Reducing Frame Rate and Pulse Rate for Routine Diagnostic Cerebral Angiography: Alara Principles in Practice

Authors

Arvin R Wali
Sarath Pathuri
Michael G Brandel
Ryan W Sindewald
Brian R Hirshman
Javier A Bravo
Jeffrey A Steinberg
Scott E Olson
Jeffrey S Pannell
Alexander Khalessi
David Santiago-Dieppa

Language

English

Publication Date

3-1-2024

Journal

Journal of Cerebrovascular and Endovascular Neurosurgery

DOI

10.7461/jcen.2023.E2023.01.007

PMID

38092365

PMCID

PMC10995471

PubMedCentral® Posted Date

12-14-2023

PubMedCentral® Full Text Version

Post-print

Abstract

Objective: Diagnostic cerebral angiograms (DCAs) are widely used in neurosurgery due to their high sensitivity and specificity to diagnose and characterize pathology using ionizing radiation. Eliminating unnecessary radiation is critical to reduce risk to patients, providers, and health care staff. We investigated if reducing pulse and frame rates during routine DCAs would decrease radiation burden without compromising image quality.

Methods: We performed a retrospective review of prospectively acquired data after implementing a quality improvement protocol in which pulse rate and frame rate were reduced from 15 p/s to 7.5 p/s and 7.5 f/s to 4.0 f/s respectively. Radiation doses and exposures were calculated. Two endovascular neurosurgeons reviewed randomly selected angiograms of both doses and blindly assessed their quality.

Results: A total of 40 consecutive angiograms were retrospectively analyzed, 20 prior to the protocol change and 20 after. After the intervention, radiation dose, radiation per run, total exposure, and exposure per run were all significantly decreased even after adjustment for BMI (all p< 0.05). On multivariable analysis, we identified a 46% decrease in total radiation dose and 39% decrease in exposure without compromising image quality or procedure time.

Conclusions: We demonstrated that for routine DCAs, pulse rate of 7.5 with a frame rate of 4.0 is sufficient to obtain diagnostic information without compromising image quality or elongating procedure time. In the interest of patient, provider, and health care staff safety, we strongly encourage all interventionalists to be cognizant of radiation usage to avoid unnecessary radiation exposure and consequential health risks.

Keywords

Cerebral angiography, Radiation, Fluoroscopy, Endovascular procedures, ALARA

Published Open-Access

yes

Recommended Citation

Wali, Arvin R; Pathuri, Sarath; Brandel, Michael G; et al., "Reducing Frame Rate and Pulse Rate for Routine Diagnostic Cerebral Angiography: Alara Principles in Practice" (2024). Faculty, Staff and Student Publications. 6360.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/6360