To quantify radiation dose and associated risks for prostatic artery embolization (PAE) when performed by experienced operators at high-volume centers. Fluoroscopy time (FT), cumulative air kerma (CAK), and field of view area (FoV) data were retrospectively collected for 1387 PAE procedures performed on fixed interventional fluoroscopic units from January 2014 to January 2022, by operators with >10 years of PAE experience from 10 high-volume centers ( >75 procedures) worldwide. CAK, FT, and kerma-area product (KAP) were plotted against sequential procedure number for each site. Piecewise linear segmented regression identified optimal curve breakpoints as cutoffs to exclude operator learning curve procedures that might skew data1. Mean/median effective dose (ED) were calculated and radiation-related adverse events tabulated for all included procedures. Excess relative risk of cancer-related death from PAE was calculated using the International Commission on Radiological Protection extrapolation model of 4.1-4.8%/Sv of ED2. 42 learning curve procedures from 1 center were excluded. Radiation dose data were analyzed for 1345 PAE procedures (Table 398.1). Mean values across all centers were FT=40.2±12.0 min, CAK=1315±510 mGy, KAP=194±75 Gy×cm2, and ED=21.4±8.2 mSv. Median overall ED was 18.0 mSv, with no reported 90-day deterministic-type adverse events. Calculated median excess relative risk of cancer-related death from PAE was 0.08–0.09%. PAE performed by experienced operators at high-volume centers resulted in low patient radiation doses with no deterministic adverse events and minimal excess risk for stochastic events.
To assess for differences in radiation dose to patients during prostatic artery embolization (PAE) procedures using fixed versus portable interventional fluoroscopic platforms. A single operator with over 11 years of PAE experience performed 75 PAE procedures with a fixed interventional fluoroscopy unit (GE-630 or GE-640) and 131 PAE procedures using a portable interventional fluoroscopy unit (OEC-Elite) from January 2018 to January 2022. Data for patient age, body mass index (BMI), total procedure time (PT), fluoroscopy time (FT), reference point cumulative air kerma (CAK), and field-of-view area were retrospectively collected. Kerma-area product (KAP) and mean/median effective dose (ED) were calculated. Two-sample t-tests compared means for each parameter between fixed and portable imaging platform subgroups, to assess for differences between subgroup patient characteristics, procedural characteristics, and radiation dose values. Patient age and BMI did not differ between groups (P=0.76 and 0.68) (Table 397.1). Procedure time was shorter for portable unit procedures (P< 0.001). Fluoroscopy times between groups did not differ (P=0.67). Mean field-of-view size was larger for portable unit procedures (P< 0.001). Reference point CAKs, KAPs, and calculated EDs were lower for PAE procedures performed with portable units (P< 0.001 for all) (see Table 397.1). Patient- and operator-related parameters contributing to radiation dose did not differ between fixed and portable interventional fluoroscopic units in this study. However, use of portable interventional fluoroscopic units for PAE was associated with substantial reductions in reference point CAK, KAP, and hence ED. Further analysis for differences in technical, clinical, and adverse event outcomes between the two platforms for PAE is warranted.
