Limiting radiation exposure during prostatic arteries embolization: influence of patient characteristics, anatomical conditions, and technical factors

Matthias Barral; François Gardavaud; Louis Lassalle; Mohamed Ben Ammar; Milan Najdawi; Léo Razakamanantsoa; Raphaele Renard-Penna; Olivier Cussenot; François H Cornelis

doi:10.1007/s00330-021-07844-7

Limiting radiation exposure during prostatic arteries embolization: influence of patient characteristics, anatomical conditions, and technical factors

Eur Radiol. 2021 Sep;31(9):6471-6479. doi: 10.1007/s00330-021-07844-7. Epub 2021 Mar 10.

Authors

Matthias Barral¹, François Gardavaud¹, Louis Lassalle², Mohamed Ben Ammar¹, Milan Najdawi¹, Léo Razakamanantsoa¹, Raphaele Renard-Penna³, Olivier Cussenot⁴, François H Cornelis⁵

Affiliations

¹ Department of Interventional Radiology and Oncology, Tenon Hospital, Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France.
² Department of Radiology, Cochin Hospital, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
³ Department of Radiology, Tenon Hospital, Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France.
⁴ Department of Urology, Tenon Hospital, Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France.
⁵ Department of Interventional Radiology and Oncology, Tenon Hospital, Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France. francois.cornelis@aphp.fr.

PMID: 33693993
DOI: 10.1007/s00330-021-07844-7

Abstract

Objective: To assess the influence of patient characteristics, anatomical conditions, and technical factors on radiation exposure during prostatic arteries embolization (PAE) performed for benign prostatic hyperplasia.

Materials and methods: Patient characteristics (age, body mass index (BMI)), anatomical conditions (number of prostatic arteries, anastomosis), and technical factors (use of cone beam computed tomography (CBCT), large display monitor (LDM), and magnification) were recorded as well as total air kerma (AK), dose area product (DAP), fluoroscopy time (FT), and number of acquisitions (NAcq). Associations between potential dose-influencing factors and AK using univariate analysis and a multiple linear regression model were assessed.

Results: Forty-one consecutive men (68 ± 8 years, min-max: 40-76) were included. LDM and CBCT decreased the use of small field of view with 13.9 and 3.8% respectively, both p < 0.001. The use of a LDM significantly reduced AK (1006.6 ± 471.7 vs. 1412 ± 754.6 mGy, p = 0.02), DAP (119.4 ± 64.4 vs. 167.9 ± 99.2, p = 0.04), FT (40.4 ± 11.5 vs. 53.6 ± 25.5 min, p = 0.01), and NAcq (16.3 ± 6.3 vs. 18.2 ± 7, p = 0.04). In multivariate analysis, AK reduction was associated with lower patient BMI (β = 0.359, p = 0.002), shorter FT (β = 0.664, p < 0.001) and CBCT use (β = - 0.223, p = 0.03), and decreased NAcq (β = 0.229, p = 0.04).

Conclusion: LDM and CBCT are important technical dose-related factors to help reduce radiation exposure during PAE, and should be considered in standard practice.

Key points: • The use of large display monitor (LDM) and cone beam computed tomography (CBCT) both decreased the need for magnification during prostatic arteries embolization (PAE). • The use of LDM reduces radiation exposure during PAE. • Total air kerma is associated with patient's body mass index, fluoroscopy time, CBCT, and the number of acquisitions.

Keywords: Benign prostatic hyperplasia; Cone beam computed tomography; Interventional radiology; Prostatic artery embolization; Radiation exposure.

MeSH terms

Arteries / diagnostic imaging
Cone-Beam Computed Tomography
Embolization, Therapeutic*
Humans
Male
Prostate / diagnostic imaging
Prostatic Hyperplasia* / diagnostic imaging
Prostatic Hyperplasia* / therapy
Radiation Exposure* / prevention & control
Retrospective Studies