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European Radiology
Published in: European Radiology 6/2019

01-06-2019 | Angiography | Computed Tomography

Radiation dose and image quality in intraoperative CT (iCT) angiography of the brain with stereotactic head frames

Authors: Robert Forbrig, Lucas L. Geyer, Robert Stahl, Jun Thorsteinsdottir, Christian Schichor, Friedrich-Wilhelm Kreth, Maximilian Patzig, Moriz Herzberg, Thomas Liebig, Franziska Dorn, Christoph G. Trumm

Published in: European Radiology | Issue 6/2019

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Abstract

Objectives

Intraoperative CT (iCT) angiography of the brain with stereotactic frames is an integral part of navigated neurosurgery. Validated data regarding radiation dose and image quality in these special examinations are not available. We therefore investigated two iCT protocols in this IRB-approved study.

Methods

Retrospective analysis of patients, who received a cerebral stereotactic iCT angiography on a 128 slice CT scanner between February 2016 and December 2017. In group A, automated tube current modulation (ATCM; reference value 410 mAs) and automated tube voltage selection (reference value 120 kV) were enabled, and only examinations with a selected voltage of 120 kV were included. In group B, fixed parameters were applied (300 mAs, 120 kV). Radiation dose was measured by assessing the volumetric CT dose index (CTDIvol), dose length product (DLP) and effective dose (ED). Signal-to-noise ratio (SNR) and image noise were assessed for objective image quality, visibility of arteries and grey-white differentiation for subjective image quality.

Results

Two hundred patients (n = 100 in each group) were included. In group A, median selected tube current was 643 mAs (group B, 300 mAs; p < 0.001). Median values of CTDIvol, DLP and ED were 91.54 mGy, 1561 mGy cm and 2.97 mSv in group A, and 43.15 mGy, 769 mGy cm and 1.46 mSv in group B (p < 0.001). Image quality did not significantly differ between groups (p > 0.05).

Conclusions

ATCM yielded disproportionally high radiation dose due to substantial tube current increase at the frame level, while image quality did not improve. Thus, ATCM should preferentially be disabled.

Key Points

• Automated tube current modulation (ATCM) yields disproportionally high radiation dose in intraoperative CT angiography of the brain with stereotactic head frames.
• ATCM does not improve overall image quality in these special examinations.
• ATCM is not yet optimised for CT angiography of the brain with major extracorporeal foreign materials within the scan range.
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Metadata
Title
Radiation dose and image quality in intraoperative CT (iCT) angiography of the brain with stereotactic head frames
Authors
Robert Forbrig
Lucas L. Geyer
Robert Stahl
Jun Thorsteinsdottir
Christian Schichor
Friedrich-Wilhelm Kreth
Maximilian Patzig
Moriz Herzberg
Thomas Liebig
Franziska Dorn
Christoph G. Trumm
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5930-0

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