Center experience and other determinants of patient radiation exposure during prostatic artery embolization: a retrospective study in three Scandinavian centers

Svarc, Petra; Hagen, Thijs; Waltenburg, H; Andersson, Christian X.; Bläckberg, Mats; Baco, Eduard; Taudorf, Mikkel; Røder, Martin Andreas; Lindgren, Hans; Kløw, Nils‐Einar; Lönn, Lars

doi:10.1007/s00330-021-08351-5

Cited by 4 publications

(13 citation statements)

References 30 publications

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“…A multicenter study demonstrated a pronounced variability reported in DAP values, some being six times lower than those reported from the other centers. Lower DAP values were explained by use of pre-procedural CTA with little use of CBCT, reported shorter procedure and fluoroscopy times, and a larger cohort with intended unilateral PAE (Svarc et al 2022). Interestingly, the Center with the lowest DAP values had the most experienced physicians, and their patients represented more than half the study population (Svarc et al 2022).…”

Section: Discussionmentioning

confidence: 99%

“…CBCT, used by interventional radiologists at their discretion during PAE, is in line with reported use (Andrade et al 2017). CBCT has been significantly correlated to increased dose area product [DAP; Gy (cm 2 ); Svarc et al 2022]; however, CBCT is known to reduce the number of digital subtraction angiography (DSA) acquisitions needed, previously shown to be responsible for the largest percentage of procedure radiation exposure. Arterial mapping from CBCT and the skills of interventional radiologists can reduce the need for DSA acquisitions (Kriechenbauer et al 2020), potentially minimizing total patient radiation exposure (Svarc et al 2022).…”

Section: Discussionmentioning

confidence: 99%

“…For PAE, factors such as fluoroscopy time, digital subtraction angiography, and the use of intraprocedural cone-beam computed tomography (CBCT) can lead to high radiation doses (Andrade et al 2017), which has been a concern raised by the urological and radiological community (Foster et al 2019; Svarc et al 2022). However, these techniques are essential to facilitate catheter navigation and prevent nontarget embolization (Schott et al 2019).…”

Section: Introductionmentioning

confidence: 99%

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Radiation Exposure during Prostatic Artery Embolization: A Single Institution Review

Ngov

Self

Schammel³

et al. 2023

Health Physics

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Prostate artery embolization is a minimally invasive treatment for benign prostatic hyperplasia, and imaging is indispensable for the technical success of this procedure; however, imaging is a major source of radiation exposure for patients and healthcare providers. Radiation emission during prostate artery embolization procedures at a single institution was evaluated to determine radiation exposure with the goal to work toward minimizing exposure. All patients at a single institution that underwent outpatient unilateral/bilateral prostate artery embolization between 4 January 2019 and 16 November 2021 were retrospectively evaluated; data collected included body mass index, prostate volume, and indications for prostate artery embolization. Technical parameters recorded were air kerma, procedure time, fluoroscopy time, number of acquisitions, and intra-procedural imaging modalities. Fisher’s t-test, ANOVA, and chi-square analyses were used as appropriate for statistical analysis (P < 0.05). Overall, 56 patients were included in the study. Body mass index (obesity; P = 0.0017) was a significant predictor of increased air kerma; prostate size and bilateral vs. unilateral prostate artery embolization were not significantly associated with increased air kerma despite the number of acquisitions being significantly different between bilateral and unilateral embolization (P = 0.0064). When evaluating radiation exposure during prostate artery embolization, increased body mass index significantly predicted increased air kerma. Contrary to the literature, the extent of embolization (bilateral vs. unilateral) was not associated with increased air kerma regardless of higher acquisitions and procedure time associated with bilateral prostate artery embolization. Increased radiation protection efforts should be considered for patients with higher body mass index to protect patients and practitioners. Health Phys. 124(0):000-000; 2023

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiation Exposure during Prostatic Artery Embolization: A Single Institution Review

