analysis of image quality and radiation dose. Korean J Radiol 2022;23:256-263  https://doi.org/10.3348/kjr.2021.0162
  9. Pearl MS, Torok C, Katz Z, Messina SA, Blasco J, Tamargo RJ, et al. Diagnostic quality and accuracy of low dose 3D-DSA protocols in the evaluation of intracranial aneurysms. J Neurointerv Surg 2015;7:386-390  https://doi.org/10.1136/neurintsurg-2014-011137
  10. Schneider T, Wyse E, Pearl MS. Analysis of radiation doses incurred during diagnostic cerebral angiography after the implementation of dose reduction strategies. J Neurointerv Surg 2017;9:384-388  https://doi.org/10.1136/neurintsurg-2015-012204
  11. Kim DJ, Park MK, Jung DE, Kang JH, Kim BM. Radiation dose reduction without compromise to image quality by alterations of filtration and focal spot size in cerebral angiography. Korean J Radiol 2017;18:722-728  https://doi.org/10.3348/kjr.2017.18.4.722
  12. Pearl MS, Torok C, Wang J, Wyse E, Mahesh M, Gailloud P. Practical techniques for reducing radiation exposure during cerebral angiography procedures. J Neurointerv Surg 2015;7:141-145  https://doi.org/10.1136/neurintsurg-2013-010982
  13. Soderman M, Holmin S, Andersson T, Palmgren C, Babic D, Hoornaert B. Image noise reduction algorithm for digital subtraction angiography: clinical results. Radiology 2013;269:553-560  https://doi.org/10.1148/radiol.13121262
  14. Song Y, Han S, Kim BJ, Oh SH, Kim JS, Kim TI, et al. Low-dose fluoroscopy protocol for diagnostic cerebral angiography. Neurointervention 2020;15:67-73  https://doi.org/10.5469/neuroint.2020.00129
  15. Song Y, Han S, Kim BJ, Oh SH, Kim JS, Kim TI, et al. Feasibility of low-dose digital subtraction angiography protocols for the endovascular treatment of intracranial dural arteriovenous fistulas. Neuroradiology 2021;63:267-273  https://doi.org/10.1007/s00234-020-02537-2
  16. Anam C, Fujibuchi T, Toyoda T, Sato N, Haryanto F, Widita R, et al. The impact of head miscentering on the eye lens dose in CT scanning: phantoms study. J Phys: Conf Ser 2019;1204:012022 
  17. Kim JS, Park BR, Yoo J, Ha WH, Jang S, Jang WI, et al. Measurement uncertainty analysis of radiophotoluminescent glass dosimeter reader system based on GD-352M for estimation of protection quantity. Nucl Eng Technol 2022;54:479-485  https://doi.org/10.1016/j.net.2021.08.016
  18. Oonsiri P, Kingkaew S, Vannavijit C, Suriyapee S. Investigation of the dosimetric characteristics of radiophotoluminescent glass dosimeter for high-energy photon beams. J Radiat Res Appl Sci 2019;12:65-71  https://doi.org/10.1080/16878507.2019.1594092
  19. Lee KB, Goo HW. Quantitative image quality and histogram-based evaluations of an iterative reconstruction algorithm at low-to-ultralow radiation dose levels: a phantom study in chest CT. Korean J Radiol 2018;19:119-129  https://doi.org/10.3348/kjr.2018.19.1.119
  20. Otgonbaatar C, Ryu JK, Shin J, Woo JY, Seo JW, Shim H, et al. Improvement in image quality and visibility of coronary arteries, stents, and valve structures on CT angiography by deep learning reconstruction. Korean J Radiol 2022;23:1044-1054  https://doi.org/10.3348/kjr.2022.0127
  21. Tan S, Soulez G, Diez Martinez P, Larrivee S, Stevens LM, Goussard Y, et al. Coronary stent artifact reduction with an edge-enhancing reconstruction kernel - a prospective cross-sectional study with 256-slice CT. PLoS One 2016;11:e0154292 
  22. Guberina N, Dietrich U, Forsting M, Ringelstein A. Comparison of eye-lens doses imparted during interventional and non-interventional neuroimaging techniques for assessment of intracranial aneurysms. J Neurointerv Surg 2018;10:168-170  https://doi.org/10.1136/neurintsurg-2016-012970
  23. Sandborg M, Rossitti S, Pettersson H. Local skin and eye lens equivalent doses in interventional neuroradiology. Eur Radiol 2010;20:725-733  https://doi.org/10.1007/s00330-009-1598-9
  24. Bolch WE, Dietze G, Petoussi-Henss N, Zankl M. Dosimetric models of the eye and lens of the eye and their use in assessing dose coefficients for ocular exposures. Ann ICRP 2015;44(1 Suppl):91-111  https://doi.org/10.1177/0146645314562320
  25. Pearl MS, Torok CM, Messina SA, Radvany M, Rao SN, Ehtiati T, et al. Reducing radiation dose while maintaining diagnostic image quality of cerebral three-dimensional digital subtraction angiography: an in vivo study in swine. J Neurointerv Surg 2014;6:672-676  https://doi.org/10.1136/neurintsurg-2013-010914
  26. Shaffiq Said Rahmat SM, Abdul Karim MK, Che Isa IN, Abd Rahman MA, Noor NM, Hoong NK. Effect of miscentering and low-dose protocols on contrast resolution in computed tomography head examination. Comput Biol Med 2020;123:103840 
  27. Habibzadeh MA, Ay MR, Asl AR, Ghadiri H, Zaidi H. Impact of miscentering on patient dose and image noise in x-ray CT imaging: phantom and clinical studies. Phys Med 2012;28:191-199 https://doi.org/10.1016/j.ejmp.2011.06.002