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 Gy·cm2 ± 46.8 vs 140.5 Gy·cm2 ± 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.

Minimally invasive nephron-sparing treatments for T1 renal cell cancer in patients over 75 years: a comparison of outcomes after robot-assisted partial nephrectomy and percutaneous ablation.

PURPOSE: To compare the oncological and perioperative outcomes of robot-assisted partial nephrectomy (RPN) and percutaneous thermal ablation (PTA) for treatment of T1 renal cell cancer (RCC) in patients older than 75 years. MATERIALS AND METHODS: Retrospective national multicenter study included all patients older than 75 years treated for a T1 RCC by RPN or PTA between January 2010 and January 2021. Patients' characteristics, tumor data, and perioperative and oncological outcomes were compared. RESULTS: A total of 205 patients for 209 procedures (143 RPN and 66 PTA) were included. In the PTA group, patients were older (80.4 ± 3.7 vs. 79 ± 3.7 years (p = 0.01)); frailer (ASA score (2.43 ± 0.6 vs. 2.17 ± 0.6 (p < 0.01)); and more frequently had a history of kidney surgery (16.7% [11/66] vs. 5.6% [8/143] (p = 0.01)) than in the RPN group. Tumors were larger in the RPN group (2.7 ± 0.7 vs. 3.2 ± 0.9 cm (p < 0.01)). Operation time, length of hospital stay, and increase of creatinine serum level were higher in RPN (respectively 92.1 ± 42.7 vs. 150.7 ± 61.3 min (p < 0.01); 1.7 ± 1.4 vs. 4.2 ± 3.4 days (p < 0.01); 1.9 ± 19.3% vs. 10.1 ± 23.7 (p = 0.03)). Disease-free survival and time to progression were similar (respectively, HR 2.2; 95% CI 0.88-5.5; p = 0.09; HR 2.1; 95% CI 0.86-5.2; p = 0.1). Overall survival was shorter for PTA that disappeared after Cox adjusting model (HR 3.3; 95% CI 0.87-12.72; p = 0.08). CONCLUSION: Similar oncological outcomes are observed after PTA and RPN for T1 RCC in elderly patients. CLINICAL RELEVANCE STATEMENT: Robot-assisted partial nephrectomy and percutaneous thermal ablation have similar oncological outcomes for T1a kidney cancer in patients over 75 years; however, operative time, decrease in renal function, and length of hospital stay were lower with ablation. KEY POINTS: • After adjusting model for age and ASA score, similar oncological outcomes are observed after percutaneous thermal ablation and robot-assisted partial nephrectomy for T1 renal cell cancer in elderly patients. • Operation time, length of hospital stay, and increase of creatinine serum level were higher in the robot-assisted partial nephrectomy group.

Benefits of Repeat Prostatic Artery Embolization on Persistent or Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia.

OBJECTIVES: To evaluate the benefits of repeat prostatic artery embolization (rePAE) for patients with persistent or recurrent symptoms after initial prostatic artery embolization (PAE). MATERIALS AND METHODS: This is a single-center retrospective study of all patients who underwent a rePAE between December 2014 and November 2020 for persistent or recurrent lower urinary tract symptoms. Symptoms were assessed before and after PAE and rePAE, using the International Prostate Symptom Score and quality of life (QoL) questionnaires. Patient characteristics, anatomical presentations, technical success rates, and complications of both procedures were collected. Clinical failure was defined as one of the following: less than 2 points' decrease in QoL, a QoL score higher than 3, acute urinary retention, and secondary surgery. RESULTS: A total of 21 consecutive patients (mean age: 63.8 ± 8.1; [40-75] years) who underwent rePAE were included. The median follow-up after PAE was 27.7 [18.1-36.9]) months and 8.9 [3.4-10.8] months after rePAE. rePAE was performed at a mean of 19 ± 11.1 [6.9-49.6] months following PAE, and the overall clinical success rate was 33% (7/21). In patients undergoing rePAE because of persistent symptoms, the clinical success rate (18%) was non-significantly lower than that for patients treated for recurrent symptoms (50%) [OR 4.5 (95% CI 0.63-32 P = 0.13)]. The main anatomical revascularization pattern was recanalization of the native prostatic artery (29/45, 66%). CONCLUSION: Patients who experience recurrent symptoms after PAE may benefit more from rePAE than those with persistent symptoms after PAE. Clinical success rates seem to be relatively low in both clinical scenarios.

Ergonomics in Interventional Radiology: Awareness Is Mandatory.

Ergonomics in interventional radiology has not been thoroughly evaluated. Like any operators, interventional radiologists are exposed to the risk of work-related musculoskeletal disorders. The use of lead shielding to radiation exposure and the lack of ergonomic principles developed so far contribute to these disorders, which may potentially affect their livelihoods, quality of life, and productivity. The objectives of this review were to describe the different situations encountered in interventional radiology and to compile the strategies both available to date and in development to improve ergonomics.