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Local Diagnostic Reference Levels for Intracranial Aneurysm Coil-Only Embolization Using a Low-Dose Technique.
Mariusz Sowa1, Joanna Sowa2, Kamil Węglarz1
1Department of Neurosurgery, Collegium Medicum University of Warmia and Mazury Aleja Warszawska 30, 10-082 Olsztyn, Poland.
Biomedicines
|January 28, 2026
Summary
This study demonstrates that a low-dose protocol significantly reduces radiation exposure during neurointerventional coil-only intracranial aneurysm treatments. The findings establish local diagnostic reference levels (DRLs) for optimizing patient safety and quality assurance in similar procedures.
Area of Science:
- Neurosurgery
- Radiology
- Medical Physics
Background:
- Minimizing ionizing radiation exposure is crucial in neurointerventional procedures.
- Optimizing workflow and reducing radiation dose depend on operator experience, reduced frame rates, and advanced angiographic systems.
- A low-dose protocol using low fluoroscopy (3.125 fps) and acquisition (2.45 fps) rates was implemented for coil-only intracranial aneurysm treatments.
Purpose of the Study:
- To evaluate the effectiveness of a low-dose protocol in reducing radiation exposure during coil-only endovascular treatment of intracranial aneurysms.
- To establish local diagnostic reference levels (DRLs) for dose-area product (DAP), reference air kerma (Ka,r), fluoroscopy time (FT), and digital subtraction angiography (DSA) frames.
- To compare these DRLs with published literature values.
Main Methods:
- Retrospective analysis of 245 coil-only procedures performed between 2018 and 2024 at a single tertiary center.
- Collection of dose metrics: DAP, Ka,r, FT, and total DSA frames.
- Determination of local DRLs (P75) and typical values (P50) with descriptive comparison to literature.
Main Results:
- The established DRLs (P75) were significantly lower than literature ranges: DAP (22.4 Gy·cm²), Ka,r (268 mGy), FT (18 min 56 s), and DSA frames (285).
- Typical values (P50) also indicated reduced exposure: DAP (13.8 Gy·cm²), Ka,r (196 mGy), FT (13 min 25 s), and DSA frames (208).
- The implemented low-dose protocol resulted in dose metrics within the lower range of published values.
Conclusions:
- The low-dose protocol effectively reduced radiation exposure in coil-only intracranial aneurysm treatment.
- Proposed local DRLs can aid in quality assurance, dose optimization, and patient safety.
- Further multi-center studies are needed to validate these findings and assess applicability beyond coil-only procedures.
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