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Neuroradiology
Published in: Neuroradiology 5/2019

01-05-2019 | Spinal Muscular Atrophy | Spinal Neuroradiology

Radiation exposure of image-guided intrathecal administration of nusinersen to adult patients with spinal muscular atrophy

Authors: D. Oldenburg, N. Guberina, B. Stolte, K. Kizina, E. Stenzel, A. Radbruch, C. Kleinschnitz, T. Hagenacker, M. Forsting, C. Mönninghoff

Published in: Neuroradiology | Issue 5/2019

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Abstract

Purpose

To examine diagnostic reference levels (DRL) and achievable doses (AD) of image-guided and size-specific dose estimates (SSDE) and organ and effective doses of CT-guided intrathecal nusinersen administration to adult patients with spinal muscular atrophy (SMA).

Methods

This study involved a total of 60 image-guided intrathecal nusinersen treatments between August 2017 and June 2018. Patient cohort comprised 14 adult patients with the following SMA types: type 2 (n = 9) and type 3 (n = 5) with a mean age of 33.6 years (age range 25–57 years). DRL, AD, SSDE, organ, and effective doses were assessed with a dose-monitoring program based on the Monte Carlo simulation techniques.

Results

DRL and AD for computed tomography are summarised as follows: in terms of CT-dose index (CTDIvol), DRL 56.4 mGy and AD 36.7 mGy; in terms of dose-length product (DLP), DRL 233.1 mGy cm and AD 120.1 mGy cm. DRL and AD for fluoroscopic guidance were distributed as follows: in terms of dose-area product (DAP), DRL 239.1 μGy m2 and AD 135.2 mGy cm2. Mean SSDE was 9.2 mGy. Mean effective dose of the CT-guided injections was 2.5 mSv (median 2.0 mSv, IQR 1.3–3.2 mSv). Highest organ doses in the primary beam of radiation were the small intestine 12.9 mSv, large intestine 9.5 mSv, and ovaries 3.6 mSv.

Conclusion

Radiation exposure of SMA patients measured as DRLs is generally not higher compared with patients without SMA despite severe anatomical hazards. Dose monitoring data may allow clinicians to stratify radiation risk, identify organs at risk, and adopt measures for specific radiation dose reduction.
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Metadata
Title
Radiation exposure of image-guided intrathecal administration of nusinersen to adult patients with spinal muscular atrophy
Authors
D. Oldenburg
N. Guberina
B. Stolte
K. Kizina
E. Stenzel
A. Radbruch
C. Kleinschnitz
T. Hagenacker
M. Forsting
C. Mönninghoff
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
Neuroradiology / Issue 5/2019
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-019-02189-x

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