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Techniques for reducing interventional neuroradiologic skin dose: tube position rotation and supplemental beam filtration.

PURPOSE
To limit the side effects of interventional neuroradiologic radiation, such as epilation, by applying a technique involving tube position rotation and by adding a supplemental inexpensive primary beam filter; and to show the dose effect of modifying technical factors.


METHODS
Combined skin dose from fluoroscopy and digital subtraction angiography was measured with an array of 16 thermoluminescent dosimeters during interventional neuroradiologic procedures in 12 control subjects, in 18 patients whose procedures included addition of an inexpensive primary beam filter (0.5 mm aluminum/0.076 mm copper), and in 10 patients in whom the tube position was rotated, additional primary beam filtration was used, and close attention was paid to technique.


RESULTS
Maximum thermoluminescent dosimetric measurements obtained with existing machine filtration ranged from 0.31 to 2.70 Gy in the control group (mean, 1.51 +/- 0.88); 0.25 to 2.42 Gy in the group with additional filtration alone (mean 0.96 + 0.64; average dose reduction, 36%); and 0.13 to 1.23 Gy in the group with additional filtration, tube position rotation, and close attention to technique (mean, 0.58 +/- 0.34; average dose reduction, 63%). Differences were statistically significant.


CONCLUSIONS
Greater than 50% skin dose reductions were documented during interventional neuroradiologic procedures by combining tube position rotation, supplemental primary beam filtration, and technical modifications.