Radiation exposure during endovascular procedures

The duration of fluoroscopy exposure is routinely recorded as part of endovascular procedures. However, to better relate the duration of exposure to actual doses of surface and intracranial radiation, we compared surface doses during endovascular procedures with intracranial doses in a cadaver model exposed to lateral fluoroscopy.

Optically stimulated luminescence dosimeter chips (Landauer, Glenwood, IL) were used to measure the cranial surface dose of three consecutive patients undergoing endovascular procedures. Bitemporal craniotomies were performed on a cadaver. Dosimeter chips were placed on both the ipsilateral and contralateral skin and meningeal surfaces, and the cadaver was exposed to lateral fluoroscopy. Finally, to assess mean fluoroscopy times in patients undergoing embolization procedures, the operative notes of 100 consecutive patients were reviewed.

Three patients undergoing endovascular treatment received peak doses of 0.24, 0.31, and 1.38 Gy, respectively. In the cadaver, the peak surface dose recorded after 120 minutes of exposure was 1.71 Gy. The cranium and scalp absorbed or reflected 29% of the surface dose. Time in minutes of fluoroscopy was found to correlate with surface dose (R2 = 0.925).

Our data show that radiation exposure during endovascular treatment can reach clinically significant levels. The surface doses recorded during this study were comparable to the mean dose of 1.5 Gy estimated by others to increase the relative risk of inducing meningiomas, gliomas, and nerve sheath tumors. Pending long-term follow-up of patients exposed to endovascular procedures, consent for possible long-term sequelae of radiation may be warranted.