# Radiation Dose Metrics and Local Diagnostic Reference Levels in Low-Dose Stent-Assisted Coiling of Intracranial Aneurysms

## TL;DR

This study reports radiation dose metrics for a low-dose protocol used in stent-assisted coiling of brain aneurysms, aiming to balance image quality and patient safety.

## Contribution

The paper establishes local diagnostic reference levels for radiation doses in stent-assisted coiling procedures using a low-dose protocol.

## Key findings

- The 75th percentile DAP was 19.89 Gy·cm², and the 50th percentile was 13.71 Gy·cm².
- Fluoroscopy time and DSA frame counts were lower than many published values, indicating effective dose reduction.
- Local diagnostic reference levels may help improve quality assurance and patient safety in similar clinical settings.

## Abstract

Background/Objectives: Operator experience, the implementation of low frame rates during both fluoroscopy and digital subtraction angiography (DSA), and the use of modern angiographic systems are essential for maintaining diagnostic image quality while minimizing ionizing radiation exposure during stent-assisted endovascular treatment of intracranial aneurysms. At the study center, a low-dose protocol is employed, using the lowest available fluoroscopy frame rate (3.125 frames per second) and a nominal acquisition rate of 2 frames per second for DSA, three-dimensional (3D) rotational angiography, 2D/3D mapping, and roadmapping. Methods: A retrospective analysis was performed on 132 stent-assisted procedures conducted at a single tertiary center between 2018 and 2024. For each procedure, data were collected for dose-area product (DAP), reference air kerma (Ka,r), fluoroscopy time (FT), and the total number of DSA frames. Local diagnostic reference levels (DRLs; 75th percentile [P75]) and typical values (50th percentile [P50]) were established and compared with values reported in the literature. Results: For all patients the P75 values, representing DRLs, were 19.89 Gy·cm2 for DAP, 332 mGy for Ka,r, 25 min 32 s for FT, and 354 DSA frames. The P50 values were 13.71 Gy·cm2 for DAP, 219.5 mGy for Ka,r, 20 min 36 s for FT, and 277 DSA frames. Conclusions: In this single-center cohort, dose metrics for stent-assisted coil embolization were within the lower range of published values. Cross-study comparisons remain descriptive and require cautious interpretation. The proposed local DRLs may support quality assurance, dose optimization, and patient safety in similar clinical settings. Further multicenter and multi-operator studies are necessary to assess transferability and applicability beyond coil-only procedures. Limitations include the retrospective single-center design (single operator) and the lack of a contemporaneous control group and formal image-quality/outcome assessment.