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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, Hanne ; Andersson, Christian LU ; Bläckberg, Mats LU ; Baco, Eduard ; Taudorf, Mikkel ; Røder, Martin Andreas ; Lindgren, Hans LU and Kløw, Nils Einar , et al. (2022) In European Radiology 32(4). p.2404-2413
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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Angiography, digital subtraction, Embolization, therapeutic, Fluoroscopy, Prostatic hyperplasia, Radiation exposure
in
European Radiology
volume
32
issue
4
pages
2404 - 2413
publisher
Springer
external identifiers
  • scopus:85119103538
  • pmid:34786614
ISSN
0938-7994
DOI
10.1007/s00330-021-08351-5
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2021, European Society of Radiology.
id
1c911d38-65b6-44c4-a2bd-f36acdd52daf
date added to LUP
2021-12-03 15:20:06
date last changed
2025-04-21 03:06:44
@article{1c911d38-65b6-44c4-a2bd-f36acdd52daf,
  abstract     = {{<p>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·cm<sup>2</sup>)) 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 &lt; 0.001), fluoroscopy time (p &lt; 0.001), and number of digital subtraction angiography (DSA) acquisitions (p &lt; 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.</p>}},
  author       = {{Svarc, Petra and Hagen, Thijs and Waltenburg, Hanne and Andersson, Christian and Bläckberg, Mats and Baco, Eduard and Taudorf, Mikkel and Røder, Martin Andreas and Lindgren, Hans and Kløw, Nils Einar and Lönn, Lars Birger}},
  issn         = {{0938-7994}},
  keywords     = {{Angiography, digital subtraction; Embolization, therapeutic; Fluoroscopy; Prostatic hyperplasia; Radiation exposure}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{2404--2413}},
  publisher    = {{Springer}},
  series       = {{European Radiology}},
  title        = {{Center experience and other determinants of patient radiation exposure during prostatic artery embolization : a retrospective study in three Scandinavian centers}},
  url          = {{http://dx.doi.org/10.1007/s00330-021-08351-5}},
  doi          = {{10.1007/s00330-021-08351-5}},
  volume       = {{32}},
  year         = {{2022}},
}