A new angiographic imaging platform reduces radiation exposure for patients with liver cancer treated with transarterial chemoembolization

Abstract

Objectives To quantify the reduction of radiation liver cancer patients are exposed to during transarterial chemoembolization (TACE), while maintaining diagnostic image quality, using a new C-arm imaging platform. Methods In this prospective, HIPAA-compliant, IRB-approved, two-arm trial, 78 consecutive patients with primary or secondary liver cancer were treated with TACE on a C-arm imaging platform before and after an upgrade incorporating optimized acquisition parameters and advanced real-time image processing algorithms. Dose area product (DAP) and radiation time of each digital fluoroscopy (DF), digital subtraction angiography (DSA) and cone beam CT (CBCT) were recorded. DSA image quality was assessed by two blinded and independent readers on a four-rank scale. Results Both cohorts showed no significant differences with regard to patient characteristics and tumour burden. The new system resulted in a statistically significant reduction of cumulative DAP of 66 % compared to the old platform (median 132.9 vs. 395.8 Gy cm 2 ). Individually, DAP of DF, DSA and CBCT decreased by 52 %, 79 % and 15 % (p<0.01, p<0.01, p=0.51), respectively. No statistically significant differences in DSA image quality were found between the two imaging platforms. Conclusions The new imaging platform significantly reduced radiation exposure for TACE procedures without increased radiation time or negative impact on DSA image quality. Key Points• The new C-arm system allowed reduction of radiation exposure by two thirds • The procedure's course was not affected by the new platform • No decrease in DSA image quality was observed after the radiation reduction

Dynamic 4D-CT Angiography for Guiding Transarterial Chemoembolization: Impact on the Reduction of Contrast Material, Operator Radiation Exposure, Catheter Consumption, and Diagnostic Confidence

“…Radiation dose caused by scattered x-rays during conventional angiography remains an unsolved problem addressed by numerous investigations [10,11,24]. In our study, we showed that by means of 4D-CTA, a large part of conventional angiography leading to increased radiation exposure for the radiologist during TACE may be evitable, as dose-area-product and thus, scattered radiation could be reduced by half compared to traditional TACE.…”