Background

Prostatic artery embolization (PAE) is a safe, minimally invasive angiographic procedure that effectively treats benign prostatic hyperplasia; however, PAE-related patient radiation exposure and associated risks are not completely understood.

Purpose

To quantify radiation dose and assess radiation-related adverse events in patients who underwent PAE at multiple centers.

Materials and Methods

This retrospective study included patients undergoing PAE for any indication performed by experienced operators at 10 high-volume international centers from January 2014 to May 2021. Patient characteristics, procedural and radiation dose data, and radiation-related adverse events were collected. Procedural radiation effective doses were calculated by multiplying kerma-area product values by an established conversion factor for abdominopelvic fluoroscopy-guided procedures. Relationships between cumulative air kerma (CAK) or effective dose and patient body mass index (BMI), fluoroscopy time, or radiation field area were assessed with linear regression. Differences in radiation dose stemming from radiopaque prostheses or fluoroscopy unit type were assessed using two-sample t tests and Wilcoxon rank sum tests.

Results

A total of 1476 patients (mean age, 69.9 years ± 9.0 [SD]) were included, of whom 1345 (91.1%) and 131 (8.9%) underwent the procedure with fixed interventional or mobile fluoroscopy units, respectively. Median procedure effective dose was 17.8 mSv for fixed interventional units and 12.3 mSv for mobile units. CAK and effective dose both correlated positively with BMI (R² = 0.15 and 0.17; P < .001) and fluoroscopy time (R² = 0.16 and 0.08; P < .001). No radiation-related 90-day adverse events were reported. Patients with radiopaque implants versus those without implants had higher median CAK (1452 mGy [range, 900–2685 mGy] vs 1177 mGy [range, 700–1959 mGy], respectively; P = .01). Median effective dose was lower for mobile than for fixed interventional systems (12.3 mSv [range, 8.5–22.0 mSv] vs 20.4 mSv [range, 13.8–30.6 mSv], respectively; P < .001).

Conclusion

Patients who underwent PAE performed with fixed interventional or mobile fluoroscopy units were exposed to a median effective radiation dose of 17.8 mSv or 12.3 mSv, respectively. No radiation-related adverse events at 90 days were reported.

© RSNA, 2024

See also the editorial by Mahesh in this issue.

中文翻译：

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1476 名患者的辐射暴露和前列腺动脉栓塞相关风险的多中心量化

背景

前列腺动脉栓塞术（PAE）是一种安全、微创的血管造影手术，可有效治疗良性前列腺增生；然而，PAE 相关的患者辐射暴露和相关风险尚未完全了解。

目的

量化辐射剂量并评估在多个中心接受 PAE 的患者的辐射相关不良事件。

材料和方法

这项回顾性研究纳入了 2014 年 1 月至 2021 年 5 月期间在 10 个大容量国际中心因任何适应症接受 PAE 的患者，这些患者由经验丰富的操作员进行。收集了患者特征、手术和辐射剂量数据以及与辐射相关的不良事件。通过将比释动面积乘积值乘以腹部盆腔透视引导手术的既定转换因子来计算手术辐射有效剂量。通过线性回归评估累积空气比释动能 (CAK) 或有效剂量与患者体重指数 (BMI)、透视时间或辐射野面积之间的关系。使用双样本t检验和 Wilcoxon 秩和检验评估由不透射线假体或透视装置类型引起的辐射剂量差异。

结果

总共纳入 1476 名患者（平均年龄，69.9 岁 ± 9.0 [SD]），其中 1345 名（91.1%）和 131 名（8.9%）分别接受了固定介入或移动透视装置的手术。固定介入装置的中位手术有效剂量为 17.8 mSv，移动装置为 12.3 mSv。 CAK 和有效剂量均与 BMI（ R ² = 0.15 和 0.17；P < .001）和透视时间（R ² = 0.16 和 0.08；P < .001）呈正相关。未报告与辐射相关的 90 天不良事件。有不透射线植入物的患者与无植入物的患者相比，中位 CAK 较高（分别为 1452 mGy [范围，900–2685 mGy] vs 1177 mGy [范围，700–1959 mGy]；P = .01）。移动介入系统的中位有效剂量低于固定介入系统（分别为 12.3 mSv [范围，8.5–22.0 mSv] vs 20.4 mSv [范围，13.8–30.6 mSv]；P < .001）。

结论

使用固定介入或移动透视装置进行 PAE 的患者所暴露的中位有效辐射剂量分别为 17.8 mSv 或 12.3 mSv。 90 天时未报告与辐射相关的不良事件。

© 北美放射学会，2024

另请参阅本期 Mahesh 的社论。