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Research ArticleNeurointervention

A Study on Maximum Skin Dose in Cerebral Embolization Procedures

L. D’Ercole, L. Mantovani, F. Zappoli Thyrion, M. Bocchiola, A. Azzaretti, F. Di Maria, C. Massa Saluzzo, P. Quaretti, G. Rodolico, P. Scagnelli and L. Andreucci
American Journal of Neuroradiology March 2007, 28 (3) 503-507;
L. D’Ercole
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L. Mantovani
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F. Zappoli Thyrion
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M. Bocchiola
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A. Azzaretti
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F. Di Maria
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C. Massa Saluzzo
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P. Quaretti
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G. Rodolico
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P. Scagnelli
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L. Andreucci
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Article Figures & Data

Figures

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  • Fig 1.
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    Fig 1.

    Dose/image versus PMMA phantom thickness curves for angiographic unit 1.

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    Fig 2.

    Dose/image versus PMMA phantom thickness curves for angiographic unit 2.

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    Fig 3.

    Position of the Gafchromic XR type R film and an example of a film after exposure.

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    Fig 4.

    Calibration curves for 2 different batches of Gafchromic XR type R films.

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    Fig 5.

    Correlation between fluoroscopy time and maximum skin dose (MSD) measured by radiochromic films on the skull in the 21 procedures.

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    Fig 6.

    Correlation between total dose-area product (DAP) and maximum skin dose (MSD) measured by radiochromic films on the skull in the 21 procedures.

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    Fig 7.

    Histogram of maximum skin dose calculated for 27 instances of embolization of cerebral aneurysms.

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    Fig 8.

    Sacciform aneurysm of the right carotid siphon (A) excluded with a spiral Guglielmi detachable coil (GDC) (B).

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    Fig 9.

    Aneurysms of the right carotid siphon (A) and the basilar artery embolized during the same session (B).

Tables

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    Table 1:

    Radiation exposure to 42 patients during embolization procedures (48 procedures)

    ParameterMean95% CIMinMax
    DAP (Gy*cm2)413343–482811143
    Fluoroscopy time (min)2923–35381
    Number of images448362–535821326
    • Note:—CI indicates confidence interval; DAP, dose-area product.

    • View popup
    Table 2:

    Published dosimetry data for MSD

    Sample SizeMean MSD (Gy)95% CI (Gy)Min (Gy)Max (Gy)Reference
    421.160.96–1.350.233.20This study
    1431,881.723–2.0360.3296.414[10]
    310.8690.1732.332[11]
    30*0.77 (PA)[12]
    0.78 (LAT)
    522*2.14 (PA)[13]
    1.41 (LAT)
    121.51[14]
    201.17[15]
    80.61.3[16]
    • Note:—MSD indicates maximum skin dose; CI, confidence interval; PA, posteroanterior x-ray tube; LAT, lateral x-ray tube.

    • * Biplane system.

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    Table 3:

    Potential effects of fluoroscopic exposure on the reaction of skin

    EffectApproximate Threshold Dose (Gy)DAP (Gy*cm2)Time of Onset
    Skin
        Early transient erythema2>7002–24 hours
        Main erythema reaction6>2100≈1.5 weeks
        Temporary epilation3>1100≈3 weeks
        Permanent epilation7>2400≈3 weeks
    • Note:—DAP indicates dose-area product.

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American Journal of Neuroradiology: 28 (3)
American Journal of Neuroradiology
Vol. 28, Issue 3
March 2007
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Cite this article
L. D’Ercole, L. Mantovani, F. Zappoli Thyrion, M. Bocchiola, A. Azzaretti, F. Di Maria, C. Massa Saluzzo, P. Quaretti, G. Rodolico, P. Scagnelli, L. Andreucci
A Study on Maximum Skin Dose in Cerebral Embolization Procedures
American Journal of Neuroradiology Mar 2007, 28 (3) 503-507;

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A Study on Maximum Skin Dose in Cerebral Embolization Procedures
L. D’Ercole, L. Mantovani, F. Zappoli Thyrion, M. Bocchiola, A. Azzaretti, F. Di Maria, C. Massa Saluzzo, P. Quaretti, G. Rodolico, P. Scagnelli, L. Andreucci
American Journal of Neuroradiology Mar 2007, 28 (3) 503-507;
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