Article
Radiation exposure in the acute phase of aneurysmal subarachnoid hemorrhage
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Published: | June 9, 2017 |
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Objective: The acute phase after aneurysmal subarachnoid hemorrhage (aSAH) is associated with high risk for the occurrence of adverse events such as delayed cerebral ischemia (DCI), with the necessity of further diagnostic work-up. The advances of neuroradiological diagnostics such as CT-perfusion (CTP) and CT-angiography (CTA) as well as endovascular techniques led to their increased use possibly resulting in higher radiation exposure. We assessed the cumulative radiation dose in the acute phase after aSAH in order to estimate the risk of radiation exposure in patients with aSAH, since this patient population is younger compared to other stroke forms.
Methods: A patient population admitted to our clinic with aSAH from January 2007 to June 2016 was retrospectively analyzed and the number of CT scans (native CT, CTP and CTA) and diagnostic digital subtraction angiography (DSA) was documented. The effective dose of every radiographic examination was estimated according to the patient protocol of every examination. An average effective dose per examination was calculated. Then, the average patient related cumulative radiation dose was determined.
Results: The data of 200 patients (35% male and 65% female) with mean age of 54.5±13.6 years was analyzed. High Hunt & Hess grade had 29% and a high Fisher grade 80% of the patients. The average number of performed examinations was as followed: CT n=5, CTA n=2 and CTP n=1 and DSA n=1. The mean effective dose of each CT was 2.0mSv, of each CTA 3.4mSv, of each CTP 6.5mSv, of each DSA 22mSv. The mean cumulative radiation dose during the acute aSAH phase was 55.8mSv per patient (range 1.5-193.2mSv). Higher radiation exposure was significantly correlated to higher modified Fisher grade (linear regression, p=0.004) but not with higher Hunt & Hess grade (linear regression, p=0.48).
Conclusion: The findings of this study suggest a significant imaging-related exposure to radiation of patients with aSAH. This analysis highlights the importance of accurate assessment of radiation exposure and the relevance of elaborated imaging protocols for the management of patients in the acute phase of aSAH in order to reduce the radiation exposure without compromising the quality of treatment.