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<meta name="DC.Title" content="Reduced Patient Radiation Exposure during Neurodiagnostic and Interventional X-Ray Angiography with a New Imaging Platform" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5049" />
<meta name="DC.Date" content="2017-01-19" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2017 American Society of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Advancements in medical device and imaging technology as well as accruing clinical evidence have accelerated the growth of the endovascular treatment of cerebrovascular diseases. However, the augmented role of these procedures raises concerns about the radiation dose to patients and operators. We evaluated patient doses from an x-ray imaging platform with radiation dose–reduction technology, which combined image noise reduction, motion correction, and contrast-dependent temporal averaging with optimized x-ray exposure settings.

MATERIALS AND METHODS: In this single-center, retrospective study, cumulative dose-area product inclusive of fluoroscopy, angiography, and 3D acquisitions for all neurovascular procedures performed during a 2-year period on the dose-reduction platform were compared with a reference platform. Key study features were the following: The neurointerventional radiologist could select the targeted dose reduction for each patient with the dose-reduction platform, and the statistical analyses included patient characteristics and the neurointerventional radiologist as covariates. The analyzed outcome measures were cumulative dose (kerma)-area product, fluoroscopy duration, and administered contrast volume.

RESULTS: A total of 1238 neurointerventional cases were included, of which 914 and 324 were performed on the reference and dose-reduction platforms, respectively. Over all diagnostic and neurointerventional procedures, the cumulative dose-area product was significantly reduced by 53.2% (mean reduction, 160.3 Gy × cm2; P &lt; .0001), fluoroscopy duration was marginally significantly increased (mean increase, 5.2 minutes; P = .0491), and contrast volume was nonsignificantly increased (mean increase, 15.3 mL; P = .1616) with the dose-reduction platform.

CONCLUSIONS: A significant reduction in patient radiation dose is achievable during neurovascular procedures by using dose-reduction technology with a minimal impact on workflow.

### Abbreviations

CBCT
:   conebeam CT
CPKA
:   cumulative dose (kerma)-area product
3DRA
:   3D rotational angiography
EAKR
:   phantom-entrance air kerma rate
IPDRT
:   imaging platform with dose-reduction technology
IPR
:   reference imaging platform
K̇a,r
:   air kerma rate at the fluoroscopic reference point
LAT
:   lateral plane of the biplane system
PKA
:   dose (kerma)-area product
RAKR
:   image-receptor (detector) entrance air kerma rate" />
<meta name="DC.Contributor" content="K. van der Marel" />
<meta name="DC.Contributor" content="S. Vedantham" />
<meta name="DC.Contributor" content="I.M.J. van der Bom" />
<meta name="DC.Contributor" content="M. Howk" />
<meta name="DC.Contributor" content="T. Narain" />
<meta name="DC.Contributor" content="K. Ty" />
<meta name="DC.Contributor" content="A. Karellas" />
<meta name="DC.Contributor" content="M.J. Gounis" />
<meta name="DC.Contributor" content="A.S. Puri" />
<meta name="DC.Contributor" content="A.K. Wakhloo" />
<meta name="article:published_time" content="2017-01-19" />
<meta name="article:section" content="PATIENT SAFETY" />
<meta name="citation_title" content="Reduced Patient Radiation Exposure during Neurodiagnostic and Interventional X-Ray Angiography with a New Imaging Platform" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Advancements in medical device and imaging technology as well as accruing clinical evidence have accelerated the growth of the endovascular treatment of cerebrovascular diseases. However, the augmented role of these procedures raises concerns about the radiation dose to patients and operators. We evaluated patient doses from an x-ray imaging platform with radiation dose–reduction technology, which combined image noise reduction, motion correction, and contrast-dependent temporal averaging with optimized x-ray exposure settings.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;In this single-center, retrospective study, cumulative dose-area product inclusive of fluoroscopy, angiography, and 3D acquisitions for all neurovascular procedures performed during a 2-year period on the dose-reduction platform were compared with a reference platform. Key study features were the following: The neurointerventional radiologist could select the targeted dose reduction for each patient with the dose-reduction platform, and the statistical analyses included patient characteristics and the neurointerventional radiologist as covariates. The analyzed outcome measures were cumulative dose (kerma)-area product, fluoroscopy duration, and administered contrast volume.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;A total of 1238 neurointerventional cases were included, of which 914 and 324 were performed on the reference and dose-reduction platforms, respectively. Over all diagnostic and neurointerventional procedures, the cumulative dose-area product was significantly reduced by 53.2% (mean reduction, 160.3 Gy × cm&lt;sup&gt;2&lt;/sup&gt;; &lt;i&gt;P&lt;/i&gt; &amp;lt; .0001), fluoroscopy duration was marginally significantly increased (mean increase, 5.2 minutes; &lt;i&gt;P&lt;/i&gt; = .0491), and contrast volume was nonsignificantly increased (mean increase, 15.3 mL; &lt;i&gt;P&lt;/i&gt; = .1616) with the dose-reduction platform.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;A significant reduction in patient radiation dose is achievable during neurovascular procedures by using dose-reduction technology with a minimal impact on workflow.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_author" content="K. van der Marel" />
<meta name="citation_author_institution" content="From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands." />
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<meta name="citation_author" content="S. Vedantham" />
<meta name="citation_author_institution" content="From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands." />
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<meta name="citation_author" content="I.M.J. van der Bom" />
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<meta name="citation_author" content="T. Narain" />
<meta name="citation_author_institution" content="From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0003-2328-9639" />
<meta name="citation_author" content="K. Ty" />
<meta name="citation_author_institution" content="From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands." />
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<meta name="citation_author" content="A. Karellas" />
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<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-5877-3677" />
<meta name="citation_author" content="M.J. Gounis" />
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<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-8034-2785" />
<meta name="citation_author" content="A.S. Puri" />
<meta name="citation_author_institution" content="From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-6978-6457" />
<meta name="citation_author" content="A.K. Wakhloo" />
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<meta name="twitter:title" content="Reduced Patient Radiation Exposure during Neurodiagnostic and Interventional X-Ray Angiography with a New Imaging Platform" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Advancements in medical device and imaging technology as well as accruing clinical evidence have accelerated the growth of the endovascular treatment of cerebrovascular diseases. However, the augmented role of these procedures raises concerns about the radiation dose to patients and operators. We evaluated patient doses from an x-ray imaging platform with radiation dose–reduction technology, which combined image noise reduction, motion correction, and contrast-dependent temporal averaging with optimized x-ray exposure settings.

