Abstract
OBJECTIVE: Neuroendovascular treatments are less invasive than surgical clipping. However, the number of fluoroscopy runs may be greater when a contrast medium is used than when routine angiography is performed. Several recent studies have suggested that an iodinated contrast medium causes an increase in the radiation dose. Therefore, it is clinically important to identify physical factors causing amplification of the radiation dose. The purpose of this study was to investigate how dilution of a contrast medium with water influences the amplification effect of the radiation dose using simulation analysis. METHODS: Three different types of commercially available contrast media, namely, iopamidol, iohexol, and iodixanol, were diluted 1.7-3.3 times with water and placed in the left brain parenchyma of a numerical brain phantom. Using the Monte Carlo simulation method, the phantom was exposed to X-ray beams under constant exposure conditions, and the energy absorbed in the entire region of the left brain parenchyma was estimated. At the same time, the content and volume of a contrast medium in the cerebral vessels were predicted on the basis of pharmacokinetic and fractal analyses. RESULTS: The increase in absorbed energy was attributed to secondary electrons emitted from the contrast medium and varied depending on its content and volume. Interestingly, the amount of energy absorbed increased with increasing dilution of the contrast medium. Furthermore, the amplification effect of the radiation dose varied according to the type of contrast medium used. CONCLUSION: These results suggest that the amplification effect of the radiation dose is closely related to an increase in the cross-sectional area in which the X-rays interact with the contrast medium, which is caused by increased distribution of contrast medium in the cerebral vessels. When the contrast medium is diluted with water, its spread in the cerebral vessels plays a more important role than its content in the amplification effect of the radiation dose.