Impact of Procedural-Imaging Configurations on Radiation Dose During Endovascular Flow Diverter Treatment for...

Background and Purpose: The integration of flow diverter (FD) treatment into hybrid operating rooms (HORs) raises concerns regarding radiation safety, especially when transitioning from biplane systems to single-plane configurations. In this study, we evaluated the impact of distinct procedural-imaging configurations on patient radiation exposure during FD treatment for unruptured cerebral aneurysms. Methods: We retrospectively reviewed 93 patients (HOR: 22; biplane neuroangiography suite [NIS]: 71) treated between 2020 and 2024. Key metrics included fluoroscopy time (FT) and dose area product (DAP), subdivided into 2D fluoroscopy and 3D rotational angiography (3D-RA). Linear regression was used to identify independent predictors of radiation dose. Results: While the HOR significantly reduced fluoroscopy time (19.3 vs. 26.1 min, p = 0.002), it was associated with a higher total DAP compared to the NIS (299.1 vs. 96.3 Gy·cm², p < 0.001). This increase was primarily driven by a substantially higher radiation dose delivered per 3D-RA acquisition in the HOR environment rather than an increased frequency of 3D imaging. Multivariate analysis confirmed that the surgical imaging configuration was the dominant factor influencing total radiation exposure rather than aneurysm complexity or patient characteristics. Conclusions: Hybrid ORs provide procedural efficiency but involve a significant risk of increased radiation dose due to the reliance on 3D imaging for single-plane navigation. These findings serve as preliminary institutional benchmark data, underscoring the need for adaptive radiation management and configuration-specific protocols to optimize patient safety across diverse surgical imaging suites.