MATERIALS AND METHODS: In this single-center, retrospective study, cumulative dose-area product inclusive of fluoroscopy, angiography, and 3D acquisitions for all neurovascular procedures performed during a 2-year period on the dose-reduction platform were compared with a reference platform. Key study features were the following: The neurointerventional radiologist could select the targeted dose reduction for each patient with the dose-reduction platform, and the statistical analyses included patient characteristics and the neurointerventional radiologist as covariates. The analyzed outcome measures were cumulative dose (kerma)-area product, fluoroscopy duration, and administered contrast volume.

RESULTS: A total of 1238 neurointerventional cases were included, of which 914 and 324 were performed on the reference and dose-reduction platforms, respectively. Over all diagnostic and neurointerventional procedures, the cumulative dose-area product was significantly reduced by 53.2% (mean reduction, 160.3 Gy × cm2; P &lt; .0001), fluoroscopy duration was marginally significantly increased (mean increase, 5.2 minutes; P = .0491), and contrast volume was nonsignificantly increased (mean increase, 15.3 mL; P = .1616) with the dose-reduction platform.

CONCLUSIONS: A significant reduction in patient radiation dose is achievable during neurovascular procedures by using dose-reduction technology with a minimal impact on workflow.

### Abbreviations

CBCT
:   conebeam CT
CPKA
:   cumulative dose (kerma)-area product
3DRA
:   3D rotational angiography
EAKR
:   phantom-entrance air kerma rate
IPDRT
:   imaging platform with dose-reduction technology
IPR
:   reference imaging platform
K̇a,r
:   air kerma rate at the fluoroscopic reference point
LAT
:   lateral plane of the biplane system
PKA
:   dose (kerma)-area product
RAKR
:   image-receptor (detector) entrance air kerma rate" />
<meta name="og-title" property="og:title" content="Reduced Patient Radiation Exposure during Neurodiagnostic and Interventional X-Ray Angiography with a New Imaging Platform" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2017/01/19/ajnr.A5049" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Advancements in medical device and imaging technology as well as accruing clinical evidence have accelerated the growth of the endovascular treatment of cerebrovascular diseases. However, the augmented role of these procedures raises concerns about the radiation dose to patients and operators. We evaluated patient doses from an x-ray imaging platform with radiation dose–reduction technology, which combined image noise reduction, motion correction, and contrast-dependent temporal averaging with optimized x-ray exposure settings.

