TY - JOUR
T1 - Pediatric neurointervention
T2 - Collimation on radiation exposure-associated lifetime excess tumor risk
AU - Chen, Karen
AU - Paramasivam, Srinivasan
AU - Berenstein, Alejandro
N1 - Publisher Copyright:
© 2016 Published by the BMJ Publishing Group Limited.
PY - 2017/9
Y1 - 2017/9
N2 - Background Intracranial vascular malformations in children are being addressed through a variety of treatment modalities including open surgery, external beam radiation, and image-guided neuroendovascular procedures. These patients often receive multiple treatments and incur serial exposures to ionizing radiation which has been linked to tumor development in population-based data. Objective This study quantifies the effect of collimation on exposures from single procedures and over patient lifetimes to estimate excess risk of lifetime tumor development. Methods 215 patients aged 0-21 years from a single center took part in the study. Radiation exposure from neuroendovascular procedures was tabulated and converted to brain doses using modeled data and extrapolated to risk ratios using results of population-based estimates found in the literature. Results Lifetime and per procedure risk was highest in patients with brain arteriovenous malformations, brain arteriovenous fistulas, and vein of Galen malformations, a reflection of our institutional referral patterns. Across all pathologies the per procedure excess relative risk decreased from 13.4 to 2.3 when full collimation was employed. Lifetime excess relative risk decreased from 49.0 to 7.7 for full collimation. Conclusions This is the first study to quantify the effect of collimation on lifetime and per procedure risk of tumor development in a pediatric population. In addition to collimation, technical and operator-based aspects of the neurointerventional suite are discussed to further reduce patient exposure without sacrificing image quality.
AB - Background Intracranial vascular malformations in children are being addressed through a variety of treatment modalities including open surgery, external beam radiation, and image-guided neuroendovascular procedures. These patients often receive multiple treatments and incur serial exposures to ionizing radiation which has been linked to tumor development in population-based data. Objective This study quantifies the effect of collimation on exposures from single procedures and over patient lifetimes to estimate excess risk of lifetime tumor development. Methods 215 patients aged 0-21 years from a single center took part in the study. Radiation exposure from neuroendovascular procedures was tabulated and converted to brain doses using modeled data and extrapolated to risk ratios using results of population-based estimates found in the literature. Results Lifetime and per procedure risk was highest in patients with brain arteriovenous malformations, brain arteriovenous fistulas, and vein of Galen malformations, a reflection of our institutional referral patterns. Across all pathologies the per procedure excess relative risk decreased from 13.4 to 2.3 when full collimation was employed. Lifetime excess relative risk decreased from 49.0 to 7.7 for full collimation. Conclusions This is the first study to quantify the effect of collimation on lifetime and per procedure risk of tumor development in a pediatric population. In addition to collimation, technical and operator-based aspects of the neurointerventional suite are discussed to further reduce patient exposure without sacrificing image quality.
KW - Complication
KW - Intervention
KW - Neoplasm
KW - Pediatrics
KW - Vascular Malformation
UR - http://www.scopus.com/inward/record.url?scp=85029232709&partnerID=8YFLogxK
U2 - 10.1136/neurintsurg-2016-012477
DO - 10.1136/neurintsurg-2016-012477
M3 - Article
C2 - 27596803
AN - SCOPUS:85029232709
SN - 1759-8478
VL - 9
SP - 895
EP - 898
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
IS - 9
ER -