https://doi.org/10.1140/epjp/s13360-023-04790-9
Regular Article
Dosimetric indices in fluoroscopically guided cerebral intervention procedure and complexity index: a multicenter study
1
SC di Fisica Sanitaria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
2
SC di Fisica Sanitaria, ARNAS “G. Brotzu”, Cagliari, Italy
3
SC di Fisica Sanitaria, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
4
SC di Neuroradiologia e Interventistica Vascolare, ARNAS “G. Brotzu”, Cagliari, Italy
5
SSD Biostatistica and Clinical Trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
6
SC di Radiologia Diagnostica per Immagini 2 Neuroradiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
7
S.C. Neuroradiologia, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
8
Deparment of Radiology, AOU of Cagliari, University of Cagliari, Cagliari, Italy
9
Centro Nazionale Tecnologie Innovative in Sanità Pubblica, Istituto Superiore di Sanità, Roma, Italy
Received:
19
July
2023
Accepted:
12
December
2023
Published online:
8
January
2024
Patient dose in fluoroscopically guided procedures is strongly related to procedure complexity. This Italian multicentric study aims to establish relationship between clinical, anatomical, technical factors and dosimetric indices defining a complexity index (CI) in diagnostic cerebral angiography (CA), embolization of cerebral aneurysm (AN) and mechanical thrombectomy (MT) in acute ischemic stroke. A cross-sectional study was performed at tricenter (803 procedures) and national level (1901 procedures). The relationship between cumulative Kerma Air Product (KAP), cumulative Air Kerma, fluoroscopy time, and a series of candidate predictors was assessed using univariable generalized linear regression. The weighting factors to define CI were estimated starting from the KAP multivariable regression model coefficient. Three complexity groups have been identified. Simple procedures: CI < 7 for CA, CI < 5 for AN and CI < 3 for MT; medium procedures: 7 ≤ CI ≤ 15 for CA, 5 ≤ CI ≤ 14 for AN3 ≤ CI ≤ 12 for MT; complex procedures CI > 15 for CA, CI > 14 for AN and CI > 12 for MT. KAP ratio medium vs simple procedures is from 1.1 to 2, while complex vs medium between 1.3 and 3. The National study confirmed most of results obtained in the tricenter study. For CA procedures, KAP was higher on male than female patient and increased by a factor 2 with the number of cerebral arteries in both studies. For MT procedures KAP was higher on male than female patient, increased when stent was used and depended on occlusion type with higher value for plaque/dissection on respect to embolus. For AN procedures, in both studies, cumulative KAP depended on aneurysm localization and morphology.
Supplementary Information The online version contains supplementary material available at https://doi.org/10.1140/epjp/s13360-023-04790-9.
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© The Author(s), under exclusive licence to Società Italiana di Fisica and Springer-Verlag GmbH Germany, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
