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Digital Subtraction Myelography is Associated with Less Radiation Dose than CT-based Techniques

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Abstract

Purpose

Both CT myelogram (CTM) and digital-subtraction myelogram (DSM) can be used to evaluate patients for possible cerebrospinal fluid (CSF) leaks. DSM is a relatively new technique. No data exists on the radiation dose associated with this procedure, and how it compares with CTM.

Materials and Methods

All patients who underwent DSM for spontaneous intracranial hypotension (SIH) refractory to blood patching from Dec 2016 – Sept 2019 were retrospectively assessed. DSM dose factors were then recorded (cumulative fluoroscopy time, total kerma area product (KAP, mGy.cm2), cumulative air kerma (mGy), as well as CTM dose factors (included CTDIvol (mGy) and dose-length product (DLP, mGy.cm). These indices were then used to calculate the effective dose for both procedures using standardized conversion factors.

Results

61 DSMs were performed in 42 patients, 33 of which also underwent CTM. The median effective dose was 6.6 mSv per DSM study (range: 1.2 – 17.7). On a per-patient basis (i.e. those patients who underwent more than one DSM (as the initial one was negative), the median total effective dose was 13 mSv for their total DSM imaging (range: 2.6 –31.7). For the CTM, the median effective dose was 19.7 mSv (range: 3.2 – 82.4 mSv).

Conclusion

The radiation dose with DSM appears to be significantly lower than that of CTM (p = 0.0005), when looking at CTM doses both from our institution and in the published literature.

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Funding

No funding was obtained for this study.

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Authors and Affiliations

  1. Department of Medical Imaging, Division of Neuroradiology, Toronto Western Hospital, University Health Network, 399 Bathurst, M5T 2S8, Toronto, ON, Canada

    Patrick J. Nicholson, William C. Guest & Richard I. Farb

  2. Department of Medical Physics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

    Monique van Prooijen

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  1. Patrick J. Nicholson
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  2. William C. Guest
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  3. Monique van Prooijen
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  4. Richard I. Farb
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Correspondence to Patrick J. Nicholson.

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Conflict of interest

P.J. Nicholson, W.C. Guest, M. van Prooijen and R.I. Farb declare that they have no competing interests.

Ethical standards

This retrospective study was approved by our institutional research and ethics board. Consent to participate: this was waived for this anonymized retrospective study, as per our institutional research and ethics board. Consent for publication: this was waived for this anonymized retrospective study, as per our institutional research and ethics board.

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Nicholson, P.J., Guest, W.C., van Prooijen, M. et al. Digital Subtraction Myelography is Associated with Less Radiation Dose than CT-based Techniques. Clin Neuroradiol 31, 627–631 (2021). https://doi.org/10.1007/s00062-020-00942-x

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  • DOI: https://doi.org/10.1007/s00062-020-00942-x

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