New research raises further radiation dose concerns for patients and operators during prostate artery embolization

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Two papers presented at the British Society of Interventional Radiology annual meeting (BSIR, 4–6 November, Glasgow, UK) highlighted that prostate artery embolization is a technically demanding procedure that is associated with prolonged radiation exposure to the patient and operator.

Prostate artery embolization has been suggested as an effective and less invasive approach to treat benign prostatic hyperplasia. However, prostate artery embolization can be a technically demanding procedure due to variant pelvic arterial anatomy and the need for superselective vessel catheterisation. This combination can result in prolonged screening times and resultant high radiation doses, a research group from Freeman Hospital, Newcastle, UK, reported. Sebastian Mafeld, Interventional Radiology, who presented the research, also noted that radiation dose concerns had been reported previously in the literature.

The researchers monitored radiation doses during 12 prostate artery embolization cases, all of which were carried out on a Siemens Artis zee fluoroscopy suite capable of rotational angiography (DynaCT). They used the Siemens inbuilt radiation skin exposure monitoring system to record the dose received by patients. They also monitored operator doses using the RaySafei2 (Unfors RaySafe) active dosimetry system that provides information in real time about staff radiation exposure.

Results from the study showed that the mean system recorded skin dose was 2970 milligray (mGy). The mean dose area product was 52572.7 µG/m2 range. The mean procedure time was 158.64 minutes and mean screening time was 47.55 minutes. The doses measured with RaySafe were 103.9 to the neck and 76.5μSv to the operator’s legs.

The researchers concluded that prostate artery embolization can be a technically demanding procedure that results in a prolonged radiation exposure to the patient and operator. Awareness of this radiation dose is critical for effective radiation safety, they wrote.

Another paper presented in the same session by Guy Hickson, Interventional Radiology, Southampton Hospital, Southampton, UK, reviewed the radiation doses for prostate artery embolization cases carried out at the hospital.

Data from this study included cases performed on a Siemens Axiom Artis DTA as part of an older suite, and a Siemens Artis zee that was part of a newer suite. Three cases were carried out on a now decommissioned Siemens system. Cone beam DynaCT was used intraprocedurally to improve the safety of embolization and Hickson reviewed the radiation doses of 71 patients, with a focus on assessing the impact of equipment and DynaCT.

The overall median dose area product was 19090 GyCm2, median skin dose of 1426mGy in a median screening time of 29.27 minutes. Procedures with DynaCT multiplied the dose area product and skin dose by 1.3 and 2.38. Further, four patients had skin doses above the reporting threshold of 3000mGy, and all these patients were treated using the older imaging system, reported Hickson.

Prostate artery embolization has the potential for high radiation doses. New equipment with lower dose protocols and low frame rate digital subtraction angiography can reduce this. However, DynaCT can significantly impact the radiation dose that patients receive and the risk of using DynaCT must be balanced with its benefit when used intraprocedurally, the author concluded.