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Center experience and other determinants of patient radiation exposure during prostatic artery embolization: a retrospective study in three Scandinavian centers

  • Vascular-Interventional
  • Published:
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Abstract

Objectives

To evaluate the effects of center experience and a variety of patient- and procedure-related factors on patient radiation exposure during prostatic artery embolization (PAE) in three Scandinavian centers with different PAE protocols and levels of experience. Understanding factors that influence radiation exposure is crucial in effective patient selection and procedural planning.

Methods

Data were collected retrospectively for 352 consecutive PAE procedures from January 2015 to June 2020 at the three centers. Dose area product (DAP (Gy·cm2)) was selected as the primary outcome measure of radiation exposure. Multiple patient- and procedure-related explanatory variables were collected and correlated with the outcome variable. A multiple linear regression model was built to determine significant predictors of increased or decreased radiation exposure as reflected by DAP.

Results

There was considerable variation in DAP between the centers. Intended unilateral PAE (p = 0.03) and each 10 additional patients treated (p = 0.02) were significant predictors of decreased DAP. Conversely, increased patient body mass index (BMI, p < 0.001), fluoroscopy time (p < 0.001), and number of digital subtraction angiography (DSA) acquisitions (p < 0.001) were significant predictors of increased DAP.

Conclusions

To minimize patient radiation exposure during PAE radiologists may, in collaboration with clinicians, consider unilateral embolization, pre-interventional CTA for procedure planning, using predominantly anteroposterior (AP) projections, and limiting the use of cone-beam CT (CBCT) and fluoroscopy.

Key Points

• Growing center experience and intended unilateral embolization decrease patient radiation exposure during prostatic artery embolization.

• Patient BMI, fluoroscopy time, and number of DSA acquisitions are associated with increased DAP during procedures.

• Large variation in radiation exposure between the centers may reflect the use of CTA before and CBCT during the procedure.

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Abbreviations

AP:

Anteroposterior

BMI:

Body mass index

BPH:

Benign prostatic hyperplasia

CBCT:

Cone beam computed tomography

DAP:

Dose area product

DSA:

Digital subtraction angiography

LUTS:

Lower urinary tract symptoms

PA:

Prostate artery

PAE:

Prostatic artery embolization

PV:

Prostate volume

TURP:

Transurethral resection of the prostate

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Petra Svarc, Mikkel Taudorf & Lars Birger Lönn

  2. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark

    Petra Svarc, Mikkel Taudorf, Martin Andreas Røder & Lars Birger Lönn

  3. Department of Radiology and Nuclear Medicine, Oslo University Hospital, Kirkeveien 166, Oslo, Norway

    Thijs Hagen & Nils-Einar Kløw

  4. Radiation Protection, Danish Health Authority, Knapholm 7, 2730, Herlev, Denmark

    Hanne Waltenburg

  5. Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Helsingborg Hospital, Charlotte Yhlens gata 10, 252 23, Helsingborg, Sweden

    Christian Andersson

  6. Department of Urology, Helsingborg Hospital, Charlotte Yhlens gata 10, 252 23, Helsingborg, Sweden

    Mats Bläckberg

  7. Department of Clinical Sciences, Faculty of Medicine, Lund University, Box 188, 221 00, Lund, Sweden

    Mats Bläckberg & Hans Lindgren

  8. Department of Urology, Division of Surgery, Inflammation and Transplantation, Oslo University Hospital, Kirkeveien 166, Oslo, Norway

    Eduard Baco

  9. Department of Urology, Rigshospitalet, Copenhagen Prostate Cancer Center, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Martin Andreas Røder

  10. Department of Surgery, Section of Interventional Radiology, Helsingborg Hospital, Charlotte Yhlens gata 10, 252 23, Helsingborg, Sweden

    Hans Lindgren

  11. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Kirkeveien 166, Oslo, Norway

    Nils-Einar Kløw

Authors
  1. Petra Svarc
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  2. Thijs Hagen
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  3. Hanne Waltenburg
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  4. Christian Andersson
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  5. Mats Bläckberg
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  6. Eduard Baco
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  7. Mikkel Taudorf
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  8. Martin Andreas Røder
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  9. Hans Lindgren
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  10. Nils-Einar Kløw
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  11. Lars Birger Lönn
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Corresponding author

Correspondence to Petra Svarc.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Lars Lönn.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Institutional Review Board in each respective country granted approval for the collection of data related to PAE procedures in the specified timeframe for the purpose of analysis and publication. As the study was retrospective, it did not include any additional interaction with individual patients or include data from which individual patients could be identified in any way.

Ethical approval

Institutional Review Board approvals were obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in:

14 subjects in the Copenhagen cohort: Malling B, Røder MA, Lindh M, et al (2019) Palliative prostate artery embolization for prostate cancer: a case series. Cardiovasc Intervent Radiol 42:1405–1412.

25 subjects in the Oslo cohort: Kløw NE, Grøtta OJ, Bay D, Sandbæk G, Bjerklund Johansen TE, Hagen T, Baco E. Outcome after prostatic artery embolization in patients with symptomatic benign prostatic hyperplasia. Acta Radiol 2019 Sep;60(9):1175–1180.

37 subjects in the Helsingborg cohort: Hans Lindgren and Mats Bläckberg. Introduction of prostate artery embolization (PAE) in Sweden. Scand J Urol. 2019 Apr-Jun;53(2–3):151–155.

All three studies are unrelated to the current investigation and concern clinical outcomes of PAE.

Methodology

• Retrospective

• Observational

• Multicenter study

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Svarc, P., Hagen, T., Waltenburg, H. et al. Center experience and other determinants of patient radiation exposure during prostatic artery embolization: a retrospective study in three Scandinavian centers. Eur Radiol 32, 2404–2413 (2022). https://doi.org/10.1007/s00330-021-08351-5

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  • DOI: https://doi.org/10.1007/s00330-021-08351-5

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