Virtual Injection Software Reduces Radiation Exposure and Procedural Time of Prostatic Artery Embolization Performed with Cone-Beam CT

Purpose: To evaluate the impact of virtual injection software (VIS) use during cone-beam computed tomography (CT)-guided prostatic artery embolization (PAE) on both patient radiation exposure and procedural time. Materials and Methods: This institutional review board (IRB)-approved comparative retrospective study analyzed the treatment at a single institution of 131 consecutive patients from January 2020 to May 2022. Cone-beam CT was used with (Group 1, 77/131; 58.8%) or without VIS (Group 2, 54/131, 41.2%). Radiation exposure (number of digital subtraction angiography [DSA] procedures), dose area product (DAP), total air kerma (AK), peak skin dose (PSD), fluoroscopy time (FT), and procedure time (PT) were recorded. The influences of age, body mass index, radial access, and use of VIS were assessed. Results: In bivariate analysis, VIS use (Group 1) showed reduction in the number of DSA procedures (8.6 +/- 3.7 vs 16.8 +/- 4.3; P < .001), DAP (110.4 Gycm(2) +/- 46.8 vs 140.5 Gycm(2) +/- 61; P < .01), AK (642 mGy +/- 451 vs 1,150 mGy +/- 637; P = .01), PSD (358 mGy +/- 251 vs 860 mGy +/- 510; P = .001), FT (35.6 minutes +/- 15.4 vs 46.6 minutes +/- 20; P = .001), and PT (94.6 minutes +/- 41.3 vs 115.2 minutes +/- 39.6, P = .005) compared to those in Group 2. In multivariate analysis, AK, PSD, FT, and PT reductions were associated with VIS use (P < .001, P < .001, P = .001, and P = .006, respectively). Conclusions: The use of VIS during PAE performed under cone-beam CT guidance led to significant reduction in patient radiation exposure and procedural time.