Radiation exposure in contemporary neuroendovascular practice: a single-center experience

Background Radiation exposure varies across neuroendovascular procedures, but the relative contributions of per-case dose and procedural volume to collective institutional radiation burden are incompletely understood. We aimed to characterize radiation exposure across contemporary neuroendovascular procedures and quantify procedure-specific contributions to cumulative institutional radiation burden. Methods In this single-center retrospective cohort study, consecutive diagnostic cerebral angiography and therapeutic neuroendovascular procedures performed at a high-volume academic neurovascular center from January 2021 through January 2023 were evaluated. The primary outcome was dose-area product (DAP); secondary outcomes were air kerma (AK), fluoroscopy time (FT), and cumulative institutional DAP. Results Of 2,198 procedures, 899 (40.9%) were diagnostic and 1,299 (59.1%) interventional. Interventional procedures had higher radiation exposure than diagnostic angiography: median DAP, 62.7 versus 58.3 Gy×cm²; AK, 635.0 versus 362.4 mGy; and FT, 17.5 versus 7.4 min (all p<0.001). Exposure varied by subtype; spinal vascular interventions had the highest median DAP (263.2 Gy×cm²). Cumulative DAP was 160,563 Gy×cm²; interventional procedures accounted for 63.0%. Although diagnostic procedures accounted for 37.0%, diagnostic cerebral angiography, analyzed as one aggregate category, was the largest individual contributor to cumulative DAP (59,357 Gy×cm²), exceeding every interventional subtype because of high procedural volume despite lower per-case exposure. Mechanical thrombectomy (34,564 Gy×cm²) and aneurysm treatment (26,395 Gy×cm²) were the largest interventional contributors. Conclusions Radiation exposure varies by procedure type and complexity. Radiation-optimization strategies should address both per-case dose and procedural volume.