Real World Radiation Exposure During Prostate Artery Embolization with Mobile Angiography: A Review of Over 700 Procedures

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Jade Lerner, BS (she/her/hers)

Medical Student
St. George's University School of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

AS

Abin Sajan, MD

Interventional Radiologist
Columbia University Irving Medical Center
RP

Rachel Piechowiak, MD

Vascular & Interventional Radiologist
Prostate Centers USA
AI

Ari Isaacson, MD

Interventional Radiologist; Chair of Quality & Research
Prostate Centers USA
MK

Mustafa Kasimcan, MD

Associate
Prostate Centers USA
Alex Pavidapha, MD

Vascular & Interventional Radiologist
Prostate Centers USA
Sandeep Bagla, MD

President
Prostate Centers USA

Disclosure(s):

Jade Lerner, BS: No financial relationships to disclose

Alex Pavidapha, MD: No financial relationships to disclose

Purpose:

There is increasing evidence that supports the efficacy and safety of prostate artery embolization (PAE) for benign prostatic hyperplasia (BPH), especially in comparison to transurethral resection of prostate (TURP) and other minimally invasive BPH treatments. Prior publications have raised concern regarding the high radiation exposure in initially published studies, however, there is limited data on the real-world exposure of ionizing radiation from PAE. The purpose of this study is to evaluate radiation exposure during PAE in a high-volume outpatient setting utilizing mobile angiography.

Materials and Methods:

Retrospective chart review was performed for patients who underwent PAE between September 2020 and August 2022 which included 712 patients. All procedures were performed in an outpatient lab setting with a mobile C-arm (Zenition 70, Philips Healthcare, Best, Netherlands) by 4 interventional radiologists with multiple years of experience performing PAE without cone-beam CT. Strategies to limit radiation dose included utilizing cine imaging, lowering frame rates, adjusting collimation, and magnification as necessary. Patient charts were reviewed for age, radiation skin entry, dose area product, fluoroscopy time, and technical success.

Results:

PAE was performed in 712 patients, and all procedures were technically successful, defined as embolization of at least 1 prostatic artery. 686 patients (96.3%) underwent bilateral PAE, and 26 (3.7%) received unilateral PAE. The average overall radiation skin entry and dose area product were 464 mGy and 89 Gy*cm2, respectively. The average fluoroscopy time was 24 minutes for all cases. As expected, the unilateral cases were longer (fluoroscopy time 33.8 mins) with more radiation exposure (734 mGy and 114 Gy*cm2) when compared to the bilateral cases.

Conclusion:

PAE can be successfully performed by experienced operators in the outpatient setting utilizing mobile angiography with low radiation exposure.