Radiation exposure during TACE procedures using additional cone-beam CT (CBCT) for guidance: safety and precautions

Area of Science:

• Interventional Radiology
• Medical Imaging
• Oncology

Background:

• Transarterial chemoembolization (TACE) for liver cancer utilizes cone-beam computed tomography (CBCT) for imaging, but it increases radiation exposure.
• Evaluating the radiation dose impact of CBCT during TACE is crucial for optimizing patient safety.

Purpose of the Study:

• To quantify the additional radiation dose from CBCT-assisted guidance compared to TACE using only digital subtraction angiography (DSA).

Main Methods:

• 140 patients undergoing TACE for liver cancer were analyzed; 70 received CBCT-assisted guidance.
• Radiation dose metrics including dose area product (DAP) and kerma(air), along with fluoroscopy times (FT), were recorded and statistically analyzed.
• Statistical tests included Spearman's correlation, Mann-Whitney U-test, and Kruskal-Wallis test (P < 0.05 considered significant).

Main Results:

• CBCT increased DAP by 2%, kerma(air) by 24.6%, and FT by 0.02%, though not statistically significant.
• Postembolization CBCT for detecting ethiodized oil deposits contributed to increased DAP.
• While CBCT adds dose, it facilitated TACE, potentially reducing overall DAP by up to 46% due to improved guidance.

Conclusions:

• CBCT integration in TACE does add radiation exposure.
• The real-time imaging and overlay capabilities of CBCT during TACE can significantly facilitate the procedure, potentially leading to reduced overall radiation dose.