Purpose: Prostate artery embolization (PAE) is a technically challenging procedure and can result in higher patient radiation doses than other interventional radiology procedures. Patient radiation dose can also vary due to the efficiency of the fluoroscopic unit being utilized for the procedure. The purpose of this analysis was to determine if radiation exposure during PAE was significantly different based upon the fluoroscopy unit used for the procedure.
Material and Methods: 298 male patients who underwent PAE from 2013-2019 at a single institution were identified. Procedure time, fluoroscopy time, and air kerma were measured. Data was stratified by procedural suite and angiography system: Siemens Artis Zee in suite 3 (n=18), Siemens Artis Zeego in suite 4 (n=127), and Siemens Artis Q Zeego in suite 9 (n=129). For each procedure, air kerma divided by fluoroscopy time and procedure time was calculated. Kruskal-Wallis Tests were performed to examine variances in radiation exposure between each of the fluoroscopy units during PAE. Outlier groups that were over 13 standard deviations greater than the mean were excluded from the analysis.
Results: Average total procedure time, total fluoroscopy time, and air kerma were 120.4 min, 39.64 min, and 1903.52 mGy, respectively. No group differences were found for procedure time or fluoroscopy time outcomes. Median air kerma was found to vary by group (p=0.00092), with the only pairwise difference being that suite 4 had a higher median than suite 9 (p=0.00053). Median air kerma divided by fluoroscopy time was found to vary by group (p=0.00017), with the only pairwise difference being that suite 4 had a higher median than suite 9 (p<0.0001).
Conclusions: Patients undergoing PAE in suite 4 experienced a higher median air kerma and a higher air kerma per fluoroscopy minute than those who underwent the procedure in suite 9. Procedure time and fluoroscopy time did not vary between procedural suites, suggesting that differences in air kerma were based on the efficiency of the fluoroscopy units and the version of the software utilized.