THE EFFECTS OF CONE-BEAM COMPUTED TOMOGRAPHY IMAGING GUIDANCE ON PATIENT RADIATION EXPOSURES IN TRANS-ARTERIAL...

Area of Science:

• Medical Imaging
• Interventional Radiology
• Oncology

Background:

• Trans-arterial chemoembolisation (TACE) is a standard treatment for hepatocellular carcinoma (HCC).
• Optimizing imaging guidance during TACE is crucial for balancing efficacy and patient safety.
• Digital subtraction angiography (DSA) is the conventional imaging modality for TACE procedures.

Purpose of the Study:

• To evaluate the impact of cone-beam computed tomography (CBCT) guidance on DSA utilization and patient radiation dose during TACE for HCC.
• To compare radiation exposure metrics between TACE procedures with DSA guidance alone versus combined DSA and CBCT guidance.

Main Methods:

• A retrospective, analytical cross-sectional study was conducted at a single institution.
• 122 TACE procedures for HCC were analyzed, comparing a control group (DSA guidance only) with a study group (DSA and CBCT guidance).
• Radiation dose data, including DSA runs, DSA air kerma-area product (PKA), total procedural PKA, and total procedural reference air kerma (Ka,r), were collected and compared.

Main Results:

• The CBCT guidance group showed a significant reduction in the number of DSA runs (3 vs. 5, p < 0.001) and DSA PKA (3077.3 vs. 4276.6 μGym², p = 0.042) compared to the control group.
• However, the study group exhibited a substantial increase in total procedural PKA (50% higher) and total procedural Ka,r (73% higher) than the control group.
• These findings indicate a trade-off between reduced DSA utilization and increased overall radiation exposure with CBCT guidance.

Conclusions:

• CBCT guidance effectively reduces the number of DSA runs and associated PKA required for TACE in HCC patients.
• The use of CBCT guidance leads to a significant increase in total procedural radiation dose, necessitating careful consideration and justification.
• Interventional radiologists must weigh the benefits of reduced DSA runs against the increased overall radiation exposure when employing CBCT guidance for TACE in HCC.