Lenny Octavinawaty
Department of Neurology, Faculty of Medicine, Sriwijaya University; Mohammad Hoesin General Hospital, Palembang

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Radiation Dose Reduction as an Objective Marker of Procedural Maturation During Early Neurointerventional Fellowship Training: A Six-Month Longitudinal Study Pinto Desti Ramadhoni; Lenny Octavinawaty; Diah Andini; Budiman Juniwijaya; Natasya Wanda Yuniza; Nurdiansyah Nurdiansyah; Dewie Susan; Ardy Oktaviandi
Journal of Neurointervention and Stroke Vol. 2 No. 1: MAY 2026
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2026.21.31

Abstract

Highlight: Radiation dose declined progressively during early neurointerventional training Radiation dose has a clearer temporal trend than fluoroscopy time in early training ABSTRACT Introduction: Radiation safety is a fundamental component of neurointerventional practice and competency-based fellowship training. While fluoroscopy time has traditionally been used as a surrogate marker of procedural efficiency, it may not accurately reflect total radiation exposure. Dose-related metrics may better represent technical maturation and radiation-conscious procedural behavior during fellowship progression. Objective: This study compared fluoroscopy time and radiation dose to characterize the early learning curve of neurointerventional fellowship training. Method: This retrospective observational study analyzed 108 consecutive DSA-based brain angiograms performed during the first six months of a supervised fellowship. Chronological case-sequence linear regression was employed to evaluate longitudinal changes in radiation dose and fluoroscopy time. Result: The mean fluoroscopic radiation dose decreased by 42.8%, dropping from 170.17 mGy in month 1 to 97.36 mGy in month 6. Linear regression revealed a significant negative association between case sequence and radiation dose (B = -0.468 mGy/case; p = 0.012; R2 = 0.058). In contrast, fluoroscopy time showed only modest fluctuations and no significant linear association (p = 0.780). Conclusion: During early fellowship training, fluoroscopic radiation dose demonstrates a clearer temporal trend than fluoroscopy time, suggesting it is a more informative marker of procedural maturation. However, the low explanatory power and the absence of adjustment for procedural complexity require cautious interpretation. These findings warrant further research incorporating complexity-adjusted designs to better define technical maturation.
Costs of Stroke Treatment Under National Health Insurance at Dr. Mohammad Hoesin General Hospital Pinto Desti Ramadhoni; Achmad Junaidi; Lenny Octavinawaty; Apriyono Apriyono; Ardy Oktaviandi
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.1

Abstract

Highlight: Discrepancy in costs hospitalization Prevalence and risk factors ABSTRACT Introduction: Indonesia’s National Health Insurance/Jaminan Kesehatan Nasional (JKN) consider stroke a catastrophic disease due to its high treatment costs and healthcare system burden. Stroke patients need extended hospitalization, advanced procedures, and long-term rehabilitation, making it financially and socially burdensome. Endovascular procedures like mechanical thrombectomy and coiling improve clinical outcomes but are expensive. Objective: To outline the characteristics and hospitalization costs of stroke patients—both ischemic and hemorrhagic—covered by JKN at Dr. Mohammad Hoesin General Hospital, focusing on cost differences among conservative therapy, thrombolysis, mechanical thrombectomy, and coiling.  Method: A descriptive study with retrospective data collection was performed at a Type A hospital in South Sumatra, using patient records from January to April 2024. Result: Ischemic stroke was the most common type, with most patients aged 46-65 and male. Most patients stayed less than ten days on second-class wards. Conservative therapy was the most frequently used treatment. Hypertension and kidney disorders were the biggest risk factors and comorbidities. Hospital charges for mechanical thrombectomy and coiling exceeded INA-CBG (Indonesian Case Based Groups) reimbursement rates, highlighting a substantial gap between actual hospital costs and insurance coverage. For both stroke types, medication costs dominated total expenses. Conclusion: The significant gap actual hospital costs and INA-CBG reimbursement  rates for stroke treatments, especially for mechanical thrombectomy and coiling, may affect hospital policies on these interventions. To ensure long-term stroke management, revisions to reimbursement schemes should take into account the high costs associated with endovascular therapy.