Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Reducing frame rate and pulse rate for routine diagnostic cerebral angiography: ALARA principles in practice

  • Arvin R. Wali (Department of Neurosurgery, University of California San Diego) ;
  • Sarath Pathuri (Long School of Medicine, University of Texas Health Sciences Center at San Antonio) ;
  • Michael G. Brandel (Department of Neurosurgery, University of California San Diego) ;
  • Ryan W. Sindewald (Department of Neurosurgery, University of California San Diego) ;
  • Brian R. Hirshman (Department of Neurosurgery, University of California San Diego) ;
  • Javier A. Bravo (Department of General Surgery, University of California San Diego) ;
  • Jeffrey A. Steinberg (Department of Neurosurgery, University of California San Diego) ;
  • Scott E. Olson (Department of Neurosurgery, University of California San Diego) ;
  • Jeffrey S. Pannell (Department of Neurosurgery, University of California San Diego) ;
  • Alexander Khalessi (Department of Neurosurgery, University of California San Diego) ;
  • David Santiago-Dieppa (Department of Neurosurgery, University of California San Diego)
  • Received : 2023.01.20
  • Accepted : 2023.09.16
  • Published : 2024.03.31
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Abstract

Objective: Diagnostic cerebral angiograms (DCAs) are widely used in neurosurgery due to their high sensitivity and specificity to diagnose and characterize pathology using ionizing radiation. Eliminating unnecessary radiation is critical to reduce risk to patients, providers, and health care staff. We investigated if reducing pulse and frame rates during routine DCAs would decrease radiation burden without compromising image quality. Methods: We performed a retrospective review of prospectively acquired data after implementing a quality improvement protocol in which pulse rate and frame rate were reduced from 15 p/s to 7.5 p/s and 7.5 f/s to 4.0 f/s respectively. Radiation doses and exposures were calculated. Two endovascular neurosurgeons reviewed randomly selected angiograms of both doses and blindly assessed their quality. Results: A total of 40 consecutive angiograms were retrospectively analyzed, 20 prior to the protocol change and 20 after. After the intervention, radiation dose, radiation per run, total exposure, and exposure per run were all significantly decreased even after adjustment for BMI (all p<0.05). On multivariable analysis, we identified a 46% decrease in total radiation dose and 39% decrease in exposure without compromising image quality or procedure time. Conclusions: We demonstrated that for routine DCAs, pulse rate of 7.5 with a frame rate of 4.0 is sufficient to obtain diagnostic information without compromising image quality or elongating procedure time. In the interest of patient, provider, and health care staff safety, we strongly encourage all interventionalists to be cognizant of radiation usage to avoid unnecessary radiation exposure and consequential health risks.

Keywords

Acknowledgement

Previously presented at UC San Diego Quality Improvement Symposium and SNIS (poster).

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