Influence of Interventionists’ Experience on Radiation Exposure of Patients Who Underwent Prostate Artery Embolization: 4-Year Results from a Retrospective, Single-Center Study

Abstract

Purpose To assess radiation exposure in men undergoing prostate artery embolization (PAE) for the treatment for symptomatic, benign prostatic hyperplasia depending on growing experience of interventional radiologists over a 4-year period. Methods A total of 250 consecutive patients underwent PAE at a single center. Data on radiation exposure [dose area product (DAP), effective dose (ED), entrance skin dose (ESD), and fluoroscopy time (FT)] were retrospectively evaluated. Primary outcomes of interest were patient radiation exposure in five consecutive groups of 50 patients each and Pearson correlation with the number of patients treated. Results Median DAP, ED, and ESD during prostate artery embolization were significantly higher in the first compared to the second 50 patients (56 298 µGym 2 vs. 24 709 µGym 2 , p < 0.001, 146.4 mSv vs. 64.2 mSv, p < 0.001, and 5.1 Gy vs. 2.4 Gy, p < 0.001, respectively). The following consecutive groups did not differ significantly from the respective preceding group in terms of DAP, ED, and ESD. Number of digital subtraction angiography series, FT, and procedure time decreased with increasing operator experience (Pearson’s r = − 0.240, p < 0.001, r = − 0.269, p < 0.001, and r = − 0.504, p < 0.001, respectively). Bilateral prostate artery embolization was associated with less ESD and shorter FT than unilateral embolization (median 2.5 vs. 3.5 Gy, p = 0.02, and 26 min vs. 42 min, p < 0.001, respectively). Conclusion Exposure to radiation in men who underwent PAE decreased with growing operator experience and decreasing complexity of procedures.

Radiation Exposure during Prostatic Artery Embolization: A Single Institution Review

“…The technical challenge of PAE arises from the complicated anatomy of pelvic vasculature and the necessity to identify and map prostatic artery origins, duplications, contralateral perfusion of the prostate gland, and anastomoses with vesical, rectal, or penile arteries (Kriechenbauer et al 2020). Mapping often necessitates the use of multiple acquisitions and use of intra-procedural CBCT to facilitate technical success (Adrade et al 2017; Schott et al 2019; Kriechenbauer et al 2020) and avoid consequences of nontarget vessel embolization such as penile ulceration, bladder necrosis, and rectal ischemia (Schott et al 2019; Abt et al 2021). However, increased patient BMI, extended procedure time, fluoroscopy time, complex anatomy, use of CBCT, and increased number of image acquisitions (Svarc et al 2022) contribute to higher radiation exposure to patients and physicians (Schott et al 2019; Kriechenbauer et al 2020; Svarc et al 2022).…”

Prostatic Artery Embolization: Influence of Cone-Beam Computed Tomography on Radiation Exposure, Procedure Time, and Contrast Media Use

“…The learning curve of this procedure affects performance, although we tried to overcome this by excluding data from the first 50 patients in our study, reflecting the results published earlier by our group. [ 13 ].…”

“…All patients referred to PAE between January 2015 and May 2018 were retrospectively included in this single-center observational study. Our study group previously published overall data from this cohort [ 13 ]. To give a more detailed analysis how CBCT influence the radiation exposure and CM use, this study is a sub-group analysis comparing patients allocated into two groups, group A (procedure without CBCT) and group B (procedure with CBCT).…”

“…Patients included in group B were investigated by four radiologists, each with 4 to 6 years of experience in interventional therapies. To reduce the bias in experience and with response to the learning curves according the procedure, we excluded the first 50 patients for all interventionalists based on the results of our former study [ 13 ].…”

Prostatic Artery Embolization: Indications, Preparation, Techniques, Imaging Evaluation, Reporting, and Complications

“…Although imaging settings and the staff's experience (48), with strict application of ALARA (as low as reasonably achievable) principles, are decisive in reducing radiation exposure, optimization and standardization of the imaging workflow, with advanced guidance, can also help in reduction of contrast material load and patient and staff radiation exposure, while making PAE more effective. At our institution, imaging workflow optimization (49) and routine use of CBCT for PAE planning, CBCT-fluoroscopic overlay for live three-dimensional augmented navigation guidance, and our cardiovascular interventional imaging system (Innova 4100, with Vessel ASSIST; GE Healthcare) showed promising radiation dose reduction.…”