MATERIALS AND METHODS: In this single-center, retrospective study, cumulative dose-area product inclusive of fluoroscopy, angiography, and 3D acquisitions for all neurovascular procedures performed during a 2-year period on the dose-reduction platform were compared with a reference platform. Key study features were the following: The neurointerventional radiologist could select the targeted dose reduction for each patient with the dose-reduction platform, and the statistical analyses included patient characteristics and the neurointerventional radiologist as covariates. The analyzed outcome measures were cumulative dose (kerma)-area product, fluoroscopy duration, and administered contrast volume.

RESULTS: A total of 1238 neurointerventional cases were included, of which 914 and 324 were performed on the reference and dose-reduction platforms, respectively. Over all diagnostic and neurointerventional procedures, the cumulative dose-area product was significantly reduced by 53.2% (mean reduction, 160.3 Gy × cm2; P &lt; .0001), fluoroscopy duration was marginally significantly increased (mean increase, 5.2 minutes; P = .0491), and contrast volume was nonsignificantly increased (mean increase, 15.3 mL; P = .1616) with the dose-reduction platform.

CONCLUSIONS: A significant reduction in patient radiation dose is achievable during neurovascular procedures by using dose-reduction technology with a minimal impact on workflow.

### Abbreviations

CBCT
:   conebeam CT
CPKA
:   cumulative dose (kerma)-area product
3DRA
:   3D rotational angiography
EAKR
:   phantom-entrance air kerma rate
IPDRT
:   imaging platform with dose-reduction technology
IPR
:   reference imaging platform
K̇a,r
:   air kerma rate at the fluoroscopic reference point
LAT
:   lateral plane of the biplane system
PKA
:   dose (kerma)-area product
RAKR
:   image-receptor (detector) entrance air kerma rate" />
<meta name="og-type" property="og:type" content="article" />
<meta name="og-image" property="og:image" content="" />
<link rel="shortlink" href="/node/51883" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node51883--5" data-node-nid="51883" id="top-node-51883--62054659010" data-pisa="ajnr;ajnr.A5049v1" data-pisa-master="ajnr;ajnr.A5049" data-apath="/ajnr/early/2017/01/19/ajnr.A5049.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">PATIENT SAFETY</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Reduced Patient Radiation Exposure during Neurodiagnostic and Interventional X-Ray Angiography with a New Imaging Platform</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">K. van der Marel</span>, <span class="highwire-citation-author" data-delta="1">S. Vedantham</span>, <span class="highwire-citation-author" data-delta="2">I.M.J. van der Bom</span>, <span class="highwire-citation-author" data-delta="3">M. Howk</span>, <span class="highwire-citation-author" data-delta="4">T. Narain</span>, <span class="highwire-citation-author" data-delta="5">K. Ty</span>, <span class="highwire-citation-author" data-delta="6">A. Karellas</span>, <span class="highwire-citation-author" data-delta="7">M.J. Gounis</span>, <span class="highwire-citation-author" data-delta="8">A.S. Puri</span> and <span class="highwire-citation-author" data-delta="9">A.K. Wakhloo</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2017,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5049 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-51883--62054659010" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">K. van der Marel </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2Bvan%2Bder%2BMarel%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=van%20der%20Marel%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AK.%2Bvan%2Bder%2BMarel%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-1099-9498" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. van der Marel</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">S. Vedantham </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BVedantham%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Vedantham%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BVedantham%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-4123-8392" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Vedantham</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">I.M.J. van der Bom </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=I.M.J.%2Bvan%2Bder%2BBom%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=van%20der%20Bom%20I&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AI.M.J.%2Bvan%2Bder%2BBom%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-3576-3062" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for I.M.J. van der Bom</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">M. Howk </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BHowk%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Howk%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BHowk%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-0390-4251" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Howk</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">T. Narain </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.%2BNarain%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Narain%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.%2BNarain%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-2328-9639" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T. Narain</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">K. Ty </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2BTy%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ty%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AK.%2BTy%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-5753-6744" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. Ty</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">A. Karellas </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BKarellas%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Karellas%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.%2BKarellas%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-5877-3677" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Karellas</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">M.J. Gounis </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.J.%2BGounis%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gounis%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.J.%2BGounis%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-8034-2785" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.J. Gounis</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">A.S. Puri </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.S.%2BPuri%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Puri%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.S.%2BPuri%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-6978-6457" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.S. Puri</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">A.K. Wakhloo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (K.v.d.M., S.V., M.H., T.N., K.T., A.K., M.J.G., A.S.P., A.K.W.), New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts; and Philips Healthcare (I.M.J.v.d.B.), Best, the Netherlands.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.K.%2BWakhloo%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wakhloo%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.K.%2BWakhloo%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-2126-4155" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.K. 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