Radiation Exposure and Local Diagnostic Reference Levels During Endovascular Treatment of Cerebral Arteriovenous Malformations and Dural Arteriovenous Fistulas

Background/Objectives: Endovascular treatment of cerebral arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) is associated with substantial radiation exposure due to procedural complexity and repeated angiographic acquisitions. This study evaluates radiation exposure during AVM and AVF embolization and establishes local diagnostic reference levels (DRLs). Methods: A single-center retrospective dose audit was conducted, encompassing 114 endovascular procedures performed using a low-dose workflow. Radiation exposure was quantified using dose area product (DAP), reference air kerma (Ka,r), fluoroscopy time (FT), and the number of digital subtraction angiography (DSA) frames per procedure. Median values were defined as the median (P50), and local DRLs as the 75th percentile (P75). Comparative analyses were conducted between AVM and AVF procedures, between male and female patients, and within selected AVM subgroups. Results: The analysis comprised 86 AVM procedures and 28 AVF procedures. For AVMs, the local DRLs (P75) were 28.9 Gy·cm2 for DAP, 400 mGy for Ka,r, 310 DSA frames per procedure, and 1619 s for FT. For AVFs, the respective values were 47.3 Gy·cm2, 465 mGy, 478 DSA frames, and 1820 s. No statistically significant differences were identified between female and male patients. However, AVF procedures demonstrated significantly higher radiation exposure than AVM procedures for all parameters except FT. Within the AVM subgroup, no significant differences were observed between single-stage and other AVM procedures or between female and male patients. Conclusions: AVM and AVF embolization procedures are dose-intensive neuroendovascular interventions. Establishing local DRLs for AVM and AVF may enhance radiation monitoring and facilitate procedure-specific dose optimization.