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Multicenter Quantification of Radiation Exposure and Associated Risks for Prostatic Artery Embolization in 1476
Raj Ayyagari1, Saumik Z Rahman1, Kevin Grizzard1
1From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.).
Abstract:
Background Prostatic artery embolization (PAE) is a safe, minimally invasive angiographic procedure that effectively treats benign prostatic hyperplasia; however, PAE-related patient radiation exposure and associated risks are not completely understood. Purpose To quantify radiation dose and assess radiation-related adverse events in patients who underwent PAE at multiple centers. Materials and Methods This retrospective study included patients undergoing PAE for any indication performed by experienced operators at 10 high-volume international centers from January 2014 to May 2021. Patient characteristics, procedural and radiation dose data, and radiation-related adverse events were collected. Procedural radiation effective doses were calculated by multiplying kerma-area product values by an established conversion factor for abdominopelvic fluoroscopy-guided procedures. Relationships between cumulative air kerma (CAK) or effective dose and patient body mass index (BMI), fluoroscopy time, or radiation field area were assessed with linear regression. Differences in radiation dose stemming from radiopaque prostheses or fluoroscopy unit type were assessed using two-sample t tests and Wilcoxon rank sum tests. Results A total of 1476 patients (mean age, 69.9 years ± 9.0 [SD]) were included, of whom 1345 (91.1%) and 131 (8.9%) underwent the procedure with fixed interventional or mobile fluoroscopy units, respectively. Median procedure effective dose was 17.8 mSv for fixed interventional units and 12.3 mSv for mobile units. CAK and effective dose both correlated positively with BMI (R2 = 0.15 and 0.17; P < .001) and fluoroscopy time (R2 = 0.16 and 0.08; P < .001). No radiation-related 90-day adverse events were reported. Patients with radiopaque implants versus those without implants had higher median CAK (1452 mGy [range, 900-2685 mGy] vs 1177 mGy [range, 700-1959 mGy], respectively; P = .01). Median effective dose was lower for mobile than for fixed interventional systems (12.3 mSv [range, 8.5-22.0 mSv] vs 20.4 mSv [range, 13.8-30.6 mSv], respectively; P < .001). Conclusion Patients who underwent PAE performed with fixed interventional or mobile fluoroscopy units were exposed to a median effective radiation dose of 17.8 mSv or 12.3 mSv, respectively. No radiation-related adverse events at 90 days were reported. © RSNA, 2024 See also the editorial by Mahesh in this issue.
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