Petra Svarc1,2, Thijs Hagen3, Hanne Waltenburg4, Christian Andersson5, Mats Bläckberg6,7, Eduard Baco8, Mikkel Taudorf9,10, Martin Andreas Røder10,11, Hans Lindgren7,12, Nils-Einar Kløw3,13, Lars Birger Lönn9,10. 1. Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark. petra.svarc@regionh.dk. 2. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark. petra.svarc@regionh.dk. 3. Department of Radiology and Nuclear Medicine, Oslo University Hospital, Kirkeveien 166, Oslo, Norway. 4. Radiation Protection, Danish Health Authority, Knapholm 7, 2730, Herlev, Denmark. 5. Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Helsingborg Hospital, Charlotte Yhlens gata 10, 252 23, Helsingborg, Sweden. 6. Department of Urology, Helsingborg Hospital, Charlotte Yhlens gata 10, 252 23, Helsingborg, Sweden. 7. Department of Clinical Sciences, Faculty of Medicine, Lund University, Box 188, 221 00, Lund, Sweden. 8. Department of Urology, Division of Surgery, Inflammation and Transplantation, Oslo University Hospital, Kirkeveien 166, Oslo, Norway. 9. Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark. 10. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark. 11. Department of Urology, Rigshospitalet, Copenhagen Prostate Cancer Center, Blegdamsvej 9, 2100, Copenhagen, Denmark. 12. Department of Surgery, Section of Interventional Radiology, Helsingborg Hospital, Charlotte Yhlens gata 10, 252 23, Helsingborg, Sweden. 13. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Kirkeveien 166, Oslo, Norway.
Abstract
OBJECTIVES: To evaluate the effects of center experience and a variety of patient- and procedure-related factors on patient radiation exposure during prostatic artery embolization (PAE) in three Scandinavian centers with different PAE protocols and levels of experience. Understanding factors that influence radiation exposure is crucial in effective patient selection and procedural planning. METHODS: Data were collected retrospectively for 352 consecutive PAE procedures from January 2015 to June 2020 at the three centers. Dose area product (DAP (Gy·cm2)) was selected as the primary outcome measure of radiation exposure. Multiple patient- and procedure-related explanatory variables were collected and correlated with the outcome variable. A multiple linear regression model was built to determine significant predictors of increased or decreased radiation exposure as reflected by DAP. RESULTS: There was considerable variation in DAP between the centers. Intended unilateral PAE (p = 0.03) and each 10 additional patients treated (p = 0.02) were significant predictors of decreased DAP. Conversely, increased patient body mass index (BMI, p < 0.001), fluoroscopy time (p < 0.001), and number of digital subtraction angiography (DSA) acquisitions (p < 0.001) were significant predictors of increased DAP. CONCLUSIONS: To minimize patient radiation exposure during PAE radiologists may, in collaboration with clinicians, consider unilateral embolization, pre-interventional CTA for procedure planning, using predominantly anteroposterior (AP) projections, and limiting the use of cone-beam CT (CBCT) and fluoroscopy. KEY POINTS: • Growing center experience and intended unilateral embolization decrease patient radiation exposure during prostatic artery embolization. • Patient BMI, fluoroscopy time, and number of DSA acquisitions are associated with increased DAP during procedures. • Large variation in radiation exposure between the centers may reflect the use of CTA before and CBCT during the procedure.
OBJECTIVES: To evaluate the effects of center experience and a variety of patient- and procedure-related factors on patient radiation exposure during prostatic artery embolization (PAE) in three Scandinavian centers with different PAE protocols and levels of experience. Understanding factors that influence radiation exposure is crucial in effective patient selection and procedural planning. METHODS: Data were collected retrospectively for 352 consecutive PAE procedures from January 2015 to June 2020 at the three centers. Dose area product (DAP (Gy·cm2)) was selected as the primary outcome measure of radiation exposure. Multiple patient- and procedure-related explanatory variables were collected and correlated with the outcome variable. A multiple linear regression model was built to determine significant predictors of increased or decreased radiation exposure as reflected by DAP. RESULTS: There was considerable variation in DAP between the centers. Intended unilateral PAE (p = 0.03) and each 10 additional patients treated (p = 0.02) were significant predictors of decreased DAP. Conversely, increased patient body mass index (BMI, p < 0.001), fluoroscopy time (p < 0.001), and number of digital subtraction angiography (DSA) acquisitions (p < 0.001) were significant predictors of increased DAP. CONCLUSIONS: To minimize patient radiation exposure during PAE radiologists may, in collaboration with clinicians, consider unilateral embolization, pre-interventional CTA for procedure planning, using predominantly anteroposterior (AP) projections, and limiting the use of cone-beam CT (CBCT) and fluoroscopy. KEY POINTS: • Growing center experience and intended unilateral embolization decrease patient radiation exposure during prostatic artery embolization. • Patient BMI, fluoroscopy time, and number of DSA acquisitions are associated with increased DAP during procedures. • Large variation in radiation exposure between the centers may reflect the use of CTA before and CBCT during the procedure.
Authors: Matthias Barral; François Gardavaud; Louis Lassalle; Mohamed Ben Ammar; Milan Najdawi; Léo Razakamanantsoa; Raphaele Renard-Penna; Olivier Cussenot; François H Cornelis Journal: Eur Radiol Date: 2021-03-10 Impact factor: 5.315