Introduction As the prevalence of neuroendovascular interventions increases, it is critical to mitigate unnecessary radiation for patients, providers, and health care staff. Our group previously demonstrated the feasibility of reducing radiation dose and exposure during diagnostic angiography by reducing the default pulse and frame rate on our Siemens Artis Q biplane. We applied the same technique to reduce radiation dose and exposure for basic neuroendovascular interventions.

Methods We performed a retrospective review of prospectively acquired data on a Siemens Artis Q biplane after implementing a quality improvement protocol in January 2022 in which pulse rate and frame rate were reduced from 15 p/s to 7.5 p/s and 7.5 f/s to 4.0 f/s respectively. We studied consecutive, unilateral middle meningeal artery embolizations treated with particles. Total radiation dose, radiation per angiographic run, total radiation exposure, and exposure per run were calculated. Multivariable log-linear regression was performed to account for patient body mass index (BMI), number of angiographic runs, and number of vessels catheterized. Statistical analysis was performed using STATA MP Version 17.0 (Stata Corp LP, College Station, Texas). Significance was defined as p < 0.05.

Results A total of 16 consecutive, unilateral middle meningeal artery embolizations were retrospectively analyzed, 8 prior to the protocol change and 8 after (table 1). Univariable analysis revealed that radiation dose (660.9 vs. 407.5 mGy, p=0.002), radiation dose per angiographic run (40.3 vs. 25.7, p<0.001), total radiation exposure (8825.8 vs. 5510.4 μGym², p=0.002), and exposure per run (537.9 vs. 353.5, p=0.002) were all significantly decreased after the protocol was implemented. Average patient BMI, fluoroscopy time, number of vessels catheterized, and number of angiographic runs did not differ between groups, demonstrating consistency in practice despite the change in protocol.

On multivariable log-linear regression adjusting for BMI, number of runs, vessels catheterized, and fluoroscopy time, the radiation reduction protocol was associated with a 33.8% decrease in the total radiation dose (95% Confidence Interval [CI] 8.0-59.6%, p=0.015) and a 34.8% decrease in radiation dose per run (11.7-57.8%, p=0.007). The protocol was associated with a 32.8% decrease in the total radiation exposure (6.5-59.1%), p=0.019) and a 33.8% decrease in exposure per run (10.0-57.6, p=0.010).

Conclusion Radiation reduction protocols can be readily applied to neuroendovascular interventions without increasing overall fluoroscopy time and reduce radiation dose and exposure by 32.8% and 33.8% respectively. We strongly encourage all interventionalists to be cognizant of pulse rate and frame rate when performing routine interventions to avoid unnecessary radiation towards patients, providers, and health care staff.

Disclosures A. Wali: None. M. Brandel: None. J. Pannell: None. S. Olson: None. J. Steinberg: None. A. Khalessi: None. D. Santiago: None.