ParticipantsSwetadri Vasan Setlur Nagesh, MS,PhD, Buffalo, NY (Presenter) Nothing to Disclose
Andrew Kuhls-Gilcrist, PHD, Tustin, CA (Abstract Co-Author) Employee, Canon Medical Systems Corporation
Kunal Vakharia, Buffalo, NY (Abstract Co-Author) Nothing to Disclose
Stephan Munich, Buffalo , NY (Abstract Co-Author) Nothing to Disclose
Muhammad Waqas, MD,MBBS, Buffalo, NY (Abstract Co-Author) Nothing to Disclose
Yiemeng Hoi, PhD, Tustin, CA (Abstract Co-Author) Employee, Canon Medical Systems Corporation
Kenneth V. Snyder, Buffalo , NY (Abstract Co-Author) Nothing to Disclose
Jason Davies, Buffalo, NY (Abstract Co-Author) Nothing to Disclose
Daniel Bednarek, PhD, Buffalo, NY (Abstract Co-Author) Research Grant, Canon Medical Systems Corporation
Stephen Rudin, PhD, Buffalo, NY (Abstract Co-Author) Research Grant, Canon Medical Systems Corporation
Elad Levy, MD, Buffalo, NY (Abstract Co-Author) Shareholder, Intratech Medical Ltd Shareholder, Blockade Medical LLC Shareholder, NeXtGen Owner, Intratech Medical Ltd Owner, Blockade Medical LLC Owner, NeXtGen Biologics Investigator, Medtronic plc Speaker, Medtronic plc Consultant, Pulsar Vascular Consultant, Blockade Medical LLC Advisory Board, Stryker Corporation Advisory Board, NeXtGen Biologics Advisory Board, MEDX Inc Support, Abbott Laboratories
Adnan Siddiqui, MD, PhD, Buffalo, NY (Abstract Co-Author) Grant, Canon Medical Systems Corporation
To quantify the clinical impacts and radiation dose of a novel fluoroscopic x-ray detector that combines high definition (Hi-Def) crystalline-Si imaging modes with 76µm pixels and high efficiency amorphous-Si imaging modes with 194µm pixels.
METHOD AND MATERIALSDICOM Radiation Dose Structured Report (RDSR) data was collected for all neurointerventional procedures performed before and after installation of the Hi-Def detector at a single center over a 32 month period. There were 1,702 pre- and 2,499 post-Hi-Def cases with over 390k irradiation events in total. A real-time patient skin dose tracking system was used to monitor peak skin dose during the Hi-Def cases. A two-sample student's t-Test analysis was performed to compare various technical parameters included in the RDSR before and after installation of the new Hi-Def technology. To further investigate any potential impacts on radiation dose, cumulative air kerma, dose area product and peak skin dose were plot as a function of Hi-Def utilization as a percentage of the total number of irradiation events.
RESULTSHi-Def modes were used in more than 50% of the most complicated cases defined as having procedure times lasting more than 90 minutes. Improved visualization capabilites were demonstrated especially during device deployment and manipulation. Average procedure time and the total number of irradiation events were both significantly reduced by 9% (p< 0.01). Average fluoro time, number of CBCT scans and cumulative air kerma were trending lower (5-10% less) but not yet reaching statistical significance (0.05< p < 0.16). Peak skin dose data was available for 1,518 cases with 97.7% and 99.5% of cases below 3Gy and 5Gy, respectively. No correlation was observed (R2< 0.10) using a best of all fits for all dosimetric indications as a function of Hi-Def utilization.
CONCLUSIONPreliminary results from over 4,000 neurointerventional procedures at a single center demonstrate that the improved spatial resolution of the Hi-Def detector may result in reduced procedure time and number of irradiation events. In addition, there was no observable increase in patient dose with the utilization of the Hi-Def detector.
CLINICAL RELEVANCE/APPLICATIONThis is the first study investigating clinical benefits of a new detector that can provide more than 2x the spatial resolution of any other clinically available technology and no patient dose penalty.