PT - JOURNAL ARTICLE AU - A. Sonig AU - S.V. Setlur Nagesh AU - V.S. Fennell AU - S. Gandhi AU - L. Rangel-Castilla AU - C.N. Ionita AU - K.V. Snyder AU - L.N. Hopkins AU - D.R. Bednarek AU - S. Rudin AU - A.H. Siddiqui AU - E.I. Levy TI - A Patient Dose-Reduction Technique for Neuroendovascular Image-Guided Interventions: Image-Quality Comparison Study AID - 10.3174/ajnr.A5552 DP - 2018 Feb 14 TA - American Journal of Neuroradiology 4099 - http://www.ajnr.org/content/early/2018/02/15/ajnr.A5552.short 4100 - http://www.ajnr.org/content/early/2018/02/15/ajnr.A5552.full AB - BACKGROUND AND PURPOSE: The ROI–dose-reduced intervention technique represents an extension of ROI fluoroscopy combining x-ray entrance skin dose reduction with spatially different recursive temporal filtering to reduce excessive image noise in the dose-reduced periphery in real-time. The aim of our study was to compare the image quality of simulated neurointerventions with regular and reduced radiation doses using a standard flat panel detector system.MATERIALS AND METHODS: Ten 3D-printed intracranial aneurysm models were generated on the basis of a single patient vasculature derived from intracranial DSA and CTA. The incident dose to each model was reduced using a 0.7-mm-thick copper attenuator with a circular ROI hole (10-mm diameter) in the middle mounted inside the Infinix C-arm. Each model was treated twice with a primary coiling intervention using ROI-dose-reduced intervention and regular-dose intervention protocols. Eighty images acquired at various intervention stages were shown twice to 2 neurointerventionalists who independently scored imaging qualities (visibility of aneurysm-parent vessel morphology, associated vessels, and/or devices used). Dose-reduction measurements were performed using an ionization chamber.RESULTS: A total integral dose reduction of 62% per frame was achieved. The mean scores for regular-dose intervention and ROI dose-reduced intervention images did not differ significantly, suggesting similar image quality. Overall intrarater agreement for all scored criteria was substantial (Kendall τ = 0.62887; P < .001). Overall interrater agreement for all criteria was fair (κ = 0.2816; 95% CI, 0.2060–0.3571).CONCLUSIONS: Substantial dose reduction (62%) with a live peripheral image was achieved without compromising feature visibility during neuroendovascular interventions.DRIdose-reduced interventionRDIregular-dose intervention