Cumulative in-hospital radiation dose in patients with acute ruptured intracranial aneurysm: A comparative analysis evaluating the effect of radiation dose reducing efforts

Background: The cumulative impact of radiation dose reduction strategies in acute hospital settings remains underreported. This study quantifies and compares cumulative radiation exposure in patients with ruptured intracranial aneurysms before and after implementing dose reduction strategies. Methods: This retrospective study included 166 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms, comparing two time periods: pre-adjustment (July 2012-March 2013) and post-adjustment (January 2017-March 2022) of dose reduction strategies. Radiation doses from imaging modalities, including X-ray, computed tomography (CT), and angiography, were collected. Cumulative radiation dose (CRD) and cumulative effective dose (CED) were calculated and compared between the two periods. Results: Angiography accounted for the largest share of the CRD in clipping and coiling procedures (about 75% and 95%, respectively), whereas its contribution to the CED was lower in clipping and coiling procedures (about 20 and 60%, respectively), reflecting differences in radiation weighting for biological effects. Significant reductions in both mean CRD and CED were observed in the post-period for both clipping and coiling procedures, with reductions of approximately 40% and 30% in CRD (P<.001 and P=0.013) and 45% and 35% in CED (P<.001 and P=0.002), respectively. Conclusion: The implementation of radiation dose reduction strategies significantly decreased both cumulative radiation and effective doses, highlighting the importance of continuous optimization to enhance patient safety without compromising diagnostic and therapeutic efficacy.