Radiation Dosimetry of 3D Rotational Neuroangiography and 2D-DSA in Children

• Published in: American journal of neuroradiology : AJNR 2018-04, Vol.39 (4), p.727-733
• Main Authors: Shkumat, N A, Shroff, M M, Muthusami, P
• Format: Article
• Language: English
• Subjects: Angiography; Angiography, Digital Subtraction - methods; Background radiation; Central Nervous System Vascular Malformations - diagnostic imaging; Cerebral Angiography - methods; Child; Children; Computed tomography; Customization; Diagnostic systems; Dosimeters; Dosimetry; Female; Humans; Image reconstruction; Imaging, Three-Dimensional - methods; Interventional; Lesions; Male; Medical imaging; Neuroimaging - methods; Optimization; Patient Safety; Patients; Pediatrics; Radiation; Radiation Dosage; Radiation dosimetry; Radiometry; Risk assessment
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a5568

The benefit-risk assessment concerning radiation use in pediatric neuroangiography requires an extensive understanding of the doses delivered. This work evaluated the effective dose of 3D rotational angiography in a cohort of pediatric patients with complex neurovascular lesions and directly compared it with conventional 2D-biplane DSA. Thirty-three 3D rotational angiography acquisitions were acquired in 24 pediatric patients (mean age, 10.4 years). When clinically indicated, following 2D-biplane DSA, 3D rotational angiography was performed with 1 of 3 technical protocols (2 subtracted, 1 unsubtracted). The protocols consisted of 1 factory and 2 customized techniques, with images subsequently reconstructed into CT volumes for clinical management. Raw projections and quantitative dose metrics were evaluated, and the effective dose was calculated. All 3D rotational angiography acquisitions were of diagnostic quality and assisted in patient management. The mean effective doses were 0.5, 0.12, and 0.06 mSv for the factory-subtracted, customized-subtracted, and customized-unsubtracted protocols, respectively. The mean effective dose for 2D-biplane DSA was 0.9 mSv. A direct intraprocedural comparison between 3D and 2D acquisitions indicated that customized 3D rotational angiography protocols delivered mean relative doses of 9% and 15% in unsubtracted and subtracted acquisitions, respectively, compared with biplane DSA, whereas the factory subtracted protocol delivered 68%. In pediatric neuroangiography, the effective dose for 3D rotational angiography can be significantly lower than for 2D-biplane DSA and can be an essential adjunct in the evaluation of neurovascular lesions. Additionally, available 3D rotational angiography protocols have significant room to be tailored for effectiveness and dose optimization, depending on the clinical question.