Cone Beam CT with Dedicated Planning Software Improves Optimal Gantry Angle Selection for Prostate Artery Embolization

Monday, March 6, 2023

3:18 PM – 3:27 PM

Location: Phoenix Convention Center, 226ABC

Presenting Author(s)

MK

Mohammad-Kasim Kasim, MD

Resident
Weill Cornell Medicine/New York Presbyterian Hospital

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

AB

Adithya Balasubramanian, MD

Resident
Weill Cornell Medicine/New York Presbyterian Hospital
Ana K. Ortiz, MS

Research Fellow
Weill Cornell Medicine
RD

Raphael Doustaly, Master of Science

Research Engineer
General Electric Healthcare
JF

Jonathan Fainberg, MD

Fellow
New York Presbyterian - Weill Cornell
CT

Charlene Thomas, MS

Research Biostatistician
Weill Cornell Medicine
AR

Arindham RoyChoudury, PhD

Associate Professor of Population Health Sciences
Weill Cornell Medicine
Andrew Kesselman, MD

Clinical Assistant Professor
Stanford Medicine
Kyungmouk Steve Lee, MD

Department of Radiology, Division of Interventional Radiology, Assistant Professor
Weill Cornell Medicine
AT

Alexis Te, MD

Attending Physician
Weill Cornell Medicine
TM

Tim McClure, MD

Attending Physician
Weill Cornell Medicine

Disclosure(s):

Mohammad-Kasim Kasim, MD: No financial relationships to disclose

Adithya Balasubramanian, MD: No financial relationships to disclose

Andrew Kesselman, MD: No financial relationships to disclose

Tim McClure, MD: boston scientific: Advisory Committee or Review Panel Member (Ongoing); Johnson & Johnson: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing)

Purpose: Complex pelvic vascular anatomy makes prostate artery embolization (PAE) both time-consuming and technically challenging. Traditionally, PAE is performed under digital subtraction angiography (DSA) with an ipsilateral-oblique gantry angle between 25-to-55 degrees. This angle is recommended to yield the highest level of anatomic detail during PAE. More recently, cone-beam computed tomography (CBCT) with advanced planning and guidance software have been developed in conjunction with DSA to improve PAE accuracy and efficiency. This study aims to compare the optimal gantry angle selected with CBCT and PAE planning software versus the traditional ipsilateral-oblique 25-to-55 degree angle recommendation from PAE guidelines.

Materials and Methods: PAEs were performed by a single Interventional Radiologist (IR) from 8/2020 to 1/2021 using Embo ASSIST software (GE Healthcare, Chicago, IL). CBCT was performed on all cases from the internal iliac artery and virtual injection technology was used to identify the prostatic artery (PA) and create 3D pelvic angiography models. The PA was confirmed with selective DSA and CBCT. Internal iliac anatomy was classified via the de Assis/Carnevale classification. Three IRs independently reviewed the 3D pelvic models to determine the optimal gantry angle to catheterize the PA(s). Multivariate mixed linear effects modeling evaluated the effect of age and BMI on chosen optimal gantry angles. Intraclass coefficient (ICC) and Light’s Kappa (K) assessed agreement amongst the 3 IRs.

Results: 21 PAE cases were included yielding 42 PA 3D models. Mean patient age was 68.5±12.8 years with a mean BMI of 26.5±4.3 kg/m². A majority of PAs (48%) displayed a Type 1 angiographic classiﬁcation. Reviewing IRs identified a median 13-degree optimal gantry angle for visualizing the PA (ICC=0.384). The optimal gantry angle for visualizing the PA was ipsilateral in 49% of independently reviewed models (Κ=0.371) and was outside the traditional ipsilateral-oblique gantry angle range of 25 to 55-degree in 84% of independently reviewed models (Κ=0.223). Neither BMI (p=0.6) nor age (p=0.3) had a statistically significant impact on optimal gantry angle selection.

Conclusion: Our preliminary results suggest that CBCT-based planning and guidance software may improve gantry angle and laterality selection for PAE beyond traditional range. Augmenting existing PAE gantry and image acquisition best practices may enable better visualization of patient anatomy, improve procedural success, and minimize radiation doses to both the IR and patient.