PT  - JOURNAL ARTICLE
AU  - Sonig, A.
AU  - Setlur Nagesh, S.V.
AU  - Fennell, V.S.
AU  - Gandhi, S.
AU  - Rangel-Castilla, L.
AU  - Ionita, C.N.
AU  - Snyder, K.V.
AU  - Hopkins, L.N.
AU  - Bednarek, D.R.
AU  - Rudin, S.
AU  - Siddiqui, A.H.
AU  - Levy, E.I.
TI  - A Patient Dose-Reduction Technique for Neuroendovascular Image-Guided Interventions: Image-Quality Comparison Study
AID  - 10.3174/ajnr.A5552
DP  - 2018 Apr 01
TA  - American Journal of Neuroradiology
PG  - 734--741
VI  - 39
IP  - 4
4099  - http://www.ajnr.org/content/39/4/734.short
4100  - http://www.ajnr.org/content/39/4/734.full
SO  - Am. J. Neuroradiol.2018 Apr 01; 39
AB  - BACKGROUND AND PURPOSE: The ROI–dose-reduced intervention technique represents an extension of ROI fluoroscopy combining x-ray entrance skin dose reduction with spatially different recursive temporal filtering to reduce excessive image noise in the dose-reduced periphery in real-time. The aim of our study was to compare the image quality of simulated neurointerventions with regular and reduced radiation doses using a standard flat panel detector system.MATERIALS AND METHODS: Ten 3D-printed intracranial aneurysm models were generated on the basis of a single patient vasculature derived from intracranial DSA and CTA. The incident dose to each model was reduced using a 0.7-mm-thick copper attenuator with a circular ROI hole (10-mm diameter) in the middle mounted inside the Infinix C-arm. Each model was treated twice with a primary coiling intervention using ROI-dose-reduced intervention and regular-dose intervention protocols. Eighty images acquired at various intervention stages were shown twice to 2 neurointerventionalists who independently scored imaging qualities (visibility of aneurysm-parent vessel morphology, associated vessels, and/or devices used). Dose-reduction measurements were performed using an ionization chamber.RESULTS: A total integral dose reduction of 62% per frame was achieved. The mean scores for regular-dose intervention and ROI dose-reduced intervention images did not differ significantly, suggesting similar image quality. Overall intrarater agreement for all scored criteria was substantial (Kendall τ = 0.62887; P < .001). Overall interrater agreement for all criteria was fair (κ = 0.2816; 95% CI, 0.2060–0.3571).CONCLUSIONS: Substantial dose reduction (62%) with a live peripheral image was achieved without compromising feature visibility during neuroendovascular interventions.DRIdose-reduced interventionRDIregular-dose intervention