Comparison of Patient Dose and Exposure Time Across Various Techniques Used to Treat Intracranial Aneurysms : Analysis of the German Neurointerventional Database (DeGIR/DGNR) from 2018 to 2023.

Abstract

Purpose: The national diagnostic reference level (DRL) for intracranial aneurysm therapy is set at 20,000 cGy cm² for the patient. An adjustment between the expected dosage and exposure time requirement among a variety of applicable techniques is not commonly provided. Therefore patient dose and exposure times were analyzed when using the following techinques; dosimetric data of coils (CE), flow diverter (FD), stent-assisted coiling (SAC), intra-aneurysmatic flow diverter (IaFD), balloon-assisted coiling (BAC), flow diverter assisted coiling (FDAC), IaFD-assisted coiling (IaFDAC), x, y or t‑remodeling stent-assisted coiling (xyt-SAC), and stent-assisted IaFD (SAIaFD).

Methods: A retrospective analysis of the German DeGIR-QS registry was conducted between 2018 and 2023. This study aimed to investigate the median dose-area product and exposure time for each technique, aneurysm location, type and size. The goal was to ascertain which technique is the most time- and dose-efficient.

Results: FD (84.13%/79.41%) and IaFD (89.64%/73.53%) exhibited superior performance in terms of both effectiveness and efficiency when compared to CE (100% dose-area product/100% exposure time). However, certain aneurysm types and location combinations resulted in lower dose-area product and exposure time when CE was used rather than IaFD or FD. A comparison of the median dose-area product technique with the DRL reveals that all of the aforementioned procedures fall below this value. Aneurysm size has little impact on the finding that FD and IaFD are more efficient in terms of dose and time consumption than CE.

Conclusion: Patients' exposure can be reduced by selecting a technique associated with lower exposure levels, depending on the aneurysm's location and type. However, conformity is provided for all techniques mentioned.