Impact of Cone Beam CT on Radiation Dose during Prostatic Embolization

Monday, March 6, 2023

3:09 PM – 3:18 PM

Location: Phoenix Convention Center, 226ABC

Presenting Author(s)

XL

Xin Li, MD

Resident Physician
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

YB

Yonatan B. Babore, BA (he/him/his)

Medical Student
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
Timothy Clark, MD

Professor
University of Pennsylvania
KK

Kathleen Kratz, PA-C

PA
Penn Presbyterian Medical Center
LH

Lauren Haimes, PA-C

PA
Penn Presbyterian Medical Center
Ansar Z. Vance, MD (he/him/his)

Attending Physician
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Disclosure(s):

Xin Li, MD: No financial relationships to disclose

Timothy Clark, MD: No relevant disclosure to display

Ansar Z. Vance, MD: No relevant disclosure to display

Purpose: Cone-beam CT (CBCT) is commonly used during prostate artery embolization (PAE) to confirm catheter position and to reduce risks of non-target embolization of penile, cystic and rectal arteries. We sought to characterize the incremental radiation dose produced by CBCT in a prostate embolization protocol.

Materials and Methods: Dosimetry data from 128 PAE patients were retrospective analyzed. Patients without intraoperative CBCT and/or dosimetry data were excluded. Patient age, prostate volume, and procedural dosimetry data were recorded. All embolization procedures were performed using the same angiographic system (Axiom Artis, Siemens Healthineers, Erlangen, Germany) using a dedicated CBCT protocol configured for prostate embolization.

Results: A total of 117 patients were included in the final analysis. Mean age was 71 years and mean prostate volume was 104 gm. Mean fluoroscopy time was 48 ± 17 minutes (range, 14-95 minutes), and median number of digital subtraction acquisitions (DSA) was 9 (range 2-49). Mean dose area product (DAP) and absorbed dose for each embolization procedure was 38,211µGy/m2 and 2,346 mGy, respectively. Of this, CBCT acquisitions (mean acquisitions/ procedure = 2.4) accounted for 21.8% and 11.1% of cumulative DAP and absorbed dose. Conversely, fluoroscopy accounted for 41.0% and 58.7% of cumulative DAP and absorbed dose, respectively.

Conclusion: The addition of CBCT to prostate embolization protocols accounts for a minority of the cumulative radiation dose. The benefit of CBCT in confirming prostatic parenchymal supply as well as lack of non-target supply likely outweighs the additional radiation dose.