Radiation exposure in the endovascular therapy of cranial and spinal dural arteriovenous fistula in the last decade: a retrospective, single-center observational study

PURPOSE: This study aims to determine local diagnostic reference levels (DRLs) in the endovascular therapy (EVT) of patients with cranial and spinal dural arteriovenous fistula (dAVF). METHODS: In a retrospective study design, DRLs and achievable dose (AD) were assessed for all patients with cranial and spinal dAVF undergoing EVT (I) or diagnostic angiography (II). All procedures were performed at the flat-panel angiography-system Allura Xper (Philips Healthcare). Interventional procedures were differentiated according to the region of fistula and the type of procedure. RESULTS: In total, 264 neurointerventional procedures of 131 patients with dAVF (94 cranial, 37 spinal) were executed between 02/2010 and 12/2020. The following DRLs, AD, and mean values could be determined: for cranial dAVF (I) DRL 507.33 Gy cm(2), AD 369.79 Gy cm(2), mean 396.51 Gy cm(2); (II) DRL 256.65 Gy cm(2), AD 214.19 Gy cm(2), mean 211.80 Gy cm(2); for spinal dAVF (I) DRL 482.72 Gy cm(2), AD 275.98 Gy cm(2), mean 347.12 Gy cm(2); (II) DRL 396.39 Gy cm(2), AD 210.57 Gy cm(2), mean 299.55 Gy cm(2). Dose levels of EVT were significantly higher compared to diagnostic angiographies (p < 0.001). No statistical difference in dose levels regarding the localization of dAVF was found. CONCLUSION: Our results could be used for establishing DRLs in the EVT of cranial and spinal dAVF. Because radiation exposure to comparably complex interventions such as AVM embolization is similar, it may be useful to determine general DRLs for both entities together.