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Measurement of the average radiation dose to patients during intracranial aneurysm coil embolization
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Introduction: Intracranial aneurysm coil embolization is a fluoroscopically guided interventional procedure that is often preferred over surgical clipping for the treatment of intracranial aneurysms. Fluoroscopically guided procedures are associated with high levels of radiation doses which have the potential to induce skin injuries; and this necessitates adherence to radiation protection measures, especially the optimization of radiation exposure during fluoroscopically guided procedures. Optimization of radiation exposure can be achieved by applying the as low as reasonably achievable (ALARA) principle and by implementing diagnostic reference levels (DRLs). Monitoring and documentation of radiation doses at the end of each procedure is also essential to identify patients that are at risk of developing radiation-induced injuries for possible follow-up. Aim: This research study aimed to determine the average radiation dose to patients' thyroid glands and skin during intracranial aneurysm coil embolization. The objectives were to establish preliminary DRLs for intracranial aneurysm coil embolization; to ascertain whether the anatomical location of the intracranial aneurysm had an effect on the radiation dose and to compare the measured thyroid gland and skin doses to the Monte Carlo calculated doses. Methods: A prospective quantitative research study was conducted on 34 participants who had intracranial aneurysms that required coil embolization during the study period. Radiation doses to the anterior neck of participants, over the thyroid gland region, were measured using lithium fluoride thermoluminescent dosimeters (TLDs). In addition, the air-kerma area product (KAP) values were used to determine the participants' skin dose and the DRLs. Considering that it is not possible to perform direct thyroid measurements on human beings, phantom-based simulation studies were performed to evaluate the difference between the dose measured on the anterior neck and the dose measured directly on the thyroid gland. Three different aneurysm coil embolization scenarios were simulated during the phantom-based simulation studies. TLDs were placed on the anterior neck and in the thyroid hole of the phantom, which represents the anatomical location of the thyroid gland, during each simulation. The thyroid and skin doses were also calculated using a Monte Carlo program. The measured thyroid gland and skin doses were compared to the doses obtained from Monte Carlo calculations. Results: The average percentage difference between the anterior neck doses and thyroid radiation doses was found to be 61%. This value was added to the radiation dose measured on the anterior neck of participants to obtain the thyroid absorbed doses during coil embolization procedures. The thyroid absorbed doses ranged between 3.2 and 20.95 mGy with a mean of 11.25 mGy. The KAP values ranged between 33 and 125 Gy.cm2. The DRL established during this study was 68 Gy.cm2, 616 image frames and 30 minutes of fluoroscopy time. There was no agreement between measured thyroid dose and calculated thyroid doses while there was strong positive correlation between measured and calculated skin doses. The results showed no statistically significant relationship between aneurysm location and the radiation dose. Conclusion: The skin doses in this research study were below the threshold doses suggested in the literature for deterministic effects of radiation. The study results therefore suggest that patients that undergo intracranial aneurysm coil embolization at the research site are not at risk of developing radiation-induced skin injuries. The established DRLs were also lower than internationally published DRLs for intracranial aneurysm coil embolization.