Radiation Dose Reduction in Prostate Artery Embolization Using Advanced Imaging Guidance

Monday, March 6, 2023

5:05 PM – 5:10 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Brian Yost, MD

Resident
New York Presbyterian Weill Cornell Medical Center

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

BC

Brian M. Currie, MD

Assistant Professor of Radiology
Weill Cornell Medical College
Ana K. Ortiz, MS

Research Fellow
Weill Cornell Medicine
AT

Alexis Te, MD

Attending Physician
Weill Cornell Medicine
Tim McClure, MD

Professor
Weill Cornell Medicine

Disclosure(s):

Brian Yost, 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
Prostate artery embolization (PAE) has the potential for significant radiation exposure. This study evaluated the dose reduction associated with a standardized procedural workflow and advanced guidance software and compared this to other commonly performed procedures in interventional radiology.
Materials and Methods
IRB-approved single institution retrospective study of all patients undergoing PAE from 2017-2022 for hematuria or lower urinary tract symptoms (LUTS) secondary to benign prostatic hypertrophy (BPH) (n = 143), with a comparison cohort of patients receiving primary transjugular intrahepatic portosystemic shunts (TIPS, n = 50) or radioembolization (TARE, n = 50). Patients receiving PAE were separated into two cohorts based on the implementation of a previously reported procedural workflow and the use of advanced planning software.
Results
There was a greater than 3-fold reduction in radiation exposure (dose area product) in patients who underwent the standardized workflow with advanced planning software compared to those who did not (71.7 vs. 236.4 Gy-cm2, p < 0.0001). There were also reductions in total contrast used (104.1 vs. 136.2 ml, p = 0.021) and failure rates (0% vs. 10.5%, p = 0.025). Despite more patients requiring protective embolization in the advanced protocol, suggesting greater complexity of cases, there was no difference in fluoroscopy time (50 v 48.5 min, p = 0.657). PAE also resulted in significantly lower dose compared to primary TIPS and TARE (71.7 vs. 204.6 vs 284.3, respectively, p < 0.0001), even when accounting for body mass index (BMI).
Conclusion
Advanced imaging guidance and a standard workflow can lead to substantial reductions in radiation dose, contrast utilization, and failure rates for prostate artery embolization. The reduction was realized shortly after implementation of these techniques, which supports ease of use and fluid incorporation into existing clinical practices.
The radiation dose achieved is significantly lower than other commonly performed IR procedures, which should obviate concerns of referring providers about the risk of radiation exposure.