Ngov

Self

Schammel³

et al. 2023

Health Physics

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“…Compared to this first report, in the present series, AP-PAE could be successfully applied in significantly more patients (52.5% versus 26%), perhaps as a result of the newer equipment and of increased experience; AP-PAE failed in less than 10% of the patients in whom it was attempted (three patients, eventually excluded from the study), and even in these cases, the additional dose attributed to AP-PAE was negligible. Of note, a variant of the herein adopted AP-PAE technique was utilized in a large multicenter PAE study [9] and also contributed significantly to dose limitation.…”

Section: Discussionmentioning

confidence: 99%

“…However, the utilization of such a low- dose protocol has not been reported in large PAE studies. PAE with anteroposterior (AP) imaging only and intentionally unilateral PAE have also been proposed as options to limit radiation dose [8,9], but they have not been adequately validated yet. Further research is therefore required to extensively test existing and newer approaches for the reduction of radiation exposure during PAE and identify the most efficient and practical of these solutions, which could be incorporated into the standard PAE procedure.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective, Single-Center Study of Technical-Procedural Factors Affecting Radiation Dose During Prostatic Artery Embolization

Moschouris¹,

Σταματίου²,

Spanomanolis³

et al. 2022

Cureus

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This study aims to evaluate the effect of technical-procedural factors on radiation dose during prostatic artery embolization (PAE). MethodsThis was a single-center, retrospective study of 59 patients with benign prostatic hyperplasia (BPH) who underwent prostatic artery embolization from March 2020 to September 2021. Computed tomography angiography (CTA) was performed for vascular planning prior to PAE in all patients. The effect of the following techniques on the dose area product (DAP) of PAE was evaluated: application of low-dose protocol (LDP) for digital subtraction angiography (DSA), reduction of oblique projections by performing PAE of at least one pelvic side utilizing anteroposterior projections only (AP-PAE), utilization of "roadmap" technique instead of DSA for the delineation of pelvic arterial anatomy (RDMP-PAE), and cone-beam CT (CBCT). The impact of the patient's body mass index (BMI) on DAP was also calculated. The effective dose (ED) of PAE and pre-PAE CTA was calculated from DAP and from dose length products, respectively, using appropriate conversion factors. ResultsFor the entire study population (n = 59), the mean DAP of PAE was 16,424.7 ± 8,019 μGy‧m 2 . On simple regression analysis, LDP, AP-PAE, and RDMP-PAE significantly contributed to DAP reduction during PAE (30% (p = 0.004), 26.7% (p = 0.013), and 31.2% (p = 0.004), respectively). On multiple regression, LDP and AP-PAE maintained their significant effect (p = 0.002 and p = 0.006, respectively). CBCT was associated with a not statistically significant increase in DAP (10.1%) (p = 0.555). The ED of CTA represented 21.2% ± 10.6% of the ED of PAE. ConclusionOf the four studied factors, LDP, AP-PAE, and RDMP-PAE proved to be relatively simple and widely available techniques that could limit radiation exposure of both the operators and the patients during PAE. The contribution of planning CTA to the overall radiation exposure of patients undergoing PAE appears to be not negligible.

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Virtual Injection Software Reduces Radiation Exposure and Procedural Time of Prostatic Artery Embolization Performed with Cone-Beam CT

Barral,

Lassalle,

Gardavaud

et al. 2024

Journal of Vascular and Interventional Radiology

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Center experience and other determinants of patient radiation exposure during prostatic artery embolization: a retrospective study in three Scandinavian centers

Cited by 4 publications

References 30 publications

Radiation Exposure during Prostatic Artery Embolization: A Single Institution Review

Radiation Exposure during Prostatic Artery Embolization: A Single Institution Review

A Retrospective, Single-Center Study of Technical-Procedural Factors Affecting Radiation Dose During Prostatic Artery Embolization

Virtual Injection Software Reduces Radiation Exposure and Procedural Time of Prostatic Artery Embolization Performed with Cone-Beam CT

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