Monitoring Radiation Doses during Diagnostic and Therapeutic Neurointerventional Procedures: Multicenter Study for Establishment of Reference Levels

Yon Kwon Ihn, Bum soo Kim, Hae Woong Jeong, Sang Hyun Suh, Yoo Dong Won, Young Jun Lee, Dong Joon Kim, Pyong Jeon, Chang Woo Ryu, Sang il Suh, Dae Seob Choi, See Sung Choi, Sang Heum Kim, Jun Soo Byun, Jieun Rho, Yunsun Song, Woo Sang Jeong, Noah Hong, Sung Hyun Baik, Jeong Jin ParkSoo Mee Lim, Jung Jae Kim, Woong Yoon

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: To assess patient radiation doses during diagnostic and therapeutic neurointerventional procedures from multiple centers and propose dose reference level (RL). Materials and Methods: Consecutive neurointerventional procedures, performed in 22 hospitals from December 2020 to June 2021, were retrospectively studied. We collected data from a sample of 429 diagnostic and 731 therapeutic procedures. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time (FT), and total number of image frames (NI) were obtained. RL were calculated as the 3rd quartiles of the distribution. Results: Analysis of 1160 procedures from 22 hospitals confirmed the large variability in patient dose for similar procedures. RLs in terms of DAP, CAK, FT, and NI were 101.6 Gy·cm2, 711.3 mGy, 13.3 minutes, and 637 frames for cerebral angiography, 199.9 Gy·cm2, 3,458.7 mGy, 57.3 minutes, and 1,000 frames for aneurysm coiling, 225.1 Gy·cm2, 1,590 mGy, 44.7 minutes, Ihn YK et al. Reference Doses for Interventional Neuroradiology Procedures in Korea and 800 frames for stroke thrombolysis, 412.3 Gy·cm2, 4,447.8 mGy, 99.3 minutes, and 1,621.3 frames for arteriovenous malformation (AVM) embolization, respectively. For all procedures, the results were comparable to most of those already published. Statistical analysis showed male and presence of procedural complications were significant factors in aneurysmal coiling. Male, number of passages, and procedural combined technique were significant factors in stroke thrombolysis. In AVM embolization, a significantly higher radiation dose was found in the definitive endovascular cure group. Conclusion: Various RLs introduced in this study promote the optimization of patient doses in diagnostic and therapeutic interventional neuroradiology procedures. Proposed 3rd quartile DAP (Gy·cm2) values were 101.6 for diagnostic cerebral angiography, 199.9 for aneurysm coiling, 225.1 for stroke thrombolysis, and 412.3 for AVM embolization. Continual evolution of practices and technologies requires regular updates of RLs.

Original languageEnglish
Pages (from-to)240-251
Number of pages12
Issue number3
StatePublished - Nov 2021

Bibliographical note

Publisher Copyright:
© 2021 Korean Society of Interventional Neuroradiology


  • Cerebral angiography
  • Diagnostic reference levels
  • Intracra-nial aneurysm
  • Intracranial arteriovenous malformation
  • Radiation monitoring
  • Thrombectomy


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