Limiting radiation exposure during prostatic arteries embolization: influence of patient characteristics, anatomical conditions, and technical factors

Objective To assess the influence of patient characteristics, anatomical conditions, and technical factors on radiation exposure during prostatic arteries embolization (PAE) performed for benign prostatic hyperplasia. Materials and methods Patient characteristics (age, body mass index (BMI)), anatomical conditions (number of prostatic arteries, anastomosis), and technical factors (use of cone beam computed tomography (CBCT), large display monitor (LDM), and magnification) were recorded as well as total air kerma (AK), dose area product (DAP), fluoroscopy time (FT), and number of acquisitions (NAcq). Associations between potential dose-influencing factors and AK using univariate analysis and a multiple linear regression model were assessed. Results Forty-one consecutive men (68 +/- 8 years, min-max: 40-76) were included. LDM and CBCT decreased the use of small field of view with 13.9 and 3.8% respectively, both p < 0.001. The use of a LDM significantly reduced AK (1006.6 +/- 471.7 vs. 1412 +/- 754.6 mGy, p = 0.02), DAP (119.4 +/- 64.4 vs. 167.9 +/- 99.2, p = 0.04), FT (40.4 +/- 11.5 vs. 53.6 +/- 25.5 min, p = 0.01), and NAcq (16.3 +/- 6.3 vs. 18.2 +/- 7, p = 0.04). In multivariate analysis, AK reduction was associated with lower patient BMI (beta = 0.359, p = 0.002), shorter FT (beta = 0.664, p < 0.001) and CBCT use (beta = - 0.223, p = 0.03), and decreased NAcq (beta = 0.229, p = 0.04). Conclusion LDM and CBCT are important technical dose-related factors to help reduce radiation exposure during PAE, and should be considered in standard practice.